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1.
Isr Med Assoc J ; 23(1): 12-16, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33443336

RESUMO

BACKGROUND: Dietary modifications and patient-tailored medical management are significant in controlling renal stone disease. Nevertheless, the literature regarding effectiveness is sparse. OBJECTIVES: To explore the impact of dietary modifications and medical management on 24-hour urinary metabolic profiles (UMP) and renal stone status in recurrent kidney stone formers. METHODS: We reviewed our prospective registry database of patients treated for nephrolithiasis. Data included age, sex, 24-hour UMP, and stone burden before treatment. Under individual treatment, patients were followed at 6-8 month intervals with repeat 24-hour UMP and radiographic images. Nephrolithiasis-related events (e.g., surgery, renal colic) were also recorded. We included patients with established long-term follow-up prior to the initiation of designated treatment, comparing individual nephrolithiasis status before and after treatment initiation. RESULTS: Inclusion criteria were met by 44 patients. Median age at treatment start was 60.5 (50.2-70.2) years. Male:Female ratio was 3.9:1. Median follow-up was 10 (6-25) years and 5 (3-6) years before and after initiation of medical and dietary treatment, respectively. Metabolic abnormalities detected included: hypocitraturia (95.5%), low urine volume (56.8%), hypercalciuria (45.5%), hyperoxaluria (40.9%), and hyperuricosuria (13.6%). Repeat 24-hour UMP under appropriate diet and medical treatment revealed a progressive increase in citrate levels compared to baseline and significantly decreased calcium levels (P = 0.001 and 0.03, respectively). A significant decrease was observed in stone burden (P = 0.001) and overall nephrolithiasis-related events. CONCLUSIONS: Dietary modifications and medical management significantly aid in correcting urinary metabolic abnormalities. Consequently, reduced nehprolithiasis-related events and better stone burden control is expected.


Assuntos
Dietoterapia/métodos , Cálculos Renais , Nefrolitíase , Assistência ao Convalescente/métodos , Assistência ao Convalescente/estatística & dados numéricos , Cálcio/urina , Ácido Cítrico/urina , Feminino , Humanos , Israel/epidemiologia , Cálculos Renais/complicações , Cálculos Renais/epidemiologia , Cálculos Renais/fisiopatologia , Masculino , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Metaboloma/efeitos dos fármacos , Metaboloma/fisiologia , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Nefrolitíase/diagnóstico , Nefrolitíase/dietoterapia , Nefrolitíase/tratamento farmacológico , Nefrolitíase/metabolismo , Avaliação de Processos e Resultados em Cuidados de Saúde , Cólica Renal/epidemiologia , Cólica Renal/etiologia , Prevenção Secundária/métodos , Prevenção Secundária/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Ácido Úrico/urina
4.
Biomed Res Int ; 2020: 1354672, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31998778

RESUMO

The purpose of this study was to assess risk factors of urosepsis after minimally invasive percutaneous nephrolithotomy (MPCNL) for the treatment of upper urinary tract stones in patients with preoperative urinary tract infection (UTI) and to explore preventive measures. Between 2008 and 2016, patients with preoperative UTI who underwent MPCNL for upper urinary tract stones were retrospectively collected. Patients were divided into nonurosepsis and urosepsis groups. Perioperative outcomes of all patients were evaluated and compared between the two groups. Risk factors for post-MPCNL urosepsis were investigated using univariate and multivariate regression analysis. A total of 843 patients including 22 patients with postoperative urosepsis (urosepsis group) and 821 patients without urosepsis (nonurosepsis group) were finally included in this study. All patients with postoperative urosepsis were cured and discharged after treatment. In univariate analysis it was demonstrated that the incidence of urosepsis after MPCNL was significantly correlated with channel size (P=0.001), surgical time (P=0.003), as well as the tear of the collection system and percutaneous renal channel crossing the renal papilla (P=0.004). Moreover, multivariate analysis showed that smaller channel size (OR = 11.192, 95% CI: 2.425-51.650, P=0.002), longer surgical time (OR = 6.762, 95% CI: 1.712-17.844, P=0.008), and tear of collection system and percutaneous renal channel crossing the renal papilla (OR = 5.531, 95% CI 1.228-14.469, P=0.012) were independent risk factors for urosepsis following MPCNL in patients with preoperative UTI. In conclusion, in patients with preoperative UTI undergoing MPCNL for upper urinary tract stones, smaller channel size, prolonged operation time, as well as tear of the collection system and percutaneous renal channel crossing the renal papilla are independent risk factors for postoperative urosepsis. Therefore, it is indicated that, in clinical practice, it is of great significance to choose appropriate channel size and avoid renal injury and control surgical time to prevent the urosepsis after MPCNL in patients with preoperative UTI.


Assuntos
Nefrolitotomia Percutânea , Infecções Urinárias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Cálculos Renais/epidemiologia , Cálculos Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Sepse/epidemiologia , Sepse/etiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/cirurgia
5.
Urolithiasis ; 48(1): 37-46, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30900001

RESUMO

Previous studies assumed a uniform relationship between heat and kidney stone presentations. Determining whether sex and other characteristics modify the temperature dependence of kidney stone presentations has implications for explaining differences in nephrolithiasis prevalence and improving projections of the effect of climate change on nephrolithiasis. We performed an aggregated case-crossover study among 132,597 children and adults who presented with nephrolithiasis to 68 emergency departments throughout South Carolina from 1997 to 2015. We used quasi-Poisson regression with distributed lag non-linear models to estimate sex differences in the cumulative exposure and lagged response between maximum daily wet-bulb temperatures and emergent kidney stone presentations, aggregated at the ZIP-code level. We also explored interactions by age, race, payer, and climate. Compared to 10 °C, daily wet-bulb temperatures at the 99th percentile were associated with a greater increased relative risk (RR) of kidney stone presentations over 10 days for males (RR 1.73; 95% CI 1.56, 1.91) than for females (RR 1.15; 95% CI 1.01, 1.32; interaction P < 0.001). The shape of the lagged response was similar for males and females, with the greatest risk estimated for the 2 days following high temperatures. There were weak differences by age, race, and climatic zone, and no differences by payer status. The estimated risk of presenting emergently with kidney stones within 10 days of high daily wet-bulb temperatures was substantially greater among men than women, and similar between patients with public and private insurance. These findings suggest that the higher risk among males may be due to sexually dimorphic physiologic responses rather than greater exposure to ambient temperatures.


Assuntos
Mudança Climática , Resposta ao Choque Térmico/fisiologia , Temperatura Alta/efeitos adversos , Cálculos Renais/epidemiologia , Exacerbação dos Sintomas , Adulto , Idoso , Estudos Cross-Over , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Cálculos Renais/fisiopatologia , Cálculos Renais/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Sexuais , South Carolina/epidemiologia , Adulto Jovem
6.
BJU Int ; 125(2): 276-283, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31721407

RESUMO

OBJECTIVES: To evaluate prospectively whether a tubeless (JJ stent-only) percutaneous nephrolithotomy (PCNL) might reduce the risk of hydrothorax, compared to an approach where a nephrostomy tube is left. MATERIALS AND METHODS: We conducted a two-arm open-label prospective randomized study (NCT02036398) comparing tubeless supra-costal PCNL (with a JJ stent only) to standard PCNL (with nephrostomy tube and JJ stent) using intention-to-treat (ITT) and per-protocol (PP) analyses. All patients underwent a standard single-stage prone supra-costal procedure with single-tract access. Complication data were collected according to the Clavien-Dindo grading system. The primary endpoint was the rate of hydrothorax, and secondary endpoints included stone-free rate (SFR) and complication rate. Multivariable logistic regression analysis identified factors associated with hydrothorax formation. RESULTS: Out of 101 patients approached, 75 were finally analysed. No differences were observed between the two arms with regard to baseline demographic and stone characteristics. The mean largest stone size ranged between 23 and 24.2 mm. No significant difference was seen in the mean operating time and length of hospital stay. The incidence of hydrothorax was significantly higher in the nephrostomy group in comparison to the tubeless group (37.8% vs 15.8%, P = 0.031, and 38.4% vs 13.8%, P = 0.016, in the ITT and PP analyses, respectively). The SFR and complication rate were similar in both groups using the ITT and PP analyses. Multivariable logistic regression analysis showed that nephrostomy tube placement was the only covariate associated in a statistically significant manner to hydrothorax (odds ratio 3.628, 95% confidence interval 1.073-12.265; P = 0.038). CONCLUSION: The rate of hydrothorax in supra-costal PCNL is associated with the type of postoperative drainage left. When possible, a tubeless approach should be applied as it may confer a lower risk of hydrothorax.


Assuntos
Hidrotórax/epidemiologia , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Feminino , Humanos , Hidrotórax/prevenção & controle , Cálculos Renais/epidemiologia , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Resultado do Tratamento
7.
Urology ; 137: 152-156, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31883881

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of supracostal percutaneous nephrolithotomy (PCNL) through the 11th intercostal space and compare it with subcostal PCNL in children with renal calculi. MATERIALS AND METHODS: Children with renal calculi who underwent PCNL between January 2010 and December 2017 were divided into 2 groups: supracostal PCNL (group 1) and subcostal PCNL (group 2). Stone location, stone burden, location of the access points, operative time, postoperative visual pain score, success rate, hospital stay, and complications according to the modified Clavien classification were compared. Comparison of medians was done using Mann Whitney U test and the means were compared using t test. RESULTS: Group 1 had 50 patients while group 2 had 60 patients. The stone-free rate was 84.0% and 85.0% in groups 1 and 2, respectively after 1 session of PCNL (P = .885). After auxiliary procedures, it increased to 96.0% and 96.6%, respectively (P = .852). The mean fall in hematocrit was 0.9% in group 1 and 1.5% in group 2 (P = .11) whereas the median pain score was 4 in group 1 and 3 in group 2 (P = .37). In all, 54 complications were recorded the commonest among which were grade I (81.5%). Twenty-nine complications were observed in group 1 while 25 complications were observed in group 2 (P = .088). One patient developed nephropleural fistula while another patient developed hydropneumothorax. Both belonged to group 1. CONCLUSION: Supracostal access for PCNL is an effective and safe alternative to subcostal access for children with renal calculi in terms of stone-free rate and complications.


Assuntos
Hidropneumotórax , Cálculos Renais , Nefrolitotomia Percutânea , Complicações Pós-Operatórias/diagnóstico , Fístula Urinária , Criança , Feminino , Humanos , Hidropneumotórax/diagnóstico , Hidropneumotórax/etiologia , Índia/epidemiologia , Cálculos Renais/diagnóstico , Cálculos Renais/epidemiologia , Cálculos Renais/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Duração da Cirurgia , Resultado do Tratamento , Fístula Urinária/diagnóstico , Fístula Urinária/etiologia
8.
Sci Rep ; 9(1): 17296, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31754202

RESUMO

Nephrolithiasis is a common disease affecting almost all populations, with an increasing prevalence over the past decades. Previous studies revealed several functional polymorphisms associated with the pathogenesis of nephrolithiasis. However, data on Asian populations are limited. In this study, three candidate polymorphisms were selected from previous studies to investigate the correlations with nephrolithiasis in a Taiwanese population. In total, 454 nephrolithiasis patients were recruited from Kaohsiung Medical University Hospital, with SNP frequency for 1513 subjects of general population from the Taiwan Biobank (TWB) as a genotypic reference. Results revealed that subjects with minor TT genotype at rs1256328 (alkaline phosphatase, liver/bone/kidney (ALPL)) have higher susceptibility to nephrolithiasis (odds ratio (OR) = 2.03, p = 0.0013). In addition, subjects carrying the minor AA genotype at rs12654812 (regulator of G protein signaling 14 (RGS14)) have higher susceptibility to nephrolithiasis (OR = 1.91, p = 0.0017). Among nephrolithiasis patients, subjects with GG at rs7627468 (calcium-sensing receptor (CASR)) have lower pH level in urine (p = 0.0088). Importantly, rs7627468 is associated with the expressions of IQCB1 and EAF2. rs12654812 could influence the expression of RGS14 itself, MXD3, and FGFR4. In summary, this study successfully validated the genetic roles of rs1256328 and rs12654812 in human nephrolithiasis.


Assuntos
Fosfatase Alcalina/genética , Cálcio/metabolismo , Predisposição Genética para Doença , Cálculos Renais/genética , Proteínas RGS/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Concentração de Íons de Hidrogênio , Cálculos Renais/química , Cálculos Renais/epidemiologia , Cálculos Renais/urina , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Prevalência , Receptores de Detecção de Cálcio/genética , Receptores de Detecção de Cálcio/metabolismo , Transdução de Sinais/genética , Taiwan/epidemiologia , Adulto Jovem
9.
Perm J ; 232019.
Artigo em Inglês | MEDLINE | ID: mdl-31702984

RESUMO

INTRODUCTION: Despite guidelines for prevention of recurrent renal calculi, routine dietary modification and metabolic evaluation are often not performed. OBJECTIVE: To determine feasibility of a multicenter, pharmacist-staffed program to enroll patients at high risk of recurrent kidney stones and provide dietary instruction, metabolic evaluation, and medical therapy via telemedicine. METHODS: A total of 536 consecutive adult patients were referred from 3 Northern California Kaiser Permanente facilities. We determined the proportion of patients who enrolled, received dietary counseling, and completed metabolic evaluation at 12 months. The program was staffed by a clinical pharmacist and supervised by urologists following a protocol based on the American Urological Association guidelines. Patients were contacted entirely via telemedicine. Cystine or struvite kidney stones, renal tubular acidosis, and primary hyperoxaluria were exclusion criteria. RESULTS: Of the 536 patients, 500 agreed to enrollment. Among patients enrolled for 3 months, 99% self-reported compliance with at least 3 of 5 aspects of dietary advice. A complete metabolic evaluation including 24-hour urine collection was performed in 80% of patients by 12 months. A significant improvement in all urinary parameters occurred in 52 patients with calcium stones who repeated 24-hour urine testing. The 12-month dropout rate was 12.4%. CONCLUSION: A telemedicine-administered, pharmacist-staffed, protocol-driven program can provide dietary advice and obtain compliance with metabolic testing for patients at high risk of recurrent kidney stones. Rates of metabolic testing and dropout compare favorably with previously reported rates. This report represents, to our knowledge, the first telemedicine-administered, pharmacist-staffed, kidney stone prevention program published in the literature.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Cálculos Renais/prevenção & controle , Farmacêuticos , Telemedicina/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Prestação Integrada de Cuidados de Saúde/organização & administração , Dieta , Estudos de Viabilidade , Feminino , Humanos , Cálculos Renais/epidemiologia , Masculino , Pessoa de Meia-Idade , Farmacêuticos/organização & administração , Projetos Piloto , Telemedicina/organização & administração , Adulto Jovem
10.
Environ Int ; 132: 105115, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31473411

RESUMO

BACKGROUND: Nephrotoxic metals of arsenic, cadmium, lead and mercury exposures are common environmental pollutants. The associations between arsenic, cadmium, lead and mercury exposures and the risk of kidney stones are unclear. OBJECTIVE: To explore the associations between biomarkers of arsenic, cadmium, lead and mercury exposures and the odds of kidney stones. METHODS: Adult participants (≥20 years) from the 2007-2016 NHANES were included. Restricted cubic splines were adopted. RESULTS: The odds ratio (95% confidence interval) of kidney stones increased with increasing blood cadmium and reached the maximum at 1.00 µg/L [1.38 (1.02-1.88) overall, 1.62 (1.11-2.32) for women and 1.53 (1.06-2.22) for non-Hispanic white]. The odds of kidney stones increased with increasing urinary cadmium and reached the maximum at 1.50 µg/L [2.56 (1.17-5.59) overall, 5.57 (1.88-16.49) for women, 4.31 (1.75-10.63) for obese individuals and 3.75 (1.60-8.78) for non-Hispanic white]. The odds of kidney stones increased with increasing total urinary arsenic and urinary dimethylarsinic acid in women, and reached the maximum of 1.69 (1.08-2.67) at 40 µg/L and 1.71 (1.07-2.72) at 10.00 µg/L, respectively. Inverse associations were found between the odds of kidney stones and blood lead within 5.00 µg/dL [0.64 (0.46-0.90) overall, 0.53 (0.33-0.84) for men and 0.58 (0.37-0.92) for non-Hispanic white], methyl mercury within 3.00 µg/L [non-obese individuals: 0.71 (0.51-0.99)] and urinary arsenous acid within 1.20 µg/L [individuals other than non-Hispanic white: 0.63 (0.41-0.95)]. No association was found with other biomarkers. CONCLUSIONS: Several biomarkers of arsenic, cadmium, lead and mercury exposures were associated with the odds of kidney stones in adults.


Assuntos
Arsênico/sangue , Cádmio/sangue , Poluentes Ambientais/sangue , Cálculos Renais/epidemiologia , Chumbo/sangue , Mercúrio/sangue , Adulto , Monitoramento Biológico , Feminino , Humanos , Cálculos Renais/sangue , Masculino , Inquéritos Nutricionais
11.
Int J Med Sci ; 16(8): 1050-1056, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31523166

RESUMO

This study sought to evaluate associations between nephrolithiasis and hemorrhagic and ischemic stroke using a national sample cohort from Korea. Data from 2002 to 2013 were collected for individuals ≥ 20 years of age in the Korean National Health Insurance Service (NHIS)-National Sample Cohort. We extracted nephrolithiasis patients (n = 22,636) and 1:4 matched controls (n = 90,544) and analyzed the occurrence of stroke. Matching was performed based on age, sex, income, region of residence, hypertension, diabetes mellitus, and dyslipidemia history. Crude and adjusted hazard ratios (HRs) were calculated using Cox proportional hazard models, and 95% confidence intervals (CIs) were determined. We performed subgroup analyses according to age, sex, and follow-up period. The adjusted HR of ischemic stroke was 1.13 (95% CI = 1.06-1.21) in the nephrolithiasis group (P < 0.001). The relationship between nephrolithiasis and ischemic stroke remained present for the young women and middle-aged men as well as during a follow-up period of ≤ 1 year. The HR for hemorrhagic stroke did not reach statistical significance. The risk of ischemic stroke was higher in the nephrolithiasis patients.


Assuntos
Isquemia Encefálica/etiologia , Hemorragias Intracranianas/etiologia , Cálculos Renais/complicações , Acidente Vascular Cerebral/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/epidemiologia , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Seguimentos , Humanos , Hemorragias Intracranianas/epidemiologia , Cálculos Renais/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto Jovem
12.
Urology ; 134: 62-65, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31536740

RESUMO

OBJECTIVE: To evaluate feasibility of percutaneous nephrolithotomy (PCNL) for complex nephrolithiasis in patients 80 years of age and older compared to younger individuals. METHODS: From an institutional IRB-approved database, 1,647 patients were identified who underwent PCNL from 1999 to 2019. Patients were stratified by age: group 1 (20-59), group 2 (60-79), and group 3 (>80). Statistics were performed using chi-square and ANOVA to compare outcomes. RESULTS: Of the 1,647 patients, median age was 46, 66, and 83, respectively (P <0.0001). Three patients within group 3 were 90 or older. Females made up 54%, 46%, 56% of patients (P = 0.02). Average stone size with SD was 2.6 ± 2.2, 2.5 ± 2.3, 2.2± 1.9 cm for each group (P = 0.06). Mean preoperative hemoglobin (Hgb) was significantly lower in the 80+ group (13.8, 13.4, 13.1 g/dL, P <.0001). Change in Hgb was not significantly different. There were more Clavien II-IV complications (10.4, 14.4, 28.8%; P = 0.02) and transfusions (2.3, 4.7, 10.2%; P <0.001) in the elderly. The most common complications in the 80+ group were bleeding related (10.1%). No difference in readmission rates or ICU admissions was noted. CONCLUSION: PCNL is feasible in the extremely elderly; however with a higher rate of complications and longer hospitalizations. No long-term sequelae or deaths in the 80 and older cohort were seen. This study allows us to appropriately counsel older patients on a realistic postoperative course and supports use of PCNL as the best means of long-term survival.


Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Hemorragia Pós-Operatória , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Hemoglobinas/análise , Humanos , Cálculos Renais/sangue , Cálculos Renais/epidemiologia , Cálculos Renais/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/mortalidade , Hemorragia Pós-Operatória/terapia , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Estados Unidos/epidemiologia
13.
J Urol ; 202(6): 1217-1223, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31430246

RESUMO

PURPOSE: High animal protein intake is a risk factor for nephrolithiasis. Whether plant based sources of protein are associated with kidney stone risk is not well studied. We examined the association of animal and plant protein intake with the risk of incident kidney stones in Shanghai, China. MATERIALS AND METHODS: Dietary intakes were obtained from a validated food frequency questionnaire at baseline. Self-reported stone events were ascertained at baseline and at followup visits. Multivariable Cox regression models were used to evaluate the associations of protein intake with the incident stone risk. RESULTS: During 319,211 and 696,950 person-years of followup 1,451 men and 1,202 women, respectively, reported incident stones. The average ± SD intake of animal and plant protein standardized to 2,000 kcal was 31.3 ± 13.7 and 48.4 ± 7.2 gm per day in women, and 30.8 ± 13.3 and 51.3 ± 7.6 gm per day, respectively, in men. On multivariable analysis participants in the highest quintiles of animal and nondairy animal protein intake showed an increased risk of incident stones compared to those in the lowest quintiles (HR 1.16, 95% CI 1.01-1.32, p=0.03 vs HR 1.14, 95% CI 1.01-1.30, p=0.04). Compared to the lowest quintile the highest intake quintiles of the animal-to-plant protein ratios and the nondairy animal-to-plant protein ratios were positively associated with stone risk (HR 1.17, 95% CI 1.03-1.33, p=0.02 and HR 1.20, 95% CI 1.06-1.36, p=0.005, respectively). No association was observed with plant protein intake (ptrend=0.14). CONCLUSIONS: In this population with a relatively low animal protein intake and a high plant protein intake, a greater animal protein intake was associated with a kidney stone risk. Increasing the proportion of plant protein relative to animal protein appeared protective against the risk.


Assuntos
Proteínas na Dieta/administração & dosagem , Comportamento Alimentar , Cálculos Renais/epidemiologia , Adulto , Idoso , China/epidemiologia , Proteínas na Dieta/efeitos adversos , Feminino , Humanos , Incidência , Cálculos Renais/etiologia , Cálculos Renais/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Autorrelato/estatística & dados numéricos
14.
J Endourol ; 33(11): 954-959, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31436119

RESUMO

Purpose: There has been an increase in the number of staghorn calculi that form in the absence of infection (metabolic staghorns). It is unknown why some large metabolic calculi form as solitary or multiple separate, nonbranching caliceal stones, whereas others develop as staghorn stones forming a cast of the collecting system. We sought to compare these two groups of metabolic stone formers (SFs) in an attempt to shed light on these disparate stone-forming phenomena. Materials and Methods: From January 2017 to September 2018, 190 patients underwent percutaneous nephrolithotomy for stones >2 cm. We identified 86 (45%) patients with a metabolic stone, defined as ≥80% calcium oxalate monohydrate or dihydrate and/or calcium phosphate. Exclusion criteria included stones composed of cystine, >20% uric acid, or any infectious element (struvite or carbonate apatite). Metabolic staghorn and nonstaghorn SFs were compared with respect to medical comorbidity, 24-hour urine parameters, stone and urine microbiology, stone compositions, and intraoperative findings. Statistical differences were assessed using chi-square analysis, Fisher's exact test, and Student's t-test. Results: In total, 25 (29%) staghorn and 61 (71%) nonstaghorn SFs were included for analysis. The groups were statistically similar in age, sex, body mass index, and medical comorbidity. Staghorn SFs had larger stone burdens (p < 0.0001), but did not require more punctures (p = 0.783). Staghorn SFs were more likely to have hyperoxaluria (p = 0.041) and higher mean 24-urine oxalate levels (p = 0.040). There were no other significant differences in 24-hour urine profiles, rates of metabolic abnormalities, stone compositions, stone or urine cultures, presence of collecting system obstruction, or pelvicaliceal anatomy. Conclusions: Although potentially driven by urinary oxalate, whether a metabolic stone will form into a staghorn configuration or not does not appear significantly influenced by standard determinants of stone development, including metabolic profile, cultures, hydronephrosis, and pelvicaliceal anatomy, among others. Further work is needed to elucidate the physicochemical factors that govern the pathogenesis of this increasingly prevalent entity.


Assuntos
Hiperoxalúria/epidemiologia , Cálculos Renais/epidemiologia , Cálculos Coraliformes/epidemiologia , Adulto , Idoso , Oxalato de Cálcio/química , Fosfatos de Cálcio/química , Estudos de Casos e Controles , Feminino , Humanos , Cálculos Renais/química , Cálculos Renais/cirurgia , Cálculos Renais/urina , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea , Punções , Fatores de Risco , Cálculos Coraliformes/química , Cálculos Coraliformes/cirurgia , Cálculos Coraliformes/urina , Ácido Úrico/análise , Ácido Úrico/química
15.
BMC Nephrol ; 20(1): 273, 2019 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324154

RESUMO

BACKGROUND: A study to evaluate the prevalence of uric acid (UA) nephrolithiasis with dual-energy CT (DECT) and explore the risk factors for kidney stones in primary gout patients. METHODS: Eighty-four consecutive gout patients underwent urinary tract ultrasonography or DECT to confirm the existence of kidney stones. Urine and blood samples were also taken for laboratory analysis. RESULTS: Forty-one subjects (48.8%) had nephrolithiasis diagnosed; 38 had a kidney stone. Thirty-two of the 38 patients underwent a DECT scan, and 27 patients had nephrolithiasis in DECT. Among them, 63.0% (17/27) and 14.8% (4/21) of the patients had pure UA and UA-based mixed stone, respectively, and 22.2% (6/27) had a non-UA stone. Those with nephrolithiasis suffered from more frequent acute attacks and had longer disease durations of gout. At least one urine biochemical abnormality was found in 81% of patients. Forty-four (55.0%) patients presented hypomagnesuria. Forty-three (51.8%) patients had low urine volume. Unduly acidic urine (UAU) was present in 36 patients (44.4%). Hyperuricosuria was only found in ten (12.2%) patients. In comparison to the non-lithiasic group, the lithiasic group was more likely to have a UAU. Binary logistic regression showed that female gender was a protective factor, while disease duration of gout and low urine pH were risk factors for nephrolithiasis. CONCLUSION: Our results indicated that nephrolithiasis, especially UA stones, were more common than previous reports in gout patients indicated, and that disease duration of gout, and low urine pH, were risk factors for nephrolithiasis.


Assuntos
Cálculos Renais/química , Cálculos Renais/epidemiologia , Tomografia Computadorizada por Raios X , Ácido Úrico/análise , Adulto , Idoso , China , Feminino , Gota/complicações , Humanos , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/etiologia , Masculino , Pessoa de Meia-Idade , Nefrolitíase/diagnóstico por imagem , Nefrolitíase/epidemiologia , Nefrolitíase/etiologia , Prevalência , Tomografia Computadorizada por Raios X/métodos
16.
Microb Pathog ; 135: 103647, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31356929

RESUMO

K. pneumoniae termed as classical K. pneumoniae (cKP) and hypervirulent K. pneumoniae (hvKP) have significant role in pathogenicity of complicated UTI (cUTI). hvKP has not been ever reported from Pakistan. This study aimed to determine the prevalence of hvKP among kidney stone patients and their association with cUTI. Total 121 urine samples were collected from two tertiary care hospitals (Poly Clinic and Pakistan Institute of Medical Sciences hospital, Islamabad). From 43.5% (53) kidney stone patients, 61 isolates of K. pneumoniae (cKP 43, hvKP 18) were confirmed through standard microbiological and biochemical characterization methods. K. pneumoniae prevalence in kidney stone patients with cUTI was 67.6% (48) (hvKP 25%, cKP 75%). All K. pneumoniae isolates were strong biofilm formers. Age was important in development of cUTI in patients of age group 31-50 years in which biofilm formation and bactericidal activity of K. pneumoniae was significant with P = 0.017 and P = 0.05 respectively. Antibiotic susceptibility was tested and 20 (33%) isolates showed Multi-drug resistance (MDR). hvKP isolated from cUTI, showed comparatively enhanced virulence attributes with multidrug resistance, suggesting their role in development of cUTI in kidney stone patients, hence there is need for whenever prescribing antimicrobial therapy in these patients, hvKP should also be focused.


Assuntos
Cálculos Renais/epidemiologia , Cálculos Renais/etiologia , Infecções por Klebsiella/complicações , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/genética , Adulto , Antibacterianos , Biofilmes/crescimento & desenvolvimento , Farmacorresistência Bacteriana , Feminino , Humanos , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Paquistão/epidemiologia , Prevalência , Virulência
17.
J Am Coll Radiol ; 16(11): 1547-1553, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31220447

RESUMO

PURPOSE: The aim of this study was to examine changing characteristics of utilization and potential disparities in US emergency department (ED) patients undergoing CT of the abdomen and pelvis (CTAP) for suspected urolithiasis. METHODS: A retrospective study was conducted among all patients from 2006 to 2015 with a primary diagnosis of suspected urolithiasis within the Nationwide Emergency Department Sample, the largest publicly available all-payer ED database in the United States. The annual numbers of ED visits for suspected urolithiasis and associated CTAP examinations per visit were determined. The compound annual growth rate for CTAP was calculated. Using multivariate logistic regression analyses, patient demographics and payer and hospital characteristics were evaluated as potential independent predictors of utilization. RESULTS: Nationwide, the number of ED visits per year for suspected urolithiasis increased from 1,057,119 in 2006 to 1,246,041 in 2014 (relative +17.9%), whereas the annual use of CTAP increased from 24.6% to 49.4% per visit (relative +100.8%; CAGR +8.0%). Multivariate analysis showed higher CTAP use associated with higher patient household income ZIP code quartile (odds ratio [OR] for wealthiest/poorest, 1.48), private payer (ORs, 1.21 versus Medicare and 1.22 versus Medicaid), Northeast geographic region (ORs, 5.07 versus Midwest, 4.16 versus West, and 1.77 versus South), hospital urban status (OR, 1.42), and nonteaching hospitals (OR, 1.20) (P < .05 for all). CONCLUSIONS: The relative use of CTAP in ED patients presenting with suspected urolithiasis doubled between 2006 and 2014 and showed marked geographic variation. Among ED patients with suspected urolithiasis, CTAP was more frequent in patients from higher household income ZIP codes, with private insurance, in the Northeast, and at urban and nonteaching hospitals.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , Cálculos Renais/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Urolitíase/diagnóstico por imagem , Abdome/diagnóstico por imagem , Estudos de Coortes , Bases de Dados Factuais , Feminino , Geografia , Humanos , Incidência , Renda , Cobertura do Seguro/economia , Cálculos Renais/epidemiologia , Masculino , Análise Multivariada , Pelve/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Estados Unidos , Urolitíase/epidemiologia
18.
J Pediatr Urol ; 15(5): 467.e1-467.e7, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31235439

RESUMO

INTRODUCTION: Asymptomatic, or incidental, pediatric kidney stones detected on abdominal imaging pose a clinical challenge as their significance and expected outcome are not well described. OBJECTIVE: Our primary objective was to estimate the incidence of nephrolithiasis in pediatric patients undergoing abdominal ultrasound (US) or computerized tomography (CT), for all indications, in a pediatric tertiary care hospital. Our secondary objective was to determine the clinical outcome of these radiographically detected stones. METHODS: All abdominal US or CT radiology reports for patients younger than 18 years between January 1, 2011, and December 31, 2016, were retrieved. Reports were automatically flagged using textual analysis if they contained one of the 32 keywords potentially indicating nephrolithiasis. Flagged reports, as well as 10% of unflagged reports, were reviewed to confirm the radiologist impression of presence or absence of stones. Patient and stone-related clinical data were extracted. RESULTS: Two thousand four hundred forty-nine (5%) of 53 235 imaging reports cited at least one of the keywords. Manual review of flagged reports identified 498 studies having a radiologist impression of stones (244 unique patients). Stone incidence in children undergoing abdominal imaging more than doubled between 2011 and 2016. Medical record review found that 140 patients (57%) were symptomatic, while the other 104 patients (43%) were asymptomatic. Spontaneous resolution was greater (57% vs 34%) in asymptomatic patients compared to symptomatic patients. Asymptomatic patients were younger with a median age of 0.6 compared to 12.3 years. Asymptomatic and symptomatic stones were followed up for similar lengths of time (2.3 vs 2.0 years, p > 0.05) and had a similar number of follow-up USs (3.9 vs 4.6 studies, p > 0.05). CONCLUSIONS: The incidence of radiologically identified stones in children undergoing abdominal imaging at our center increased over time. Asymptomatic stones follow a benign course with minimal need for intervention; however, they were detected almost as frequently as symptomatic stones. Asymptomatic stones may represent increased healthcare resource utilization due to similar follow-up compared to symptomatic stones. Further research regarding the optimal imaging intervals and long-term follow-up for asymptomatic stones is warranted.


Assuntos
Cálculos Renais/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Adolescente , Doenças Assintomáticas , Canadá/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Cálculos Renais/epidemiologia , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos
19.
BJU Int ; 124(3): 514-521, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31140706

RESUMO

OBJECTIVES: To measure and analyse various factors affecting radiation exposure (RE) to surgeons during percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: A total of 212 patients who underwent PCNL were analysed. Informed consent was obtained from all enrolled patients. Ultrasonography/fluoroscopy guided punctures were done. The tract was dilatated and sheath placement done after which the procedure was completed in a routine fashion. A JJ or ureteric catheter or percutaneous nephrostomy (PCN) tube was placed as per the merit of the case. A digitalised mobile surgical C-arm image-intensifier system was used in all cases. RE was determined using a pen dosimeter worn outside the lead apron of the surgeon at the level of the chest for uniformity and was recorded on a per case basis at the end of the procedure. Data were recorded for analysis with respect to relevant parameters. Multivariate regression analysis was used to identify various parameters which affect RE (mSv). RESULTS: The parameters analysed included: age, number and size of stones, body mass index (BMI) of patients, Hounsfield unit of stone (HU), degree of hydronephrosis, number of tracts, mode of access to pelvicalyceal system (PCS), sheath size (F), operative time (min), placement of a JJ or ureteric catheter or PCN tube, and kV used for exposure. There was a significant statistical relationship between stone volume (P < 0.001), number of tracts (P < 0.001), mode of access to PCS (P = 0.001), and sheath size (P = 0.002), with RE. The HU had a negative relationship, with a decrease in HU causing increased RE (P = 0.002). BMI, number of stones, degree of hydronephrosis, operative time and placement of a JJ or ureteric catheter or PCN tube did not have any correlation with RE in our study. CONCLUSION: The mean (SD) RE per procedure was 0.21 (0.11) mSv. Increasing size and low HU of stone, increasing number of tracts, fluoroscopic access to PCS, increasing sheath size and kV were found to increase RE. Although the exposure levels are within safety limits, serial monitoring and constant vigilance are mandatory to inform surgeons.


Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Exposição à Radiação , Adulto , Feminino , Humanos , Cálculos Renais/epidemiologia , Cálculos Renais/patologia , Cálculos Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Nefrolitotomia Percutânea/estatística & dados numéricos , Estudos Prospectivos , Exposição à Radiação/análise , Exposição à Radiação/estatística & dados numéricos
20.
Nutrients ; 11(5)2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31137803

RESUMO

Kidney stone disease should be viewed as a systemic disorder, associated with or predictive of hypertension, insulin resistance, chronic kidney disease and cardiovascular damage. Dietary and lifestyle changes represent an important strategy for the prevention of kidney stone recurrences and cardiovascular damage. A full screening of risk factors for kidney stones and for cardiovascular damage should be recommended in all cases of calcium kidney stone disease, yet it is rarely performed outside of stone specialist clinics. Many patients have a history of kidney stone disease while lacking a satisfactory metabolic profile. Nonetheless, in a real-world clinical practice a rational management of kidney stone patients is still possible. Different scenarios, with different types of dietary approaches based on diagnosis accuracy level can be envisaged. The aim of this review is to give patient-tailored dietary suggestions whatever the level of clinical and biochemistry evaluation. This can help to deliver a useful recommendation, while avoiding excessive dietary restrictions especially when they are not based on a specific diagnosis, and therefore potentially useless or even harmful. We focused our attention on calcium stones and the different scenarios we may find in the daily clinical practice, including the case of patients who reported renal colic episodes and/or passed stones with no information on stone composition, urinary risk factors or metabolic cardiovascular risk factors; or the case of patients with partial and incomplete information; or the case of patients with full information on stone composition, urinary risk factors and metabolic cardiovascular profile.


Assuntos
Bebidas , Cálcio na Dieta/administração & dosagem , Dieta Saudável , Ingestão de Líquidos , Exercício Físico , Cálculos Renais/prevenção & controle , Comportamento de Redução do Risco , Bebidas/efeitos adversos , Cálcio na Dieta/efeitos adversos , Cálcio na Dieta/metabolismo , Humanos , Cálculos Renais/epidemiologia , Cálculos Renais/metabolismo , Fatores de Proteção , Medição de Risco , Fatores de Risco
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