The characterization of soluble matrix proteins in selected human renal calculi using two-dimensional polyacrylamide gel electrophoresis.

In the current study a novel method of matrix extraction was utilized to permit the analysis of soluble matrix proteins of different types of kidney stones by two-dimensional electrophoresis. Two-dimensional polyacrylamide gel electrophoresis (SDS-PAGE) was performed on each soluble matrix protein sample resulting in a characteristic "map" of spots for each stone. The soluble matrix protein "map" was complex yet reproducible for each sample studied. The soluble matrix protein maps resembled urinary protein maps and stones of different crystalline content had significantly different matrix protein maps. The two-dimensional electrophoretic maps of matrix proteins extracted from calcium oxalate and uric acid calculi were similar to previously published two-dimensional electrophoretic maps of urinary proteins recovered from calcium oxalate and uric acid crystals. The majority of the protein maps were noteworthy for the presence of a low molecular weight pattern (MW less than 17,500 dalton) not seen in association with normal urinary protein maps. The significance of this pattern is not known but could be the result of degradation of larger proteins, evidence of renal tubular disease, or evidence of selective incorporation of low molecular weight proteins during stone formation.

An intrarenal opacity resisting extracorporeal shock wave lithotripsy.

Milk of calcium renal stone refers to an entity described in connection to a similar condition in gallbladder disease. The intrarenal accumulation of calcium carbonate imitates a calcific density and frequently is located within a caliceal diverticulum or a pyelogenic cyst. Symptomatology, if present, mainly refers to a continuous flank distress but colicky pain complaints are rare. The diagnosis is radiological. The typical impression of a shifting fluid level is apparent when comparing x-rays with the patient in the supine position, and in the upright and lateral projections. When extracorporeal shock waves are applied on this target no fragmentation is achieved. Although the calcium content will account for a difference in acoustical impedance, neither a cleavage nor a fracture plane can be generated within the fluid calcium salt deposits.

Gota: una revisión clínica / Gout: a clinical review

La gota es una enfermedad articular crónica, habitualmente autolimitada; a través del tiempo con cierta frecuencia se encuentran nódulos llamados tofos y se asocia a litiasis renal. Se analiza el metabolismo del ácido úrico, la incidencia de la enfermedad, el mecanismo de la inflamación. En el cuadro clínico se describe el ataque agudo, la gota crónica tofácea. Se hace énfasis en el tratamiento del ataque agudo, de la gota crónica y de la litiasis renal úrica

Morphostructural patterns in staghorn renal calculi seen under the scanning electron microscope.

A total of 43 surgically removed staghorn urinary calculi were examined under a scanning electron microscope; the findings, together with microanalytical data, were used to determine morphostructural patterns corresponding to different mineral compositions. The stones were classified into 3 groups: phosphatic, urate and cystine.

Place of extracorporeal shock-wave lithotripsy (ESWL) in management of cystine calculi.

We treated 12 patients with sixteen renal and one ureteral cystine stones primarily with extracorporeal shock-wave lithotripsy (ESWL). Among the stones thirteen were greater than 25 mm. In four stones less than 25 mm, three stones completely disappeared and 1 was reduced to small fragments, following ESWL. In thirteen stones greater than 25 mm, twelve were treated by ESWL initially, and one by surgery. Of the 12 cases treated initially by ESWL, 4 became stone-free, 4 remained with small fragments, and 1 remained with large fragments. Two patients were operated on because of poor response to ESWL and 1 patient lost kidney function because of prolonged obstruction. Disintegration of cystine stones greater than 25 mm required an average of 8,522 shock-waves in 4.33 sessions. The problems associated with application of ESWL monotherapy to cystine stones are presented.

Glycosaminoglycan content, oxalate self-exchange and protein phosphorylation in erythrocytes of patients with 'idiopathic' calcium oxalate nephrolithiasis.

1. This study was performed to test the hypothesis that glycosaminoglycans may play an important role in the observed abnormalities in oxalate flux seen in patients with calcium oxalate nephrolithiasis. 2. Oxalate flux rate, erythrocyte membrane glycosaminoglycan content, membrane protein phosphorylation and effect of heparan sulphate on erythrocyte oxalate flux in vitro were studied in control subjects and patients with calcium oxalate nephrolithiasis. 3. In comparison with control subjects, renal stone-formers showed a significantly higher oxalate self-exchange, a lower erythrocyte membrane glycosaminoglycan content and a higher membrane phosphorylation rate. In stone-formers, erythrocyte glycosaminoglycan content correlated inversely with both oxalate flux rate and protein phosphorylation. In vitro, heparan sulphate promoted a significant fall in the rate of oxalate self-exchange. 4. These findings support the hypothesis that a lower erythrocyte membrane content of glycosaminoglycans enhances membrane protein phosphorylation, leading to an increased rate of transmembrane oxalate flux.

Treatment of staghorn calculi by fiberoptic transurethral nephrolithotripsy.

We treated 34 patients with staghorn calculi by fiberoptic transurethral nephrolithotripsy with a flexible nephroureteroscope and an electrohydraulic lithotriptor. Of the 34 patients 30 (88.2%) were treated successfully. There were 17 patients each with complete and partial staghorn calculi. There was no difference in the success ratio and the rate of residual fragments between the 2 groups. However, post-procedural fever, sepsis and extrapelvic extravasation were observed more frequently in patients with complete than with partial staghorn calculi. Countermeasures to avoid complications must be developed in the future. However, we believe that fiberoptic transurethral nephrolithotripsy is a safe and effective treatment for staghorn calculi. This procedure also should be recommended, as well as the combination of percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy.

Dietary intake and habits of Japanese renal stone patients.

The daily consumption of various nutrients as well as the daily habits of 241 male stone patients were investigated. Hypercalciuric (300 mg. or more per day) calcium stone patients ingested much more total protein, fats, oils and calcium than normocalciuric calcium stone patients, and uric acid stone patients ingested much more total and animal protein, and carbohydrates than calcium stone patients. However, the amount of ingested calcium by the patients (470 mg.) was similar to that of age-matched healthy male subjects (476 mg.) and did not reach the level of the daily nutritive requirements (600 mg.). The patients ingested large amounts of nutrients, especially animal protein, during the evening meal. From these results it was believed that synthetic dietary management, including not only ingesting various amounts of nutrients but also changing dietary habits, is necessary for the prophylaxis of renal stones.

[Treatment with extracorporeal shockwave lithotripsy (ESWL), endourology and dissolution for staghorn calculi composed of cystine: report of two cases].

Two cases of complete staghorn calculi composed of cystine that were treated with ESWL, endourology and dissolution are reported. After successful dissolution in vitro using tromethamine (pH 8-10), the same solution was used to irrigate the renal collecting system via nephrostomy tube for residual fragments after ESWL and/or endourology. One patient was treated with dissolution for 60 days, the other patient for 6 days. After this therapy, these patients became almost stone-free. Our experience demonstrates that the residual fragments after ESWL and/or endourology with staghorn calculi composed of cystine can be dissolved by tromethamine.

Bacteriology of upper urinary tract stones.

Extensive cultures of stones and urine were performed in 215 patients who underwent an operation for upper urinary tract calculi. Microorganisms could be cultured from the stone in 1 of every 3 patients. Despite the extended culture technique urease-producing microorganisms could be cultured from the stone in only 48% of the patients with calculi that contained magnesium ammonium phosphate. This finding suggests that an infection with urease-producing microorganisms is not obligatory for the formation of this type of stone. Of the patients with calcium oxalate phosphate stones 32% had positive stone cultures, which distinguished them from patients with pure calcium oxalate stones, only 8% of whom had a positive stone culture (p less than 0.001).

[Should fragments of stone expelled after extracorporeal lithotripsy always be analyzed?]. / Faut-il toujours analyser les fragments de calculs expulsés après lithotritie extracorporelle?

The morphological and constitutional analysis of renal stone fragments expelled after extracorporeal shock wave lithotripsy enables the structure and morphological type of stones to be reconstructed in 92.8 per cent of the cases as regards surface and section and in 74.5 per cent of the cases down to the core. A study of the molecular and crystalline composition of such fragments demonstrated the preponderance of whewellite in both sexes (men 85.4 per cent; women 72.4 per cent). The frequency of weddellite was 1.6 times higher in men (73.8 per cent) than in women (44.8 per cent), and the frequencies of struvite and ammonium urate were 2.8 and 2.6 times respectively higher in women than in men, despite a significant fall in frequency as compared to a previous series. Correlations between morphological type of stone and biochemical data (when available) could be established in 84 per cent of the cases. This made it possible to initiate treatments aimed at preventing recurrences, the cost of these treatments in the long term being lower than that of the curative urological treatments, including extracorporeal shock wave lithotripsy.

Laxative abuse as a cause for ammonium urate renal calculi.

Nine women with laxative abuse and predominantly ammonium urate renal calculi underwent metabolic studies to identify common chemical abnormalities and determine pathophysiology. The 24-hour urine studies demonstrated marked decreases in volume (902 cm.3), sodium (28 mEq.), citrate (116 mg.) and potassium (21 mEq.). A significant elevation in ammonium urate supersaturation was found compared to control subjects when studied by the computer model EQUIL 2. Of the patients 7 had 1 or more urine specimens positive for phenolphthalein. Gastrointestinal loss of fluid and electrolytes allowed for chronic extracellular volume depletion. Intracellular acidosis was present as judged by low urinary citrate and potassium. The fact that the ion product for ammonium urate is increased significantly compared to controls reflects the stated pathophysiological changes. Laxative abuse should be suspected whenever a woman has an ammonium urate renal calculus in sterile urine.

Effect of magnesium citrate and magnesium oxide on the crystallization of calcium salts in urine: changes produced by food-magnesium interaction.

The effect of magnesium citrate and magnesium oxide on urinary biochemistry and on the crystallization of calcium salts was examined in 7 normal subjects and 4 patients with recurrent calcium oxalate nephrolithiasis. When magnesium citrate or magnesium oxide was administered on an empty stomach (10 mEq. 4 times per day or 486 mg. magnesium per day for 2 weeks) urinary magnesium increased by only 77 to 79 mg. per day and urinary citrate increased by 98 to 142 mg. per day. However, urinary calcium increased by 21 to 25 mg. per day. No significant changes were noted in urinary saturation of calcium oxalate or brushite or in the limit of metastability (formation product) of these salts. However, when magnesium salts were provided with meals there were more prominent increases in urinary magnesium (by 92 to 96 mg. per day) and in citrate (by 218 to 226 mg. per day). Moreover, urinary oxalate decreased. Owing to these changes the urinary saturation of calcium oxalate decreased and the formation product increased. If magnesium citrate and magnesium oxide are to be used in the management of recurrent calcium oxalate nephrolithiasis, they should be administered with meals.

Role of percutaneous procedures in the management of renal calculi.

Appropriate management of the variety of patients with stone disease demands access to all methods of stone removal. Percutaneous procedures are an integral aspect of the surgical management of stone patients, and the urologist must recognize when a patient's situation is best served by percutaneous surgery. Percutaneous stone removal procedures are preferred when: 1. The stone is large, i.e., greater than 2 to 3 cm. 2. The stone is staghorn in configuration, with percutaneous measures being used either as primary treatment or in combination with shock wave lithotripsy. 3. The stone is composed of cystine 4. When certain removal of the stone is important. 5. When there is obstructive uropathy. 6. When other modalities have failed. 7. In morbidly obese individuals and others whose body habitus precludes use of the shock wave machine. 8. In children, at least until the issue of long-term safety of extracorporeal lithotripsy is settled.