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1.
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
2.
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
3.
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
4.
Urology ; 131: 57-63, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31132427

RESUMO

OBJECTIVE: To determine social factors associated with advanced stone disease (defined as unilateral stone burden >2 cm) at time of presentation to a regional stone referral center. Little is known about social determinants of urolithiasis. We hypothesize that socioeconomic factors impact kidney stone severity at intake to referral centers. METHODS: A retrospective review of the prospectively collected data from the Registry for Stones of the Kidney and Ureter from 2015 to 2018 was conducted to evaluate patient characteristics predictive of having a large (>2 cm) unilateral kidney stone. Data on patient age, gender, body mass index, diabetes, race, language, education level, infection, distance, income, referring regional urologist density, American Society of Anesthesiologists score, and stone analysis were evaluated. RESULTS: Complete imaging and patient variable data was present in 650 of 1142 patients including 197 patients with unilateral stone burden >2 cm. On multivariate analysis, obesity, lower education level, increased distance from the referral center, and symptoms of infection predicted for unilateral stone burden greater than 2 cm. Among 191 patients with stone analysis data present, stone type, income, and urologist density predicted for unilateral stone burden greater than 2 cm. CONCLUSION: In addition to known biological risk factors, patients with lower education levels and from regions of lower mean income were found to be more likely to present to our tertiary care center with stone burden greater than 2 cm. More research is needed to elucidate the social and societal determinants of advanced stone disease and the impact this has on population costs for stone treatment.


Assuntos
Cálculos Renais/epidemiologia , Cálculos Renais/patologia , Cálculos Ureterais/epidemiologia , Cálculos Ureterais/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Fatores Socioeconômicos , Centros de Atenção Terciária , Estados Unidos , Adulto Jovem
5.
Scand J Urol ; 53(2-3): 139-144, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31070078

RESUMO

Objectives: The aim of this study was to investigate frequencies of kidney stone constituents in a Norwegian population and examine trends over time by comparing with an earlier study of this population. Materials and methods: Upper urinary tract calculi consecutively collected from patients who underwent stone surgery at Akershus University Hospital from July 2014 to December 2017, in total 1252 calculi, were analysed by infrared spectroscopy. The results were compared with a study of 500 calculi collected from June 1975 to September 1980 at the same hospital. Results: The male:female ratio was 1.83:1. Single-component stones constituted 39%, 35% were binary, and 25% ternary. Main stone component frequencies were oxalate 71.3%, calcium oxalate monohydrate 53.7% with higher occurrence in males, calcium oxalate dihydrate 17.6%, carbonate apatite 10.8% and struvite 5.7%, both with higher occurrence in females, uric acid 8.9% with a non-significant male predominance, brushite 1.6% and cystine about 1%. Over four decades the frequency of UA stones increased by 4.6-times, whereas struvite and pure carbonate apatite stones decreased and no change was observed for brushite stones. Conclusion: Frequencies of kidney stone types in this Norwegian population are mainly in accordance with other studies, except a large increase in UA stones over four decades, partly caused by a particularly low frequency of UA stones in the old study, a decreased carbonate apatite frequency over four decades, and an unaltered brushite frequency. Also, in contrast to other studies, a relatively small and non-significant male UA stone predominance was found.


Assuntos
Apatitas , Oxalato de Cálcio , Cálculos Renais/química , Estruvita , Ácido Úrico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Cálculos Renais/epidemiologia , Cálculos Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea , Noruega/epidemiologia , Distribuição por Sexo , Espectroscopia de Infravermelho com Transformada de Fourier , Ureteroscopia , Adulto Jovem
6.
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 , Ingestão de Líquidos , Exercício , 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
7.
Urol Clin North Am ; 46(2): 303-313, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30961862

RESUMO

Diagnosis, treatment, and follow-up are all influential in determining the overall cost to the health care system for kidney stones. New innovations in the field of nephrolithiasis have been abundant, including disposable ureteroscopes, ultrasound-guided approaches to percutaneous nephrolithotomy, and advanced laser lithotripters. Identifying cost-effective treatment strategies encourages practitioners to be thoughtful about providing value-based high-quality care and remains on important principle in the treatment of urinary stone disease.


Assuntos
Análise Custo-Benefício , Cálculos Renais/economia , Cálculos Renais/cirurgia , Efeitos Psicossociais da Doença , Assistência à Saúde/economia , Diagnóstico por Imagem/economia , Equipamentos Descartáveis/economia , Custos de Cuidados de Saúde , Humanos , Invenções/economia , Cálculos Renais/epidemiologia , Cálculos Renais/prevenção & controle , Terapia a Laser/economia , Terapia a Laser/instrumentação , Litotripsia/economia , Nefrolitíase/economia , Nefrolitíase/epidemiologia , Nefrolitíase/prevenção & controle , Nefrolitíase/cirurgia , Nefrolitotomia Percutânea/economia , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Fibras Ópticas/economia , Ureteroscopia/economia , Ureteroscopia/instrumentação
8.
Neuropediatrics ; 50(3): 160-163, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30939600

RESUMO

PURPOSE: This study was aimed to assess the accurate incidence of renal stones in severely disabled children treated with topiramate (TPM). METHOD: We reviewed the medical records of severely disabled children with epilepsy under 15 years old who underwent radiological examinations to investigate urinary stones. The study enrolled 26 patients who were divided into two groups. One group had been treated with TPM for at least 1 year and the other had not been treated with TPM, zonisamide, acetazolamide, or other diuretic drugs. We collected parameters from the medical records and compared the groups. RESULTS: All participants were evaluated radiologically, with computed tomography (CT) in two patients, ultrasonography in 22 patients, and both in two. No patient had any morphological abnormality of the kidneys and history of urinary tract infection. There were no significant differences in sex, age, body weight, or feeding manner between the groups, while the incidence of renal stones or calcifications was significantly higher in the TPM-treated group (60 vs. 0%; p = 0.00241). CONCLUSION: There is a high incidence of renal stone formation in severely disabled children treated with TPM.


Assuntos
Anticonvulsivantes/efeitos adversos , Crianças com Deficiência , Epilepsia/tratamento farmacológico , Cálculos Renais/induzido quimicamente , Índice de Gravidade de Doença , Topiramato/efeitos adversos , Adolescente , Criança , Pré-Escolar , Epilepsia/diagnóstico , Epilepsia/epidemiologia , Feminino , Humanos , Incidência , Cálculos Renais/diagnóstico , Cálculos Renais/epidemiologia , Masculino , Estudos Retrospectivos
9.
Iran J Kidney Dis ; 13(1): 21-26, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30851715

RESUMO

INTRODUCTION: The frequency of kidney disorders varies in pulmonary sarcoidosis patients. Since the prevalence of kidney disorders among Iranian sarcoidosis patients is uncertain, this study aimed to evaluate kidney disorders and associated manifestations in Iranian pulmonary sarcoidosis patients. MATERIALS AND METHODS: One hundred patients with confirmed granuloma as pulmonary sarcoidosis were studied for renal disorders. Size of urinary tract and the presence of renal stones were checked via clinical examination and urinary organ ultrasonography. Patients' 24-hour urine sample was examined for pH, calcium, protein (over 250 mg) and creatinine (over 1.4 mg). RESULTS: Thirty-three percent of the patients expressed renal disorders simultaneously.Uric acid in pulmonary sarcoidosis patients could be correlated with the probability of developing renal stone. In addition, 1,25-dihydroxyvitamin D levels above 30 ng/mL and uric acid levels above 7 mg/dL in urine were directly correlated with renal disorders in sarcoidosis patients. CONCLUSIONS: Urinalysis is an easy and reliable method for assessing renal disorders in sarcoidosis patients. The current study proposes inclusion of urinalysis in routine checkups of sarcoidosis individuals.


Assuntos
Cálculos Renais/diagnóstico , Sarcoidose Pulmonar/complicações , Urinálise , Adolescente , Adulto , Idoso , Colecalciferol/análise , Creatinina/análise , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Cálculos Renais/epidemiologia , Masculino , Pessoa de Meia-Idade , Ácido Úrico/análise , Adulto Jovem
10.
Clin Nephrol ; 91(4): 231-236, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30862351

RESUMO

OBJECTIVE: To characterize opioid utilization among those with nephrolithiasis in a national cohort. MATERIALS AND METHODS: We performed cross sectional analysis of participants in the Medical Expenditure Panel Surveys during 2008 - 2014. Sample weights were employed for analysis of complex survey design. Those reporting occurrence of "renal or ureteral calculus" during the survey period represented the cohort of stone formers (SFs). Receipt of opioid prescription as well as total number of opioid prescriptions filled over study period were noted. RESULTS: Of 65,397 adult participants - weighted to represent 209,043,539 - 1.29% reported occurrence of nephrolithiasis. SFs were older, had higher BMI, and higher likelihood of depression and anxiety. Compared with those without nephrolithiasis, SFs had higher prevalence of opioid use (59.5 vs. 20.2%, p < 0.0001). On multivariate analysis, the odds of receiving an opioid prescription were increased greater than 5 times in SFs compared with those without stones (OR 5.61, 95% CI 4.59 - 6.85). Assessing each individual's total number of opioid prescriptions revealed SFs had a greater mean number of opioid prescriptions filled than those without nephrolithiasis (2.53 vs. 0.97, p < 0.001). Among SFs receiving opioids, depression and anxiety were both associated with a significantly greater number of opioid prescriptions (6.80 vs. 3.66, p < 0.001; and 8.91 vs. 3.38, p = 0.008, respectively). CONCLUSION: A majority of those with renal stone occurrence receive prescription opioids. Of particular note, the presence of either depression or anxiety is associated with larger total number of opioid prescriptions over the study period.
.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Cálculos Renais/epidemiologia , Cálculos Ureterais/epidemiologia , Adulto , Ansiedade/epidemiologia , Estudos de Coortes , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos/epidemiologia
11.
Prog Urol ; 29(3): 166-172, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30704916

RESUMO

INTRODUCTION: The aim of this study was to determine the prevalence of anatomic variations (renal, vascular and urological) and acquired renal pathologies in living kidney donor candidates (LKDC). METHODS: This is a retrospective study of all LKDC referred to our center between April 2003 and September 2014. Of the 491 LKDC, 189 were initially excluded for medical reasons (n=140) or others reasons (n=49), without undergoing a radiological assessment. In total, 302 had a radiological assessment (angio-CT or MRI) in anticipation of the donation and 226/302 (73.5%) could donate a kidney. RESULTS: One or more anatomical variations and/or acquired abnormalities were observed in 178/302 (58.9%) of the LKDC. The most frequent were arterial variations or abnormalities (multiple arteries, fibrodysplasia, aneurysms, stenosis≥70%) which where observed in 39.3% of the LKDC, followed by the venous abnormalities (27.8%). Kidney stones were observed in 5.6% of the LKDC and the urinary abnormalities (duplication/ureteral bifidity) were found in 3% of the LKDC. No malignant tumour was diagnosed, while 4 benign tumours (1.3%) were identified, and one of them required additional investigations. CONCLUSION: We found a high prevalence of anatomical variations and acquired abnormalities in a population of LKDC. However, these findings resulted in the exclusion of only 4% of the candidates, because they did not contraindicate the donation or, in most of cases, the contralateral kidney could be used. LEVEL OF EVIDENCE: 3.


Assuntos
Seleção do Doador/métodos , Transplante de Rim/métodos , Rim/patologia , Doadores Vivos/estatística & dados numéricos , Humanos , Rim/anormalidades , Cálculos Renais/epidemiologia , Estudos Retrospectivos
12.
Nutrients ; 11(2)2019 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-30678344

RESUMO

Green tea is widely used as a ''healthy'' beverage due to its high level of antioxidant polyphenol compounds. However tea is also known to contain significant amount of oxalate. The objective was to determine, in a cross-sectional observational study among a population of 273 hypercalciuric stone-formers referred to our center for metabolic evaluation, whether daily green tea drinkers (n = 41) experienced increased stone risk factors (especially for oxalate) compared to non-drinkers. Stone risk factors and stone composition were analyzed according to green tea status and sex. In 24-h urine collection, the comparison between green tea drinkers and non-drinkers showed no difference for stone risk factors such as urine oxalate, calcium, urate, citrate, and pH. In females, the prevalence of calcium oxalate dihydrate (COD) and calcium phosphate stones, assessed by infrared analysis (IRS) was similar between green tea drinkers and non-drinkers, whereas prevalence of calcium oxalate monohydrate (COM) stones was strikingly decreased in green tea drinkers (0% vs. 42%, p = 0.04), with data in accordance with a decreased oxalate supersaturation index. In males, stone composition and supersaturation indexes were similar between the two groups. Our data show no evidence for increased stone risk factors or oxalate-dependent stones in daily green tea drinkers.


Assuntos
Dieta/estatística & dados numéricos , Cálculos Renais/epidemiologia , Chá , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ácido Cítrico/urina , Estudos Transversais , Feminino , Humanos , Concentração de Íons de Hidrogênio , Cálculos Renais/urina , Masculino , Pessoa de Meia-Idade , Oxalatos/urina , Fatores de Risco , Ácido Úrico/urina , Urinálise , Adulto Jovem
13.
Int Urol Nephrol ; 51(2): 239-245, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30604235

RESUMO

PURPOSE: We investigated the clinical efficacy of the Triple D score (TrD-S) on stone-free rate (SFR) prediction following shockwave lithotripsy (SWL) for renal stones 10-20 mm in diameter and modified the scoring system to improve outcome prediction. METHODS: We retrospectively examined clinical data from the medical records of 226 consecutive patients who underwent SWL for 10-20 mm kidney stones. The TrD-S was calculated according to the cutoffs of < 150 mm3 for stone volume, < 600 Hounsfield unit for stone density, and < 12 cm for skin-to-stone distance on computed tomography. The Quadruple D score was defined as the sum of the TrD-S and stone location (0/1 point for intrarenal stone distribution at lower/non-lower poles, respectively). Complete clearance 3 months after the final SWL was considered the stone-free status. RESULTS: The residual group (n = 102) had significantly older age, larger stones, higher stone density, higher lower-pole stone incidence, and lower TrD-S than the stone-free group (n = 124). In the multivariate analysis, age, TrD-S, and non-lower-pole stones independently predicted the SFR. The TrD-Ss of 0, 1, 2, and 3 points showed SFRs of 40.0%, 51.9%, 73.0%, and 100.0%, respectively. The Quadruple D scores of 0, 1, 2, 3, and 4 points showed SFRs of 0.0%, 37.9%, 54.5%, 84.4%, and 100.0%, respectively, with better prediction accuracy than the TrD-S (p = 0.01). CONCLUSIONS: The TrD-S is successfully validated for use in Japanese patients with 10-20-mm renal stones. Simple addition of the stone location to the TrD-S could reinforce SFR prediction after SWL.


Assuntos
Cálculos Renais , Rim/diagnóstico por imagem , Litotripsia , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Japão/epidemiologia , Cálculos Renais/diagnóstico , Cálculos Renais/epidemiologia , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Projetos de Pesquisa , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
15.
Urolithiasis ; 47(2): 165-170, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29696300

RESUMO

There is a lack of studies looking at the longitudinal follow-up of patients with cystine stones. We wanted to assess the journey of cystinuric patients through our specialist metabolic stone clinic to improve the understanding of episodes, interventions and current outcomes in this patient cohort. After ethical approval, all patients who attended our metabolic stone clinic from 1994 to 2014 with at least one cystine stone episode were included in our study. Data were retrospectively analysed for patient demographics, stone episodes or intervention, clinical parameters and patient compliance. Over a period of 21 years, 16 patients with a median age of 15.5 years underwent a mean follow-up of 8.6 years (1-21 years). The mean number of surgical interventions was 3.1 (1-8/patient), but patients who were stone free after their first treatment had lower recurrences (p = 0.91) and lower number of interventions during their follow-up (2.7/patient, compared to those who were not stone free at 4/patient). During their follow-up period, patients with < 3 interventions had a significantly better renal function than those with ≥ 3 surgical interventions (p = 0.04). Additionally, linear regression analysis showed that eGFR was demonstrated to decline with increasing numbers of stone episodes (r2 = 0.169). It was also noted that patients who began early medical management remained stone free during follow-up compared to those who had medical management after ≥ 2 stone episodes, of whom all had a recurrent episode. Our long-term longitudinal study of cystine stone formers highlights that patients who are stone free and receive early metabolic stone screening and medical management after their initial presentation have the lowest recurrence rates and tend to preserve their renal function. Hence, prompt referral for metabolic assessment, and the stone and fragments entirely removed (SaFER) principles are key to preventing stone episodes and improving long-term function.


Assuntos
Cistinúria/metabolismo , Cálculos Renais/cirurgia , Litotripsia/estatística & dados numéricos , Nefrolitotomia Percutânea/estatística & dados numéricos , Ureteroscopia/estatística & dados numéricos , Adolescente , Adulto , Criança , Cistinúria/urina , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Cálculos Renais/epidemiologia , Cálculos Renais/metabolismo , Cálculos Renais/urina , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
16.
Ann Clin Biochem ; 56(1): 15-27, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29792045

RESUMO

Renal stone disease is a worldwide problem which carries significant morbidity. It frequently requires specialist urology intervention. Patients with recurrent disease and those at high risk require specialist investigations and review. Certain cases benefit from medical and surgical intervention. In this review, we discuss the pathophysiology, risk assessment, specialist investigations and various interventions, their rationale and evidence base. This review aims to provide an update of the previous publication in 2001 in this journal on this topic.


Assuntos
Cálculos Renais , Cálcio/metabolismo , Humanos , Cálculos Renais/epidemiologia , Cálculos Renais/fisiopatologia , Cálculos Renais/terapia , Fatores de Risco , Ácido Úrico/metabolismo
17.
Urology ; 124: 57-61, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29421299

RESUMO

OBJECTIVE: To determine whether statin intake affects nephrolithiasis risk, and whether higher lipid levels correlate with stone risk. Dyslipidemia is a known independent risk factor for urolithiasis, and emerging evidence suggests common biological pathways. Previous work has suggested that statins protect against new stone formation, but these findings have not been verified by other investigators. METHODS: We queried our Institution's Electronic Data Warehouse for all patients who were newly diagnosed with hyperlipidemia between 2009 and 2011, and had never taken a statin drug. These patients' clinical outcomes were followed until 2015, to assess whether they had been newly prescribed statins and whether they had developed symptomatic urolithiasis. Patient demographics, stone risk factors, prescription data, and serum lipid values were collected. RESULTS: A total of 101,259 patients met inclusion criteria, 47.8% of whom received a statin prescription during the study period. Patients prescribed statins were significantly older, had a greater likelihood of osteoporosis, hemiplegia, immobility, and more likely to take a thiazide diuretic. Patients without a history of urolithiasis who were started on statin therapy were significantly less likely to develop new stones than patients not taking statins. This protective effect was even greater in patients with a history of stone disease. Lipid parameters (low-density lipoprotein, triglyceride, cholesterol) were lower in the statin-treated group, suggesting overall compliance with these medications. CONCLUSION: Our data confirm previous work that statins protect against urinary stone formation; however, the underlying mechanism seems to be distinct from statins' lipid-lowering effect.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Cálculos Renais/prevenção & controle , Feminino , Seguimentos , Humanos , Hiperlipidemias/complicações , Cálculos Renais/epidemiologia , Cálculos Renais/etiologia , Masculino , Pessoa de Meia-Idade , Medição de Risco
18.
Int Urol Nephrol ; 51(2): 279-284, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30515733

RESUMO

PURPOSE: Magnesium plays numerous vital roles in human's body. It is known as a protective factor in stone formation by binding to oxalate in the intestinal and urinary system, and decreasing its absorption and crystallization, respectively. Due to controversies about the association between the 24-h urine magnesium and other urine metabolites in different studies, this study was designed to find a clear answer to this question. METHODS: In this retrospective cross-sectional study, data from 24-h urinalysis of the calcium stone-forming (CSF) patients were assessed. The correlation between 24-h urine (24-U) magnesium to creatinine ratio (Mg/Cr) with other 24-U metabolites to creatinine ratio was assessed, using Spearman correlation test. The association between 24-U magnesium and 24-U oxalate was also studied in a multivariate logistic regression model. RESULTS: Among 965 patients, the level of Mg/Cr showed a direct association with all other 24-U metabolite to Cr ratio (p-value < 0.001 for all analyses). The result of multivariate regression analysis showed that the higher quartile of 24-U oxalate (> 47 mg/24 h) increased the odds of 24-U magnesium more than 75 mg/24 h (data median) (OR 1.89, 95% CI 1.14-3.13) comparing with the lower quartile of 24-U oxalate (≤ 26 mg/24 h). CONCLUSIONS: In a routine dietary habit, since rich sources of magnesium contain a high amount of oxalate at the same time, it is not surprising that magnesium level in 24-h urinalysis showed a direct association with 24-h urine oxalate.


Assuntos
Cálcio , Cálculos Renais , Rim , Magnésio , Eliminação Renal , Adulto , Cálcio/metabolismo , Cálcio/urina , Correlação de Dados , Creatinina/análise , Estudos Transversais , Feminino , Humanos , Concentração de Íons de Hidrogênio , Irã (Geográfico)/epidemiologia , Rim/metabolismo , Rim/fisiopatologia , Cálculos Renais/química , Cálculos Renais/epidemiologia , Cálculos Renais/metabolismo , Cálculos Renais/urina , Magnésio/metabolismo , Magnésio/urina , Masculino , Pessoa de Meia-Idade , Oxalatos/metabolismo , Oxalatos/urina , Estudos Retrospectivos , Urinálise/métodos
19.
Mayo Clin Proc ; 94(2): 202-210, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30527866

RESUMO

OBJECTIVE: To predict symptomatic recurrence among community stone formers with one or more previous stone episodes. PATIENTS AND METHODS: A random sample of incident symptomatic kidney stone formers in Olmsted County, Minnesota, was followed for all symptomatic stone episodes resulting in clinical care from January 1, 1984, through January 31, 2017. Clinical and radiographic characteristics at each stone episode predictive of subsequent episodes were identified. RESULTS: There were 3364 incident kidney stone formers with 4951 episodes. The stone recurrence rates per 100 person-years were 3.4 (95% CI, 3.2-3.7) after the first episode, 7.1 (95% CI, 6.4-7.9) after the second episode, 12.1 (95% CI, 10.3-13.9) after the third episode, and 17.6 (95% CI, 15.1-20.0) after the fourth or higher episode (P<.001 for trend). A parsimonious model identified the following independent risk factors for recurrence: younger age; male sex; higher body mass index; family history of stones; pregnancy; incident asymptomatic stone on imaging before the first episode; suspected stone episode before the first episode; history of a brushite, struvite, or uric acid stone; no history of calcium oxalate monohydrate stone; kidney pelvic or lower pole stone on imaging; no ureterovesical junction stone on imaging; number of kidney stones on imaging; and diameter of the largest kidney stone on imaging. The model had a C-index corrected for optimism of 0.681 and was used to develop a prediction tool. The risk of recurrence in 5 years ranged from 0.9% to 94%, depending on risk factors, number of past episodes, and years since the last episode. CONCLUSION: The revised Recurrence Of Kidney Stone tool predicts the risk of symptomatic recurrence by using readily available clinical characteristics of stone formers.


Assuntos
Cálculos Renais/diagnóstico , Cálculos Renais/epidemiologia , Fatores Etários , Índice de Massa Corporal , Feminino , Seguimentos , Previsões , Humanos , Incidência , Masculino , Minnesota , Radiografia Abdominal , Recidiva , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Ultrassonografia , Urinálise , Urografia
20.
Int J Rheum Dis ; 22(4): 567-573, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30485677

RESUMO

OBJECTIVE: To clarify the clinical and laboratory characteristics of nephrolithiasis in gout by computed tomography (CT). METHODS: In 350 gout patients, unenhanced CT was performed at the 1st visit to hospital. Calculus density spots exceeding 1 mm in diameter with a CT value >120 Hounsfield units in the kidneys were defined as kidney stones. The association between laterality and the number of stones was investigated in each stone carrier. The 350 patients were classified into three groups (bilateral, unilateral and non-stone carriers). Then serum urate (Sua), renal function, uric acid metabolism, and the prevalence of metabolic syndrome (Mets) were compared among these groups by the Tukey-Kramer test or Fisher's exact test. RESULTS: Kidney stone(s) were detected in 108 (31%) of the 350 patients (bilateral in 58 and unilateral in 50). In 64 of the 108 patients (59%), there was no history of urolithiasis. Sua, serum creatinine and uric acid clearance were significantly higher (P = 0.001, P < 0.001, P = 0.043, respectively), while the estimated glomerular filtration rate was significantly lower (P = 0.039) in bilateral stone carriers than in non-stone carriers. No significant differences of uric acid metabolism or the prevalence of Mets were noted among the three groups. CONCLUSIONS: Approximately one-third of gout patients had kidney stones and more than half of the patients with stones were bilateral and multiple stone carriers. Elevation of Sua might increase the stone burden in gout, leading to more severe renal dysfunction. An association between nephrolithiasis and Mets was not demonstrated in gout patients.


Assuntos
Gota/sangue , Cálculos Renais/diagnóstico por imagem , Tomografia Computadorizada Espiral , Adulto , Idoso , Biomarcadores/sangue , Creatinina/sangue , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Gota/diagnóstico , Gota/epidemiologia , Gota/fisiopatologia , Humanos , Japão/epidemiologia , Rim/fisiopatologia , Cálculos Renais/sangue , Cálculos Renais/epidemiologia , Cálculos Renais/fisiopatologia , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Ácido Úrico/sangue
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