Upper urinary tract stone compositions: the role of age and gender

ABSTRACT Objective: To analyze the compositions of upper urinary tract stones and investigate their distributions in different gender and age groups. Materials and Methods: Patients diagnosed with upper urinary tract stone disease between December 2014 and March 2018 were retrospectively reviewed. Patient's age, gender, BMI, comorbidities, stone event characteristics, and compositions were collected, and proportions of stone components in different gender and age groups were analyzed. Results: A total of 1532 stone analyses were performed (992 from males and 540 from females). The mean age was younger in males (p <0.001). Males included more cases with larger BMI, hyperuricemia, and obesity, while females had more urinary tract infections. Multiple components were present in 61.8% of stones. Calcium oxalate (CaOx) (67.0%) was the most common component, followed by uric acid (UA) (11.8%), infection stone (11.4%), calcium phosphate (CaP) (8.0%), cystine (1.1%), brushite (0.4%), and 2, 8-dihydroxyadenine (0.2%). Men contributed with more CaOx stones than women at age 30-49 years (all p <0.01) and more UA stones at 30-59 years (all p <0.05). Women contributed with more infection stones than men in age groups 30-49 and 60-69 years (all p <0.05), and more CaP stones at 30-49 years. The prevalence peak was 50-59 years in men and 60-69 years in women. Both genders had the lowest prevalence in adolescence. Prevalence of UA stones increased while that of infection stones decreased with aging in both genders. Conclusions: Age and sex had a strong association with distribution of stone compositions in this Chinese cohort.

Epidemiology and etiopathogenesis of urinary calculi in western Nepal (Pokhara).

Urinary stone disease is recorded in the literature from the dawn of the history and has spared no segment of society irrespective of age, gender, occupation and socio-economic status. It is still termed as "Refractory Disease" as complete medical management to prevent occurrence or recurrence is not so far available. We conducted a preliminary survey from the Manipal Teaching Hospital and carried out urinalyses to ascertain risk factors in the local population. This preliminary survey indicates the prevalence of stone disease is in moderate zone. Hyperoxaluria is an important risk factor in more than one fourth of the stone formers; and hypernatriuria is distinctly most common potentiating risk factor.

Metabolic assessment in patients with urinary lithiasis

INTRODUCTION: Metabolic investigation in patients with urinary lithiasis is very important for preventing recurrence of disease. The objective of this work was to diagnose and to determine the prevalence of metabolic disorders, to assess the quality of the water consumed and volume of diuresis as potential risk factors for this pathology. PATIENTS AND METHODS: We studied 182 patients older than 12 years. We included patients with history and/or imaging tests confirming at least 2 stones, with creatinine clearance > 60 mL/min and negative urine culture. The protocol consisted in the collection of 2, 24-hour urine samples, for dosing Ca, P, uric acid, Na, K, Mg, Ox and Ci, glycemia and serum levels of Ca, P, Uric acid, Na, K, Cl, Mg, U and Cr, urinary pH and urinary acidification test. RESULTS: 158 patients fulfilled the inclusion criteria. Among these, 151 (95.5 percent) presented metabolic changes, with 94 (62.2 percent) presenting isolated metabolic change and 57 (37.8 percent) had mixed changes. The main disorders detected were hypercalciuria (74 percent), hypocitraturia (37.3 percent), hyperoxaluria (24.1 percent), hypomagnesuria (21 percent), hyperuricosuria (20.2 percent), primary hyperparathyroidism (1.8 percent) secondary hyperparathyroidism (0.6 percent) and renal tubular acidosis (0.6). CONCLUSION: Metabolic change was diagnosed in 95.5 percent of patients. These results warrant the metabolic study and follow-up in patients with recurrent lithiasis in order to decrease the recurrence rate through specific treatments, modification in alimentary and behavioral habits.

Urinary tract calculi in southern Thailand.

OBJECTIVE: To study the epidemiology of urolithiasis in Southern Thailand. DESIGN: Descriptive study. MATERIAL AND METHOD: An overview of urolithiasis in the South of Thailand was derived from 10,344 urolithiasis patients seeking treatment in 14 hospitals in southern Thailand, from January to December 2000. An epidemiological study focused on 1,452 urolithiasis patients treated at Songklanagarind Hospital during the same period. Composition of calculi was analysed with infrared spectroscopy. RESULTS: The ratio of male to female was 1.6 : 1 and the most common age group was 41 - 50 years. Ureteric calculi were more frequently found than renal calculi. ESWL was the most common treatment for upper urinary tract (UUT) calculi, while surgery was the most common treatment for lower urinary tract (LUT) calculi. The body mass index (BMI) of 48.1% was between 18.5 - 24.9. The study of the calculi composition showed that oxalate was found in most UUT, and uric acid was found in most LUT CONCLUSION: Ureteric calculi were most common in the South of Thailand. The BMI of urolithiasis patients was higher than the population average.

Comparison of 24 hours urinary citrate levels in urolithiasis patients and healthy controls

To identify the difference in urinary citrate excretion between Stone Formers [SF] and Healthy Volunteers [HV] as a metabolic risk factor, that predisposes to urinary stone formation and to compare levels of urinary citrate in [HV] with reference values. The 24 hours urinary citrate was evaluated in 40 patients treated for renal citrate and declared stone free, and 40 age matched healthy adults taken as controls. Both the groups had a similar living environment, extrinsic factors, diet and similar genetic descent. There was no significant difference in urinary citrate excretion level among stone formers [mean 262 SD 197] and normal volunteer subjects [mean 269 SD 140]. Using the previously defined normal values [200] of urinary citrate in the local population, 55% of stone patients in our study group were hypocitric. While using the same value, 45% of our normal volunteers were also hypocitric. If 320 was taken as normal limit, 70% of the patient's population and 72% of controls were hypocitric. The prevalence of hypocitraturia was similar in the age matched adult groups. Certain intrinsic factors in our local subjects may account for the high prevalence of urolithiasis than in western population. Although the urinary citrate excretion of stone patients is similar to normal volunteers, uniformly low urinary citrate excretion may be a feature as a nation and not a predisposing factor for the lithogenesis. This supports the view that there may be more often prominent influences in stone formers possibly of genetic origin

Calculse de vias urinárias em ambulatório do sistema único de saúde - estudo de modelo de atendimento em saúde pública / Urolithiasis in public health services - a prevention protocol for outpatients

Objetivo :A calculose de vias urinarias apresenta altos níveis de incidência e recorrência, segundo dados de literatura, importando em gastos para o sistema de saúde. Métodos Foram analisadas retrospectivamente 2.648 consultas realizadas em ambulatório público desenhado para o atendimento de pacientes com litíase, no Ambulatório de Especialidades do Sistema único de Saúde em Ribeirão Preto, cidade de médio porte no interior do estado de São Paulo e que apresenta a maior concentração de médicos por habitantes do país. Resultados:Apresenta-se a prevalência, alguns aspectos epidemiológicos, clínicos, de tratamento e do seguimento da urolitíase. Discussão :Ressalta-se que, quanto ao estudo da doença, há o limite imposto pela atividade exercida em ambulatório público, considerando-se a pesquisa de calciúria, oxalúria e uricosúria. Enfatiza-se o alto nível de abandono e a pronta resolutividade do método. Conclusões :Propõe-se uma atividade que nao resulte em gastos adicionais para o Estado, exercida por neurologista e com enfoque na prevenção da doença, utilizando um protocolo de atendimento desenhado para o sistema público.

Litiasis urinaria en pediatría / Paediatric urolithiasis

Existe escasa información sobre litiasis urinaria pediátrica en Chile. Objetivo: Conocer las características epidemiológicas, clínicas y de la boratorio de esta patología. Pacientes y Métodos: Se diseñó un estudio prospectivo que incluyó ingresos hospitalarios y consultas externas por litiasis en el Hospital de la Pontificia Universidad Católica. Se elaboró una ficha que consignó identificación, antecedentes familiares, caracterización clínica, laboratorio y tratamiento. Resultados: Entre enero de 1997 y diciembre del 2000, 52 niños ingresaron al protocolo, (26 mujeres), con edad promedio de 8 años (rango 2 meses a 16 años 5 meses). El 50 por ciento tenía antecedentes familiares de urolitiasis. Los síntomas y signos al momento de la consulta fueron: dolor abdominal en 23 (44 por ciento), hematuria en 21 (40 por ciento), fiebre en 13 (25 por ciento), eliminación de cálculo en 11 (21 por ciento), vómito en 11 (21 por ciento), e infección urinaria en 9 (17 por ciento). En 9 (17 por ciento) fue un hallazgo. Se hospitalizaron 26 niños, correspondiendo a 1,6 niños con litiasis por cada 1000 ingresos en dicho período. En el estudio, 12 (23 por ciento) pacientes, tenían malformaciones urinarias, siendo las más frecuentes: doble sistema pielocalicilar (4), estenosis pielouretral (2) y reflujo vesicouretral (2). Catorce (37 pot ciento) pacientes presentaban alteraciones metabólicas al estudio, de los cuales 11 (79 por ciento) resultaron ser hipercalciuria idiopática. En cuatro (8 por ciento) la litiasis ocurrió durante períodos de inmovilización prolongada. Trece pacientes (25 por ciento) tuvieron estudio bioquímico del cálculo: todos incluían oxalato de calcio puro o en su forma mixta. Diez (20 por ciento) pacientes requirieron tratamiento urológico. Conclusiones: Los síntomas de consulta más frecuente fueron dolor abdominal, hematuria y fiebre. La mitad tenían antecedentes familiares de litiasis urinaria. El 23 por ciento tenían malformaciones urinarias y el 37 por ciento presentaban alteraciones metabólicas. El estudio bioquímico del cálculo indicó en todos la presencia de oxalato de calcio puro o mixto.

Clinical and pathological study of an outbreak of obstructive urolithiasis in feedlot cattle in southern Brazil

The epidemiology, clinical picture and pathology of an outbreak of urolithiasis in cattle in southern Brazil are described. The disease occurred in August 1999 in a feedlot beef cattle herd. Five out of 1,100 castrated steers were affected. Clinical signs included colic and ventral abdominal distension. White, sand-grain-like mineral deposits precipitated on the preputial hairs. Affected cattle died spontaneously 24-48 hrs after the onset of the clinical signs. Only one animal recovered after perineal urethrostomy. Necropsy findings included calculi blocking the urethral lumen of the distal portion of the penile sigmoid flexure, urinary bladder rupture with leakage of urine into the abdominal cavity and secondary fibrinous peritonitis. Daily water intake was low since water sources were scarce and not readily available. The animals were fed rations high in grains and received limited amounts of roughage. Biochemical analysis revealed that the calculi were composed of ammonium phosphate. A calcium-phosphorus imbalance (0.4:0.6) was detected in the feedlot ration. For the outbreak, it is suggested that contributing factors to urolith formation include insufficient fiber ingestion, low water intake and high dietary levels of phosphorus. No additional cases were observed in that feedlot after preventive measures were established. Similar dietary mismanagement in fattening steers has been associated with obstructive urolithiasis in feedlot beef cattle in other countries

Urolitíase no alotransplante renal / Urinary lithiasis in renal allografts

OBJETIVO: A litíase urinária é uma complicação incomum no alotransplante renal, a incidência varia de 0,02 a 3,4 por cento. A maioria dos cálculos forma-se após o transplante, porém alguns podem ser transferidos junto com o enxerto para o hospedeiro. O tratamento desta complicação está baseado em alguns casos descritos na literatura. O objetivo deste trabalho é o de relatar a incidência da litíase renal no paciente com transplante renal, assim como a conduta adotada no HCFMRPUSP. MÉTODOS: Foram analisados 953 pacientes submetidos a transplante renal no HCFMRPUSP, de fevereiro 1968 a maio de 2003. A idade média foi de 47,2 anos (35 a 63 anos). Em 09 pacientes, o rim foi proveniente de doador cadáver e apenas 01 doador vivo. RESULTADOS:Foram diagnosticados 10 casos de litíase (1,05 por cento). Em 02 pacientes (20 por cento) o cálculo foi diagnosticado no intraoperatório, em 01 (10 por cento) no peri-operatório (5º. dia), os 07 restantes (70 por cento) no pós-operatório tardio. Em 04 pacientes (57 por cento) não havia sintomatologia específica, 02 (29 por cento) apresentaram ITU, em 03 (43 por cento) ocorreu elevação da creatinina sérica. De 8 pacientes com litíase no pós-operatorio, em 06 os cálculos estavam localizados no rim e 02 no ureter. Dos pacientes com cálculos renais, 02 foram observados, 02 submetidos a LECO, 01 a nefrolitripsia percutânea, 01 à pielolitotomia. Em 01 paciente com cálculo ureteral foi realizada pielovesicostomia (cálculo + estenose), no outro paciente foi feita a ureterorrenoscopia retrógrada. CONCLUSAO: A urolitíase é complicação rara no transplante renal, a conduta terapêutica no pós-operatório tardio é semelhante à da população geral.

Resultados litotripsia extracorpórea en Hospital Regional de Iquique / Results of extracorporeal lithotripsy in Hospital Regional de Iquique

El objetivo de este trabajo es analizar los resultados de 486 Litotripsias Extracorpóreas (LEC) de litiasis del tracto urinario según ubicación y tamaño. Se realiza un estudio retrospectivo de 486 pacientes sometidos a LEC con el equipo Direx modelo Tripter Compact desde junio de 1996 a junio del 2001 con seguimiento mínimo de tres meses. Las litiasis se clasifican según ubicación en Renales, Ureterales (proximales, medios, distales) y según diámetro en milímetros, considerando los coraliformes como grupo aparte. Resulta exitoso todo procedimiento en el cual el paciente a los noventa días se encuentra libre de litiasis o presenta fragmentos iguales o menores a 4 mm. El éxito global independiente de la posición, del tamaño y del número de sesiones, fue 88.9 por ciento. El éxito global en riñón fue 93.8 por ciento, uréter proximal 91.3 por ciento, uréter medio 85.3 por ciento y uréter distal 75 por ciento. En relación al tamaño existe un mayor número de golpes a mayor tamaño. El éxito global se mantiene sobre el 80 por ciento para menores de 25 mm y cae a 75 por ciento en litiasis sobre ese tamaño. Las litiasis coraliforme presentan un 53.5 por ciento de éxito global. Existe relación entre localización de la litiasis y resultado, obteniendo los peores resultados coraliformes y uréter distal. Existe un mayor número de golpes a mayor tamaño y una caída en la efectividad del tratamiento para litiasis mayores o iguales a 25 mm

Revisäo: Recentes avanços em litíase urinária / Recent advances in urolithiasis

A presente pesquisa é uma revisäo näo sistemática do estudo atual da patogênese da urolitíase, nos últimos cinco anos, sobre os fatores mais importantes envolvidos na litogênese, com ênfase nos cálculos de oxalato de cálcio e os ditúrbios clínico-metabólicos associados à urolitíase. Vários fatores tem sido identificados na patogênese da urolitíase. Estudos recentes sugerem que os cristais de oxalato de cálcio monoidratados se ligam à superfície apical da célula epitelial renal, podendo ser internalizados. A adeséo dos cristais à célula renal epitelial é inibida por ânions específicos, como glicosaminoglicanos, uropontina, nefrocalcina e citrato, que se ligam à superfície do cristal. Estudos sobre a identificaçäo de moléculas no líquido tubular e na superfície celular, que modulam a interaçäo cristal-célula, assim como seu mecanismo de açäo, säo fundamentais para uma melhor compreensäo da patogênese da urolitíase. (au)

Urinary Stones following Renal Transplantation

BACKGROUND: The formation of urinary tract stones following renal transplantation is a rare complication. The clinical features of stones after transplantation differ from those of non-transplant patients. Renal colic or pain is usually absent and rarely resembles acute rejection. METHODS: We retrospectively studied 849 consecutive kidney transplant patients in The Rogosin Institute/The Weill-Cornell Medical Center, New York who were transplanted between 1980 and 1997 and had functioning grafts for more than 3 months, to determine the incidence of stone formation, composition, risk factors and patient outcome. RESULTS: At our center, urinary stones were diagnosed in 15 patients (1.8%) of 849 functioning renal grafts for 3 or more months. Of the 15 patients, 10 were males and 5 were females in their third and fourth decade. Eight patients received their transplant from living donors and 7 from cadaveric donors. The stones were first diagnosed between 3 and 109 months after transplantation (mean 17.8 months) and 5 patients had recurrent episodes. The stones were located in the bladder in 11 cases (73.3%), transplanted kidney in 3 cases and in multiple sites in one case. The size of stones varied from 3.4 mm to 40 mm (mean 12 mm). The composition of stones was a mixed form of calcium oxalate and calcium phosphate in 5 cases and 4 patients had infected stones consisting of struvite or mixed form of struvite and calcium phosphate. Factors predisposing to stone formation included tertiary hyperparathyroidism (n=8), hypercalciuria (n=5), recurrent urinary tract infection (n=5), hypocitraturia (n=4), and obstructive uropathy (n=2). Many cases had more than one risk factor. Clinically, painless hematuria was observed in 6 patients and dysuria without bacteriuria in 5 patients. None had renal colic or severe pain at any time. There were no changes in graft function at diagnosis and after removal of stones. Five patients passed stones spontaneously and 8 patients underwent cystoscopy for stone removal. CONCLUSION: Urinary stone formation following kidney transplantation is a rare complication (1.8%). Hyperparathyroidism, hypercalciuria, recurrent urinary tract infection and hypocitraturia are the most common risk factors, but often there are multiple factors which predispose to stone formation. To detect stones and determine their location and size, ultrasonography appears to be the most useful diagnostic tool. Prompt diagnosis, the removal of stones and stone-preventive measures can prevent adverse effects on renal graft outcome.

Chemical composition of urinary stones and presentation of potients reporting at PIMS, Islamabad

Urinary stones are the commonest cause of acute ureteric obstruction, which if left untreated, may result in the dilatation of proximal renal tract ultimately leading to irreversible kidney damage. Of the 80 cases of urinary stones reported at the Pakistan Institute of Medical Sciences, Islamabad, 43 [53.75 percent] were in the kidney, 18 [22.5 percent] in the urinary bladder, 10 [12.5 percent] and 9 [11.25 percent] passed through the urine. Of these cases, the incidence among males was higher than in females [3:1] with the greatest occurrence in the 25 - 34 years age group [35 percent]. The three predominant symptoms associated with urinary stones were lumbar pain [43 percent], dysuria [25 percent] and hematuria [12 percent]. Other symptoms included history of passing urinary stones [9 percent], urinary retention [7 percent], bladder irritation [3 percent] and vomiting [2 percent]. As for the chemical composition of urinary stones, most of the stones isolated in this study were composed of calcium oxalate and calcium phosphate [56.25 percent], calcium oxalate and uric acid [22.5 percent] and calcium oxalate, calcium phosphate and uric acid [12.5], however, stones composed solely of uric acid, calcium oxalate, calcium phosphate and struvite were also found