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1.
Transfus Apher Sci ; 62(3): 103702, 2023 Jun.
Article in English | MEDLINE | ID: mdl-37055329

ABSTRACT

Drug-induced nephrolithiasis can arise from insoluble components within medications or crystallization of metabolites due to changes in metabolism and urinary pH. The connection between drugs utilized for iron chelation therapy (ICT) and nephrolithiasis is not well understood. In this report, we describe two pediatric patients diagnosed with nephrolithiasis while undergoing treatment with the chelating agents deferasirox, deferiprone, and deferoxamine for iron overload secondary to repeat blood transfusion.


Subject(s)
Iron Overload , Nephrolithiasis , beta-Thalassemia , Humans , Child , Chelation Therapy/adverse effects , Iron Chelating Agents/adverse effects , Deferasirox/adverse effects , Deferiprone/therapeutic use , Deferoxamine/adverse effects , Benzoates/adverse effects , Triazoles , Iron Overload/drug therapy , Iron Overload/etiology , Nephrolithiasis/chemically induced , Nephrolithiasis/complications , Nephrolithiasis/drug therapy , Iron/therapeutic use , beta-Thalassemia/therapy
2.
Pediatr Nephrol ; 38(8): 2699-2709, 2023 08.
Article in English | MEDLINE | ID: mdl-36662300

ABSTRACT

BACKGROUND: Pediatric urinary stone disease (USD) is a costly medical problem. This study aims to assess the clinical characteristics and outcomes of common and rare causes of pediatric USD. METHODS: A retrospective descriptive cohort study included all children < 13 years of age with confirmed USD admitted to the Children's University Hospital in Damascus, Syria, from January 2013 to December 2019. The study sample was divided into two groups based on etiologies: common and rare causes groups. RESULTS: We evaluated 235 patients; 147 of them were males, and the male-to-female ratio was 1.7:1. The common causes group consisted of 203 patients (mean age 3.52 ± 3.66 years) and mainly included metabolic disorders (45.5%) and anatomical abnormalities (22.3%), while the rare causes group included 32 cases (mean age 4.93 ± 4.08 years), 12 patients with uric acid stones (37.5%), 7 patients with cystinuria (21.9%), and primary hyperoxaluria in 5 patients (15.6%). In addition, 39.6% of study patients were born to consanguineous marriages. Sixty-two patients developed AKI, and eleven patients had chronic kidney disease (CKD). Patients with rare causes were more likely to have AKI, CKD, bilateral stones, and recurrent stones (P-value < 0.05). Stone analysis was performed on 83 patients, and the main stone types were calcium oxalate (34.9%), uric acid (14.4%), and struvite stones (12%). Surgery was the most performed treatment in 101 patients (56.7%). CONCLUSION: Patients with rare causes of pediatric USD are at a higher risk for severe complications and require early diagnosis and management. The high rate of uric acid stones in our society requires further evaluation for possible underlying causes. A higher resolution version of the Graphical abstract is available as Supplementary information.


Subject(s)
Acute Kidney Injury , Kidney Calculi , Nephrolithiasis , Urinary Calculi , Urolithiasis , Humans , Male , Child , Female , Child, Preschool , Infant , Syria/epidemiology , Retrospective Studies , Cohort Studies , Uric Acid , Urinary Calculi/epidemiology , Urinary Calculi/etiology , Urolithiasis/diagnosis , Urolithiasis/epidemiology , Urolithiasis/etiology , Nephrolithiasis/complications , Acute Kidney Injury/complications , Kidney Calculi/etiology
3.
Front Endocrinol (Lausanne) ; 13: 800119, 2022.
Article in English | MEDLINE | ID: mdl-35250859

ABSTRACT

INTRODUCTION: Chronic hypoparathyroidism is a relatively rare disease associated with multicomponent medical therapy and various complications. The analysis of large databases of patients with chronic hypoparathyroidism is a necessary tool to enhance quality of medical care, as well as to determine the optimal clinical and therapeutic approaches, and prognostic markers of the disease. THE AIM: of this study is to estimate the clinical and biochemical profile, long-term complications, medical therapy and disease control of the patients with chronic postsurgical and non-surgical hypoparathyroidism. MATERIALS AND METHODS: the cross-sectional, observational, continuous study was based on the Russian Registry of patients with hypoparathyroidism. 544 patients from 63 regions of the Russian Federation were included in this study. RESULTS: The majority of cases had postsurgical etiology (88.4%). Postsurgical hypoparathyroidism prevailed in females (р<0.001). About a half of patients had blood calcium and phosphorus targets, 56 and 52% respectively. Nephrolithiasis was confirmed in 32.5%, nephrocalcinosis - in 12.3% of cases. The risk of nephrocalcinosis/nephrolithiasis increased by 1.85 times with disease duration more than 4.5 years. The cataract was found in 9.4%. The cut-off point for the development of cataracts was 9.5 years, with a 6.96-fold increased risk. The longer duration of hypoparathyroidism of any etiology was associated with more frequent cataract (p=0.0018).We found brain calcification in 4%, arrhythmias in 7.2% and neuropsychiatric symptoms in 5.15% of cases. Generally, the BMD in the studied group corresponded to age values, and there was no evidence for the phenomenon of high bone density. TBS was consistent with normal bone microarchitectonics. In our study, the majority of patients (83.5%) was treated with standard therapy of calcium and vitamin D supplements. 5 patients with severe disease course were treated with rhPTH (1-34). CONCLUSIONS: Analysis of the presented database indicates insufficient diagnosis of the complications associated with chronic hypoparathyroidism. Overall, hypoparathyroidism is associated with higher risks of renal stone formation, decreased GFR, cataract especially in patients with longer duration of disease.


Subject(s)
Cataract , Hypoparathyroidism , Nephrocalcinosis , Nephrolithiasis , Calcium , Cataract/complications , Cataract/drug therapy , Cross-Sectional Studies , Female , Humans , Hypoparathyroidism/complications , Hypoparathyroidism/epidemiology , Male , Nephrocalcinosis/drug therapy , Nephrolithiasis/complications , Nephrolithiasis/drug therapy , Registries
4.
Urologiia ; (4): 32-36, 2017 Sep.
Article in Russian | MEDLINE | ID: mdl-28952689

ABSTRACT

AIM: To evaluate the effectiveness of the herbal preparation Phytolysin in the comprehensive management of urate nephrolithiasis against the background of chronic cystitis exacerbation. MATERIALS AND METHODS: The study comprised 21 patients aged 19 to 57; 11 of them (the study group) received ciprofloxacin 500 mg once daily for 7 days, Phytolysin (for 1 month) and Blemaren (for 3 months), while 10 patients of control group were treated with antibacterial therapy and Blemaren. The clinical evaluation of the patients included laboratory testing and ultrasound imaging. RESULTS: The combination therapy resulted in a decrease in leukocyturia and bacteriuria. There was no tendency to relapse. The occurrence of relapse was identified by dysuria, urgent and frequent urination, suprapubic pain and results of laboratory testing (leukocyturia, bacteriuria >103) on days 15, 29, 57, 85 and 112 of the study. CONCLUSIONS: The findings suggest that the use of Phytolysin can be an effective and safe way to prevent exacerbation of chronic cystitis in patients with urate nephrolithiasis.


Subject(s)
Cystitis/drug therapy , Nephrolithiasis/drug therapy , Plant Extracts/therapeutic use , Adult , Case-Control Studies , Chronic Disease , Cystitis/complications , Female , Humans , Middle Aged , Nephrolithiasis/complications , Young Adult
5.
J Nephrol ; 29(6): 715-734, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27456839

ABSTRACT

BACKGROUND: Recently published guidelines on the medical management of renal stone disease did not address relevant topics in the field of idiopathic calcium nephrolithiasis, which are important also for clinical research. DESIGN: A steering committee identified 27 questions, which were proposed to a faculty of 44 experts in nephrolithiasis and allied fields. A systematic review of the literature was conducted and 5216 potentially relevant articles were selected; from these, 407 articles were deemed to provide useful scientific information. The Faculty, divided into working groups, analysed the relevant literature. Preliminary statements developed by each group were exhaustively discussed in plenary sessions and approved. RESULTS: Statements were developed to inform clinicians on the identification of secondary forms of calcium nephrolithiasis and systemic complications; on the definition of idiopathic calcium nephrolithiasis; on the use of urinary tests of crystallization and of surgical observations during stone treatment in the management of these patients; on the identification of patients warranting preventive measures; on the role of fluid and nutritional measures and of drugs to prevent recurrent episodes of stones; and finally, on the cooperation between the urologist and nephrologist in the renal stone patients. CONCLUSIONS: This document has addressed idiopathic calcium nephrolithiasis from the perspective of a disease that can associate with systemic disorders, emphasizing the interplay needed between urologists and nephrologists. It is complementary to the American Urological Association and European Association of Urology guidelines. Future areas for research are identified.


Subject(s)
Calcium/urine , Nephrolithiasis/diagnosis , Nephrolithiasis/prevention & control , Secondary Prevention/methods , Urinalysis , Biomarkers/urine , Consensus , Crystallization , Humans , Interdisciplinary Communication , Nephrolithiasis/complications , Nephrolithiasis/urine , Nephrologists , Patient Care Team , Predictive Value of Tests , Recurrence , Risk Factors , Treatment Outcome , Urologists
6.
Eur. J. Ost. Clin. Rel. Res ; 10(2): 47-53, mayo-ago. 2015. ilus
Article in Spanish | IBECS | ID: ibc-141064

ABSTRACT

Las patologías más frecuentes en las consultas urológicas, con una repercusión socioeconómica a nivel mundial muy alta. El cólico nefrítico (CN) es la presentación clínica más frecuente de la litiasis renal y una de las principales urgencias urológicas. El tratamiento farmacológico más utilizado para el control del dolor son los AINEs, seguidos de una amplia gama de fármacos como los opiáceos, anticolinérgicos, analgésicos, etc. Las manipulaciones vertebrales también tienen un efecto analgésico, aunque es necesario estudios que proporcionen una mayor evidencia científica. Objetivos: En esta revisión se pretende analizar las diferentes estrategias terapéuticas sobre el dolor en la LR y valorar la efectividad de los distintos tratamientos. Material y Métodos: Se realizó una revisión sistemática con una muestra de análisis bibliográfico integrado por 25 artículos (n=25) que cumplieron los criterios de selección en dos fases de análisis, lo que supone un 13.02% del total de los artículos encontrados (n=192) y el 43,85% de los artículos que cumplieron los criterios de selección de inclusión y exclusión (n=57). Se usaron las bases de datos Embase.com, Science Direct y PEDro. Como palabras clave principales se usaron «nephrolithiasis», «osteopathic medicine» y «spinal manipulation». Posteriormente se usaron otros términos como «complementary medicine», «chiropractic» y «pharmacology». Resultados: Se analizaron 8 estudios en los que se utilizaron distintas técnicas para el tratamiento del dolor en la LR: AINEs, opiáceos, ansiolíticos, anticolinérgicos, analgésicos, calor, estimulación nerviosa transcutánea (TENS) y manipulaciones vertebrales. Conclusiones: El uso de los AINEs, tanto de manera aislada como en combinación con otros fármacos parece ser el tratamiento farmacológico más eficaz para paliar el dolor. Los opiáceos, tienen como contrapartida efectos adversos no deseados. En cuanto a las terapias físicas el uso del calor local y el TENS son capaces de disminuir el dolor. Las manipulaciones vertebrales son capaces de reducir el dolor a corto plazo, sin los efectos adversos de los fármacos, aunque son necesarios más estudios que demuestren la evidencia (AU)


No disponible


Subject(s)
Nephrolithiasis/complications , Nephrolithiasis/therapy , Pain Management/instrumentation , Pain Management/methods , Cholinergic Antagonists/therapeutic use , Osteopathic Medicine/methods , Manipulation, Osteopathic/instrumentation , Manipulation, Osteopathic/methods , Manipulation, Osteopathic , Evaluation of the Efficacy-Effectiveness of Interventions , Comparative Effectiveness Research/methods , Opioid Peptides/therapeutic use , Analgesics/therapeutic use , Osteopathic Medicine/standards , Osteopathic Medicine/trends , Manipulation, Osteopathic/standards , Manipulation, Osteopathic/trends
7.
Emerg Med Pract ; 16(7): 1-23; quiz 23-4, 2014 Jul.
Article in English | MEDLINE | ID: mdl-25379602

ABSTRACT

Urinary tract infections are a heterogeneous group of disorders, involving infection of all or part of the urinary tract, and are defined by bacteria in the urine with clinical symptoms that may be acute or chronic. Approximately 1 million urinary tract infections are treated every year in United States emergency departments. The female-to-male ratio is 6:1. Urinary tract infections are categorized as upper versus lower tract involvement and as uncomplicated versus complicated. The emergency clinician must carefully categorize the infection and take into account patient host factors to optimally treat and disposition patients. A working knowledge of local or at least national susceptibility patterns of the most likely pathogens is essential. A variety of special populations exist that require special management, including pregnant females, patients with anatomic abnormalities, and instrumented patients.


Subject(s)
Anti-Infective Agents/therapeutic use , Emergency Service, Hospital , Urinary Tract Infections/diagnosis , Urinary Tract Infections/drug therapy , Catheter-Related Infections/diagnosis , Catheter-Related Infections/drug therapy , Catheters, Indwelling , Critical Pathways , Diabetes Complications , Diagnosis, Differential , Diagnostic Imaging , Drug Resistance, Multiple, Bacterial , Dysuria/etiology , Emergency Medicine , Female , Fluid Therapy , Humans , Immunocompromised Host , Kidney Transplantation , Male , Nausea/drug therapy , Nausea/etiology , Nephrolithiasis/complications , Pain/drug therapy , Pain/etiology , Patient Admission , Patient Discharge , Perineum/microbiology , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Prostatitis/diagnosis , Prostatitis/drug therapy , Prostatitis/microbiology , Ureter/physiology , Urinalysis/instrumentation , Urinalysis/methods , Urinary Bladder/physiology , Urinary Tract Infections/microbiology , Urination/physiology
9.
J Transl Med ; 12: 34, 2014 Feb 06.
Article in English | MEDLINE | ID: mdl-24502605

ABSTRACT

BACKGROUND: Nephrolithiasis is more frequent and severe in obese patients from different western nations. This may be supported by higher calcium, urate, oxalate excretion in obese stone formers. Except these parameters, clinical characteristics of obese stone formers were not extensively explored. AIMS: In the present paper we studied the relationship between obesity and its metabolic correlates and nephrolithiasis. MATERIALS AND METHODS: We studied 478 Caucasian subjects having BMI ≥ 25 kg/m². The presence of nephrolithiasis, hypertension, diabetes mellitus and metabolic syndrome were noted. They underwent measurements of anthropometry (BMI and waist circumference, body composition), serum variables (fasting glucose, serum lipids and serum enzymes) and Mediterranean diet (MedDiet) nutritional questionnaire. RESULTS: 45 (9.4%) participants were stone formers. Subjects with high serum concentrations of triglycerides (≥ 150 mg/dl), fasting glucose (> 100 mg/dl) and AST (>30 U/I in F or >40 U/I in M) were more frequent among stone formers than non-stone formers.Multinomial logistic regression confirmed that kidney stone production was associated with high fasting glucose (OR = 2.6, 95% CI 1.2-5.2, P = 0.011), AST (OR = 4.3, 95% CI 1.1-16.7, P = 0.033) and triglycerides (OR = 2.7, 95% CI 1.3-5.7, P = 0.01). MedDiet score was not different in stone formers and non-stone formers. However, stone formers had a lower consumption frequency of olive oil and nuts, and higher consumption frequency of wine compared with non-stone formers. CONCLUSIONS: Overweight and obese stone formers may have a defect in glucose metabolism and a potential liver damage. Some foods typical of Mediterranean diet may protect against nephrolithiasis.


Subject(s)
Diet, Mediterranean , Glucose/metabolism , Nephrolithiasis/complications , Nephrolithiasis/metabolism , Obesity/complications , Obesity/metabolism , Body Mass Index , Female , Humans , Male , Middle Aged , Nephrolithiasis/blood , Obesity/blood , Olive Oil , Plant Oils , Regression Analysis , Surveys and Questionnaires , Wine
10.
Urol Res ; 40(6): 709-16, 2012 Dec.
Article in English | MEDLINE | ID: mdl-22886308

ABSTRACT

The objective of this study is to analyze the alterations in bone mineral density and bone and calcium-phosphorus metabolism in patients with calcium nephrolithiasis. We designed a study with 182 patients who were distributed among three groups: group O, 56 patients without nephrolithiasis; group A, 67 patients with calcium nephrolithiasis and mild lithogenic activity; and group B, 59 patients with calcium nephrolithiasis and severe lithogenic activity. Metabolic parameters of blood and urine that were related to calcium-phosphorous and bone metabolism and bone densitometry were assessed in all patients. A comparative study was performed on the variables of bone and calcium-phosphorus metabolism and bone densitometry as well as the presence or absence of osteopenia/osteoporosis. The patients in group B had a greater loss of bone mineral density, measured by the T-score, than the patients in groups O and A. Moreover, the proportion of patients in group B with osteopenia/osteoporosis was statistically significantly higher than the proportion of patients in groups O and A. We observed higher values of calciuria, fasting calcium/creatinine ratio, and 24-h calcium/creatinine among the patients in group B compared to the other two groups. Calciuria, citraturia, and fasting calcium/creatinine were independent factors that showed a relationship with severe lithogenic activity compared to the control group, and ß-crosslaps is an independent factor that has a relationship with severe lithogenic activity as compared to mild lithogenic activity. Patients with calcium lithiasis and severe lithogenic activity have a greater loss in bone mineral density and therefore a greater risk of osteopenia/osteoporosis.


Subject(s)
Bone Diseases, Metabolic/etiology , Calcium , Nephrolithiasis/complications , Osteoporosis/etiology , Adult , Bone Density , Calcium/analysis , Calcium/metabolism , Female , Humans , Male , Middle Aged , Nephrolithiasis/metabolism , Phosphorus/metabolism
11.
Arch. esp. urol. (Ed. impr.) ; 62(3): 226-230, abr. 2009. ilus
Article in Spanish | IBECS | ID: ibc-60197

ABSTRACT

OBJETIVO: Presentamos un caso de litiasis recidivante asociado a alteración anatómica de la pelvis renal secundaria a cirugía.MÉTODOS/RESULTADOS: La paciente presenta un episodio de infección urinaria complicada con pionefrosis y septicemia. En la urografía intravenosa se observa litiasis radiodensa infecciosa, pielolocalicial múltiple compleja, sobre riñón con hidronefrosis grado III-IV por importante esclerosis piélica secundaria a cirugía previa sobre dicha unidad renal. Se realiza nefrectomía polar inferior con nefrolitotomía y reconstrucción de la vía urinaria superior mediante uréterocalicostomía. Dos años y medio después de la cirugía la urografía de control refleja ausencia de litiasis y leve retraso de la función renal.CONCLUSIONES: La ureterocalicostomía está indicada en casos de obstrucción de la unión ureteropiélica asociada a una pelvis intrarrenal por alteraciones de la fusión, rotación o localización renal, y en casos de fibrosis peripiélica severa secundaria a una pieloplastía fallida o cirugía renal previa. En el caso presentado además del componente infeccioso de las litiasis, una alteración anatómica, probablemente secundaria a la cirugía previa, provocaba una perpetuación de la clínica litiásica. Ante tal sospecha se impuso una solución de tipo quirúrgico que solucionara en un tiempo tanto la eliminación de la litiasis como una correcta derivación de la zona funcionante del riñón para evitar recidivas posteriores(AU)


OBJECTIVE: We describe one case of recurrent lithiasis associated with anatomical alteration of the renal pelvis related to previous surgery.METHODS/RESULTS: The patient presented a urinary tract infection episode, complicated with pyonephrosis and septi-cemia. In the intravenous urography, infectious radiopaque pyelocaliceal multiple and complex lithiasis can be seen, as well as kidney hydronephrosis grade III-IV. Important pyelic sclerosis secondary to previous surgery on the renal unit was seen. Nephrectomy was performed with lower pole nephro-lithotomy and reconstruction of the upper urinary tract through ureterocalicostomy. Two and a half years after surgery, control urogram shows absence of urolithiasis and a slight delay of renal function.CONCLUSIONS: Ureterocalicostomy is indicated in cases of ureteropelvic junction obstruction associated with intrare-nal pelvis caused by alterations of fusion, rotation or location of kidney. It is also indicated in cases of severe peripyelic fibrosis secondary to previous pyeloplasty failure or renal sur-gery. In our case, in addition to the infectious component of lithiasis, an anatomical alteration, probably secondary to previous surgery, caused the chronification of lithiasis. Fa-cing such suspicion a surgical management was undertaken to eliminate the lithiasis and get a correct derivation of the working area of the kidney, in order to prevent further recu-rrences(AU)


Subject(s)
Humans , Female , Adult , Nephrolithiasis/diagnosis , Nephrolithiasis/surgery , Recurrence , Urography/methods , Nephrectomy/methods , Ciprofloxacin/therapeutic use , Nephrolithiasis/complications , Nephrolithiasis/physiopathology , Urinary Tract Infections/complications , Pyonephrosis/complications , Sepsis/complications , Hydronephrosis/complications , Ureteroscopy/methods , Comorbidity
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