Changes in blood gas in supine and prone positions in percutaneous stone surgery: does position have any advantage for hemodynamics?

To evaluate whether different positions are advantageous for hemodynamics and respiratory balance in patients undergoing percutaneous nephrolithotomy (PCNL) procedures. Pre- and postoperative arterial blood gas data obtained during spontaneous breathing for 67 prone (Group 1) and 56 supine (Group 2) patients undergoing PCNL were analyzed. Additionally data on all patients' gender, age, body mass index, stone size, access and surgical duration, volume of irrigation fluid, length of hospital stay, requirement for blood transfusion, and residual stones were recorded: There were no differences between the groups in terms of age, stone size, operation time, access time, radiation exposure, transfusion requirements, stone-free rate, and length of hospitalization. A statistically significant pH decrease was observed in both groups in the postoperative period (p = 0.001 and p = 0.001, respectively). There was a statistically significant increase in pCO2 values in both groups in the postoperative period (p = 0.001 and p = 0.024, respectively), and that increase did not differ significantly between the groups (p = 0.624). A statistically significant decrease in pO2 and SpO2 values was observed in both groups in the postoperative period compared to the preoperative period. Again, no statistical difference was observed between the groups for these values. There was a statistically significant decrease in bicarbonate in both groups period (p < 0.001 and p = 0.001, respectively). Hemodynamics and the respiratory balance of the patient are impaired in both prone and supine positions. Neither position is superior to the other in this respect.

Mitochondrial dysfunction in kidney stones and relief of kidney stones after reducing mtROS.

Mitochondria are essential organelles because they generate the energy required for cellular functions. Kidney stones, as one of the most common urological diseases, have garnered significant attention. In this study, we first collected peripheral venous blood from patients with kidney stones and used qRT-PCR to detect mitochondrial DNA (mtDNA) copy number as a means of assessing mitochondrial function in these patients. Subsequently, through Western blotting, qPCR, immunofluorescence, immunohistochemistry, and transmission electron microscopy, we examined whether calcium oxalate crystals could cause mitochondrial dysfunction in the kidney in both in vitro and in vivo. We then examined the intersection of the DEGs obtained by transcriptome sequencing of the mouse kidney stone model with mitochondria-related genes, and performed KEGG and GO analyses on the intersecting genes. Finally, we administered the mitochondrial ROS scavenger Mito-Tempo in vivo and observed its effects. Our findings revealed that patients with kidney stones had a reduced mtDNA copy number in their peripheral venous blood compared to the control group, suggesting mitochondrial dysfunction in this population. This conclusion was further validated through in vitro and in vivo experiments. Enrichment analyses revealed that the intersecting genes were closely related to metabolism. We observed that after mitochondrial function was preserved, the deposition of calcium oxalate crystals decreased, and the kidney damage and inflammation caused by them were also alleviated. Our research indicates that kidney stones can cause mitochondrial dysfunction. After clearing mtROS, the damage and inflammation caused by kidney stones are reversed, providing new insights into the prevention and treatment of kidney stones.

Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and kidney stone: evidence from NHANES 2007-2018.

BACKGROUND: As an innovative lipid parameter, NHHR (the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol) can serve as a valuable tool for assessing cardiovascular disease risk. Nevertheless, the relationship between NHHR and the risk of kidney stones remains unexplored. METHODS: A cross-sectional survey utilized data from the National Health and Population Survey (NHANES) database in the United States spanning from 2007 to 2018. Distinct statistical analyses were applied, including weighted logistic regression, stratified and interaction analysis and restricted cubic spline curve (RCS) models, to examine the correlation between NHHR and the incidence of kidney stones. RESULTS: This analysis encompassed 24,664 participants, with 9.63% reporting incidents of kidney stones. Following multivariate logistic regression and comprehensive adjustments, participants in NHHR quartile 4 (OR 1.34; 95% CI 1.12, 1.60, P < 0.01) exhibited a significantly increased risk of kidney stones compared to those in NHHR quartile 1 (Q1). The RCS result further illustrated a non-linear correlation between NHHR and the incidence of kidney stones. The result of subgroup analysis manifested that participants without diabetes had a higher risk of kidney stones when measured high NHHR levels compared those with diabetes (p for interaction < 0.05). CONCLUSION: Elevated NHHR levels were found to be associated with an increased risk of kidney stones. Based on these findings, NHHR appears to be a promising predictive indicator for the occurrence of kidney stones.

The Safety Profile of Vitamin D Supplements Using Real-World Data from 445,493 Participants of the UK Biobank: Slightly Higher Hypercalcemia Prevalence but Neither Increased Risks of Kidney Stones nor Atherosclerosis.

Background: Potential calcium-related adverse events of vitamin D supplement use have not been addressed in large-scale, real-world data so far. Methods: Leveraging data from the UK Biobank, encompassing 445,493 individuals aged 40-69, we examined associations of high 25-hydroxyvitamin (25(OH)D) levels ≥ 100 nmol/L and vitamin D supplementation with hypercalcemia (serum calcium > 2.6 mmol/L), kidney stones, and atherosclerosis assessments (pulse wave arterial stiffness index and carotid intima-medial thickness). Regression models were comprehensively adjusted for 49 covariates. Results: Approximately 1.5% of the participants had high 25(OH)D levels, 4.3% regularly used vitamin D supplements, and 20.4% reported regular multivitamin use. At baseline, the hypercalcemia prevalence was 1.6%, and 1.1% was diagnosed with kidney stones during follow-up. High 25(OH)D levels were neither associated with calcium-related adverse events nor atherosclerosis assessments. Vitamin D and multivitamin supplementation were associated with an increased prevalence of hypercalcemia (odds ratios and 95% confidence intervals: 1.46 [1.32-1.62] and 1.11 [1.04-1.18], respectively) but were neither associated with atherosclerosis nor future kidney stones. Conclusions: High 25(OH)D levels observable in routine care were not associated with any adverse outcome. Vitamin D users have a slightly higher prevalence of hypercalcemia, possibly due to co-supplementation with calcium, but without a higher atherosclerosis prevalence or risk of kidney stones.

Association between monocyte to high-density lipoprotein cholesterol ratio and kidney stone: insights from NHANES.

Purpose: The ratio of monocyte to high-density lipoprotein cholesterol (MHR) has surfaced as a novel biomarker indicative of inflammation and oxidative stress. The aim of our study was to evaluate the association between MHR and the risk of kidney stones. Methods: This study analyzed data from individuals aged 20-79 who participated in the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018. The MHR was assessed as the exposure variable, while a self-reported history of kidney stones was used as the outcome variable. The independent relationship between MHR and the risk of kidney stones was thoroughly evaluated. Results: This study included 28,878 participants, and as the quartile range of the MHR increased, the proportion of kidney stones also rose progressively (7.20% to 8.89% to 10.88% to 12.05%, P<0.001). After adjusting for confounding factors, MHR was independently associated with an increased risk of kidney stones (OR=1.31, 95%CI=1.11-1.54, P=0.001), also independent of some common inflammatory indices. Subgroup analysis suggested that the relationship between MHR and kidney stones was more pronounced in female and individuals aged 20-49. Further restricted cubic spline (RCS) analysis indicated a nonlinear relationship between MHR and the risk of kidney stones. Conclusion: Our results indicate a positive correlation between MHR and an increased risk of kidney stones in US adults, underscoring the need for further large-scale prospective cohort studies to validate these findings.

A cross-sectional analysis of the relationship between the non-high density to high density lipoprotein cholesterol ratio (NHHR) and kidney stone risk in American adults.

BACKGROUND: Recent interest in the Non-High Density to High Density Lipoprotein Cholesterol ratio (NHHR) has emerged due to its potential role in metabolic disorders. However, the connection between NHHR and the development of kidney stones still lacks clarity. The primary goal of this research is to explore how NHHR correlates with kidney stone incidence. METHODS: An analysis was conducted on the data collected by the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018, focusing on adults over 20 years diagnosed with kidney stones and those with available NHHR values. Employing weighted logistic regression and Restricted Cubic Spline (RCS) models, NHHR levels' correlation with kidney stone risk was examined. Extensive subgroup analyses were conducted for enhanced reliability of the findings. RESULTS: The findings indicate a heightened kidney stone risk for those at the highest NHHR levels relative to those at the lowest (reference group). A notable non-linear correlation of NHHR with kidney stone incidence has been observed, with a significant P-value (< 0.001), consistent across various subgroups. CONCLUSION: A clear link exists between high NHHR levels and increased kidney stone risk in the American adult population. This study highlights NHHR's significance as a potential indicator in kidney stone formation.

Factors associated to hemoglobin decrease after percutaneous nephrolithotomy: a retrospective study.

OBJECTIVE: This study aims to determine the preoperative and perioperative risk parameters associated with a decrease in hemoglobin (Hb) in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS: We collected prospective data of consecutive patients who underwent PCNL from January 2018 to December 2022. The median decrease in post-operative hemoglobin levels compared to pre-operative was found to be 1.5 g/dl. This value was the cut-off value that divided the sample into two groups. Group 1 has a decrease in Hb levels that is higher or equal to the cutoff, group 2 has a decrease in Hb levels that is lower than the cut-off. All preoperative, stone characteristics and perioperative factors were recorded. RESULTS: A total of 273 patients were included in the study, 141 in Group 1 and 132 in Group 2. The mean age of Group 1 was significantly higher (55.48 ± 8.73 vs 45.9 ± 10.75 years, p < 0.05). The mean bleeding of Group 1 was significantly higher (285.85 ± 113.68 vs 135 ± 77.54 ml, p < 0.05). There was a significant difference in mean operation time between groups (86.35 ± 32.05 vs 64.89 ± 27.83 min, p < 0.05). Multivariate analysis showed that the variables age, comorbid diabetes mellitus, intraoperative bleeding amount, and operation time had a significant relationship with Hb reduction in patients undergoing PCNL (p < 0.05). CONCLUSIONS: Older age, comorbid diabetes mellitus, large amounts of intraoperative bleeding, and longer operating time are factors associated with PCNL-related postoperative hemoglobin decrease.

Blood Calcium, Genetic Risk, and Risk of Incident Kidney Stone: A Population-Based Cohort Study.

OBJECTIVE: To investigate the association between blood calcium concentration and incident kidney stone as well as to assess the role played by genetic susceptibility. METHODS: We performed a population-based cohort study based on participants from the UK Biobank. A multivariable Cox proportional hazards regression model was used to estimate hazard ratios (HRs) and 95% CIs of incident kidney stone for blood calcium level and polygenic risk score (PRS). In addition, the potential interaction was explored. The study was conducted from January 28, 2023, through June 4, 2023. RESULTS: During the follow-up of 423,301 participants with a total of 5,490,332 person-years (median follow-up of 13.4 years), 4502 cases of kidney stone were recorded. Compared with the low blood calcium concentration group (first tertile), individuals in the high (third tertile) and moderate (second tertile) concentration groups had higher risks of kidney stone with HRs of 1.24 (95% CI, 1.15 to 1.33) and 1.11 (1.04 to 1.20), respectively. The PRS for kidney stone contained 40 independent single-nucleotide polymorphisms and was used to assign individuals to 3 groups according to the quintile. Participants with high (Q5) and moderate (Q2 to Q4) genetic risks had increased risks of kidney stone compared with low (Q1) genetic risk with HRs of 1.70 (1.53 to 1.89) and 1.31 (1.20 to 1.44), respectively. There was a joint cumulative risk of incident kidney stone between blood calcium concentration and genetic susceptibility. CONCLUSIONS: Blood calcium concentration and PRS are significantly associated with incident kidney stone risk. Excessive blood calcium concentration might bring additional stone risk in populations at high genetic risk. A nonlinear correlation between blood calcium concentration and kidney stone risk was indicated.

The magnesium depletion score is associated with increased likelihood of kidney stone disease among female adults.

OBJECT: The association between magnesium depletion score (MDS) and kidney stone disease (KSD) remains unknown. This study was designed to investigate the association of MDS with KSD in adults. METHODS: A total of 19,654 participants were enrolled from the National Health and Nutrition Examination Surveys (NHANES). The MDS was calculated by assessing four aspects, including alcohol assumption, renal function, and use of diuretics and proton pump inhibitor. Multivariable logistic regressions were performed to explore the associations between MDS and the prevalence of KSD. Linear correlations were conducted explore the relationship of testosterone with MDS. RESULTS: In the multivariable logistic regressions with full adjustment for confounding variables, the odds ratio of MDS associating with KSD was 1.28 (95% CI: 1.04-1.58, P = 0.022) in total population, and 1.70 (95% CI: 1.16-2.50, P=0.007) in female participants. Besides, compared to the lowest MDS, the highest MDS was associated with a lower testosterone (ß = -16.39, P=0.009) after full adjustment in non-menopause women. CONCLUSION: This study highlighted a positive correlation of high MDS with KSD in female population, which may be associated low level of serum testosterone.

Litiasis urinaria en pacientes de la clinica El Bosque / Urinary lithiasis in patients of clinica El Bosque

Se llevo a cabo un estudio descriptivo retrospectivo en 77 pacientes con litiasis urinaria que consultaron al departamento de urologia de la clinica el Bosque de Bogota entre junio de 1979 a diciembre de 1987. Se encontro que la urolitiasis es mas frecuente en el sexo masculino en la poblacion que se encuentra entre los 21 a 40 anos y que realiza poca actividad fisica, ademas se vio mayor incidencia de la entidad en habitantes de clima frio siendo este el unico dato desacorde con los estudios revisados. En cuanto a la presencia de antecedentes se establecio que el 20.7% de pacientes habian presentado un episodio previo y el 212.6% tenian antecedentes personales cercanos. En el cuadro clinico se vio que los sintomas mas frecuentes acusados por los pacientes fueron el dolor abdominal 77% nauseas y vomito 24%, dolor lumbar 22%, hematuria 17%, disuria 13%. La irradiacion del dolor en la mayoria de los casos fue a los genitales 24.6%, region lumbar 14.2% y muslo 12%. Como ayudas diagnosticas fueron solicitadas el cuadro hematico, el parcial de orina y medios radiologicos. En las historias clinicas revisadas no se encontraron datos acerca del tipo de alimentacion del paciente, farmacos que venian rcibiendo y el analisis de los calculos excretados, por lo que no se pudo trabajar sobre estos puntos. Tomando como base el trabajo realizado propusimos un esquema de enfoque y manejo de la entidad, para la Clinica el Bosque (Bogota).

Excreción urinaria de electrolitos en sujetos normales y en pacientes con litiasis cálcica idiopática / Urinary excretion of electrolytes in normal subjects and in patients with idiopathic calcium lithiasis

La excreción de calcio, fósforo y magnesio en orinas de 24 horas es analizada en 70 sujetos; 35 pacientes conlitiasis cálcica idiopática y 35 personas normales con igual distribución de sexo para ambos grupos. Los pacientes con litiasis cálcica presentaron un notable aumento en la calciuria de 24 horas (185,96 más-menos 118,24 para un DS) comparada con sujetos normales (129,77 más-menos 48,43 para una DS). La excreción de los otros electrolitos no tuvo diferencia significativa en los dos grupos estudiados. Las dosificaciones de calcio, fósforo, creatinina y ácido úrico en sangre se comportaron de forma similar en sujetos sanos y en pacientes con litiasis cálcica. El índice calcio/magnesio es notablemente mayor en los enfermos litiásicos que en sujetos normales(AU)