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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.
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 , Feminino , Humanos , Cálculos Renais/sangue , Masculino , Inquéritos Nutricionais
3.
Am J Clin Nutr ; 109(6): 1578-1587, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31005969

RESUMO

BACKGROUND: A growing number of randomized controlled trials (RCTs) are investigating the potential health benefits of high-dose vitamin D supplementation. However, there are limited RCT data on the safety of calcium-related adverse effects. OBJECTIVE: We investigated the incidence of kidney stone and hypercalcemia events in a large, population-based RCT of vitamin D supplementation. DESIGN: The Vitamin D Assessment (ViDA) study was a randomized, double-blind, placebo-controlled trial of vitamin D supplementation in 5110 participants in Auckland, New Zealand. This trial investigated the impact of monthly 100,000 IU vitamin D3 supplementation over several years on cardiovascular events, respiratory infections, and falls/fractures. Participants provided information about recent kidney stone events in regular questionnaires sent to them with study capsules. Hospitalization data for kidney stones were collected from health authorities. Serum calcium was measured in an 8% subsample of participants who returned annually for blood tests. HRs of time to the first kidney stone event were calculated by Cox regression. RESULTS: During a median follow-up of 3.3 y, 158 participants reported a kidney stone event (76 vitamin D, 82 placebo). The HR of reporting the first kidney stone event was 0.90 (95% CI: 0.66, 1.23; P = 0.51) for participants in the vitamin D arm compared with the placebo arm. There were 18 urolithiasis events in the hospitalization records: 7 in the vitamin D arm and 11 from the placebo arm. The HR to the first hospitalization urolithiasis event was 0.62 (95% CI: 0.24, 1.26; P = 0.30) in the vitamin D arm compared with the placebo arm. From the subsample annual blood test, there was no case of hypercalcemia in the vitamin D arm, compared with 1 in the placebo arm. CONCLUSION: Over a median of 3.3 y, monthly supplementation with 100,000 IU vitamin D3 did not affect the incidence rate of kidney stone events, or hypercalcemia. This study was registered at clinicaltrials.gov as ACTRN12611000402943.


Assuntos
Cálcio/sangue , Hipercalcemia/sangue , Cálculos Renais/sangue , Vitamina D/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Suplementos Nutricionais/análise , Feminino , Seguimentos , Humanos , Hipercalcemia/etiologia , Cálculos Renais/etiologia , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Vitamina D/efeitos adversos
4.
Int J Mol Med ; 43(4): 1611-1622, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30720053

RESUMO

Treatment targeting osteopontin (OPN) and monocyte chemoattractant protein 1 (MCP­1) has been recognized as a novel approach in renal crystal formation. The present study was designed to investigate the suppressive effects of metformin on nephrolithiasis formation and its potential mechanism. The cytotoxicity of metformin on MDCK and HK­2 cells was determined using a Cell Counting Kit­8 assay in vitro. Subsequently, the mRNA transcription and protein expression levels of MCP­1 and OPN were detected by reverse transcription­quantitative­polymerase chain reaction analysis, western blot analysis and ELISA. Male Sprague­Dawley rats were divided into a control group, ethylene glycol (EG) group and EG + metformin group. The expression levels of MCP­1 and OPN and crystal formations were evaluated in renal tissues following an 8­week treatment period. In vitro, metformin significantly inhibited the production of MCP­1 and OPN induced by oxalate at the mRNA and protein expression levels. In vivo, increased expression levels of MCP­1 and OPN were detected in the EG group compared with the controls, and this upregulation was reversed in the EG + metformin group. Renal crystal deposition in the EG + metformin group was markedly decreased compared with that in the EG group. Therefore, the results of the study suggest that metformin suppressed urinary crystal deposit formation, possibly by mediating the expression of inflammatory mediators OPN and MCP­1.


Assuntos
Quimiocina CCL2/metabolismo , Cálculos Renais/tratamento farmacológico , Cálculos Renais/prevenção & controle , Metformina/uso terapêutico , Osteopontina/metabolismo , Animais , Peso Corporal/efeitos dos fármacos , Morte Celular/efeitos dos fármacos , Quimiocina CCL2/genética , Modelos Animais de Doenças , Cães , Etilenoglicol , Humanos , Cálculos Renais/sangue , Cálculos Renais/urina , Células Madin Darby de Rim Canino , Masculino , Metformina/farmacologia , Osteopontina/genética , Oxalatos , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ratos Sprague-Dawley , Regulação para Cima/efeitos dos fármacos
5.
Urolithiasis ; 47(3): 255-261, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-29959478

RESUMO

Previous studies have suggested that ω-3 and ω-6 polyunsaturated fatty acid (PUFA) composition in plasma and red blood cell (RBC) total phospholipids plays a role in urolithiasis. Our aim was to test the robustness of this dogma by retrospectively comparing baseline profiles of these parameters in subjects from high- and low-stone-risk groups. The documented difference in stone occurrence in white (relatively common) (W) and black (rare) (B) subjects prompted us to select these groups as the high-low risk model for the study. Blood and urine samples were obtained from ten subjects in each group and were analysed for PUFAs and stone risk factors, respectively. Concentrations of linoleic acid (LA), eicosadienoic acid (EDA) and arachidonic acid (AA) in plasma and or/RBC total phospholipids were significantly higher in B. Differences in other PUFA profiles were also observed. There was no inter-group difference in AA/LA ratios. Urinary oxalate was significantly higher while urinary phosphate was significantly lower in B. We speculate that elevated AA in B might arise because of a possibly enhanced elongation of LA to EDA, as well as an enhanced ∆-8-desaturation of EDA to dihomo-gamma-linolenic acid (DGLA), which is the immediate precursor of AA. Alternatively, we speculate that the ∆-5-desaturation step of DGLA to AA might be more highly activated in this group. Irrespective of the mechanism, our observed inter-group differences in phospholipid PUFA composition are in conflict with previously published dogma which relates PUFA characteristics to high- and low-stone risk.


Assuntos
Ácidos Graxos Insaturados/sangue , Cálculos Renais/etiologia , Fosfolipídeos/química , Grupo com Ancestrais do Continente Africano , Grupo com Ancestrais do Continente Europeu , Ácidos Graxos Insaturados/química , Voluntários Saudáveis , Humanos , Cálculos Renais/sangue , Cálculos Renais/urina , Masculino , Oxalatos/urina , Projetos Piloto , Estudos Retrospectivos , Fatores de Risco , África do Sul
6.
Urolithiasis ; 47(1): 5-10, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30460525

RESUMO

Urinary stones tend to cluster in families. Of the known risk factors, evidence is strongest for heritability of urinary calcium excretion. Recent studies suggest that other stone risk factors may have heritable components including urinary pH, citrate and magnesium excretion, and circulating vitamin D concentration. Several risk factors assumed purely environmental may also have heritable components, including dietary intake and thirst. Thus, future studies may reveal that genetics plays an even stronger role in urinary stone pathogenesis than previously known.


Assuntos
Predisposição Genética para Doença , Cálculos Renais/genética , Eliminação Renal/genética , Citratos/urina , Comportamento Alimentar , Humanos , Rim/metabolismo , Cálculos Renais/sangue , Cálculos Renais/metabolismo , Cálculos Renais/urina , Magnésio/urina , Fatores de Risco , Vitamina D/sangue
7.
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
8.
Immunol Lett ; 205: 78-83, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30447308

RESUMO

Urinary stones are the third most commonly reported urinary tract disease. Kidney stones are one of the most common types of urinary stones that most of them (70-80%) are calcium oxalate. Oxalic acid is highly oxidized organic compounds, which found in dietary and produced by the intestinal microflora. Oxalyl CoA decarboxylase is a key enzyme and plays an important role in oxalate degradation. In this study, the Oxalyl CoA decarboxylase gene which contains an -histidine tag was cloned in pET 28a (+) and expressed in Escherichia coli BL21 (DE3). The purified Oxalyl CoA decarboxylase protein was injected into rabbit for immunization. The antibody against Oxalyl CoA decarboxylase protein was used in ELISA assy. eventually, this ELISA system was used for patients with calcium oxalate kidney stones. ELISA analysis of serum samples of patient white calcium oxalate kidney stones showed that 88.8% of patient was lacking in antibody against Oxalyl CoA decarboxylase. This study suggests that antibodies against oxalyl-co-decoxylase proteins are useful in the detection of urinary tract stones and It can be used to measure oxalyl CoAdecoxylase enzymes in a simple method.


Assuntos
Proteínas de Bactérias/imunologia , Carboxiliases/metabolismo , Testes Diagnósticos de Rotina/métodos , Ensaio de Imunoadsorção Enzimática , Cálculos Renais/diagnóstico , Proteínas Recombinantes de Fusão/imunologia , Animais , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Oxalato de Cálcio/análise , Carboxiliases/genética , Clonagem Molecular , Escherichia coli/genética , Escherichia coli/metabolismo , Feminino , Humanos , Imunoglobulina G/sangue , Cálculos Renais/sangue , Cálculos Renais/química , Coelhos , Kit de Reagentes para Diagnóstico , Proteínas Recombinantes de Fusão/genética
9.
Clin Endocrinol (Oxf) ; 89(6): 742-749, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30180273

RESUMO

OBJECTIVE: It is anticipated that an intake of vitamin D found acceptable by Endocrine Society Guidelines (10 000 IU/day) with co-administered calcium supplements may result in frequent hypercalciuria and hypercalcaemia. This combination may be associated with kidney stones. The objective of this study was to compare the episodes of hypercalciuria and hypercalcaemia from calcium supplements co-administered with 10 000 IU or 600 IU vitamin D daily. This design allows a comparison of the Institute of Medicine recommendation for the RDA of vitamin D along with the upper limit of calcium intake with the high intake of vitamin D suggested by the Endocrine Society. CONTEXT: Harms of currently recommended high intake of vitamin D have not been studied. DESIGN: The design was a randomized controlled trial with 2 groups with evaluation every 3 months for one year: (a) CaCO3 1200 mg/day with 10 000 IU vitamin D3 /day or (b) CaCO3 1200 mg/day with 600 IU vitamin D3 /day. PATIENTS: This study was conducted in an ambulatory research centre in healthy, white postmenopausal women. MEASUREMENTS: Serum and 24-hour urine calcium were measured. RESULTS: Hypercalcaemia and hypercalciuria occurred in both groups. At the final visit, 19/48 in the high dose D group had hypercalciuria. The odds of developing hypercalciuria were 3.6 [OR = 3.6(1.39, 9.3)] times higher in the high dose D group. The odds of developing hypercalcaemia did not differ between groups. CONCLUSIONS: The safe upper level of vitamin D recommended by the Endocrine Society when accompanied by calcium supplements results in frequent hypercalciuria. The risk of kidney stones at these levels should be investigated.


Assuntos
Cálcio/efeitos adversos , Vitamina D/efeitos adversos , Idoso , Cálcio/administração & dosagem , Cálcio/sangue , Cálcio/urina , Método Duplo-Cego , Feminino , Humanos , Hipercalcemia/sangue , Hipercalcemia/urina , Hipercalciúria/sangue , Hipercalciúria/urina , Cálculos Renais/sangue , Cálculos Renais/urina , Masculino , Pessoa de Meia-Idade , Vitamina D/administração & dosagem
10.
BMC Pediatr ; 18(1): 231, 2018 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-30001695

RESUMO

BACKGROUND: Lesch-Nyhan syndrome is a rare inborn error of purine metabolism marked by a complete deficiency of the enzyme hypoxanthine-guanine phosphoribosyltransferase (HPRT). Inherited as an X-linked recessive genetic disorder that primarily affects males, patients with Lesch-Nyhan syndrome exhibit severe neurological impairments, including choreoathetosis, ballismus, cognitive dysfunction, and self-injurious behavior. Uric acid levels are usually abnormally high, leading to kidney and bladder stones which often necessitate urological intervention. Factor V Leiden is an autosomal dominant disorder of blood clotting associated with hypercoagulability, thrombophilia, and renal disease. CASE PRESENTATION: We present the first reported case of xanthine calculi in a patient with Lesch-Nyhan syndrome and Factor V Leiden who was treated with allopurinol. A renal ultrasound and CT scan demonstrated bilateral staghorn calculi in the kidneys as well as nephrocalcinosis. Two years earlier the patient underwent cystoscopy with bilateral ureteroscopy and laser lithotripsy, and he was stone free afterwards. The patient subsequently underwent bilateral percutaneous nephrolithotomy (PCNL) and was stone free following the procedure. Patients with endogenous overproduction of uric acid who are being treated with allopurinol have a higher chance of developing xanthine stones. CONCLUSIONS: Pediatricians treating these children should be aware of these rare conditions and promptly manage the potential complications that may require medical or surgical intervention.


Assuntos
Alopurinol/efeitos adversos , Antimetabólitos/efeitos adversos , Fator V/genética , Cálculos Renais/etiologia , Síndrome de Lesch-Nyhan/complicações , Mutação Puntual , Xantina Oxidase/antagonistas & inibidores , Alopurinol/uso terapêutico , Antimetabólitos/uso terapêutico , Criança , Humanos , Cálculos Renais/sangue , Cálculos Renais/química , Cálculos Renais/terapia , Síndrome de Lesch-Nyhan/sangue , Síndrome de Lesch-Nyhan/tratamento farmacológico , Masculino , Xantina/metabolismo
11.
J Endourol ; 32(8): 771-776, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29896970

RESUMO

INTRODUCTION AND OBJECTIVES: To examine the association of glycemic control, including strict glycemic control, with 24-hour urine risk factors for uric acid and calcium calculi. MATERIALS AND METHODS: With institutional review board (IRB) approval, we identified 183 stone formers (SFs) with 459 twenty-four-hour urine collections. Hemoglobin A1c (HgbA1c) measures were obtained within 3 months of the urine collection. Collections were categorized into normoglycemic (NG, HgbA1c < 6.5) and hyperglycemic (HG, HgbA1c ≥ 6.5) cohorts; 24-hour urine parameters were compared. The NG cohort was further divided into patients with and without a history of diabetes mellitus (DM) type 2. Variables were analyzed using chi-square, Welch's t-test and multivariate linear regression to adjust for clustering, body mass index (BMI), age, gender, thiazide use, and potassium citrate use. RESULTS: Patients in the HG group were older with higher BMI. Multivariate analysis of the total study population revealed that hyperglycemia correlated with lower pH, higher uric acid relative saturation (RS), lower brushite RS, and higher citrate. NG SFs with and without a history of DM had similar risk factors for uric acid stone formation. Among NG SFs, those with DM had higher urine calcium and calcium oxalate RS than those without DM. However, this difference may be related to other factors since neither parameter correlated with DM on multivariate regression (p > 0.05). CONCLUSIONS: Successful glycemic control may be associated with reduced urinary risk factors for uric acid stone formation. Patients with well-controlled DM had equivalent risk factors to those without DM. Glycemic control should be considered a target of the multidisciplinary medical management of stone disease.


Assuntos
Diabetes Mellitus/sangue , Hemoglobina A Glicada/análise , Cálculos Renais/sangue , Adulto , Idoso , Índice de Massa Corporal , Oxalato de Cálcio , Fosfatos de Cálcio/análise , Citratos/urina , Complicações do Diabetes/sangue , Complicações do Diabetes/urina , Diabetes Mellitus/urina , Feminino , Humanos , Cálculos Renais/complicações , Cálculos Renais/urina , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nefrolitíase , Citrato de Potássio/urina , Estudos Retrospectivos , Fatores de Risco , Ácido Úrico/urina , Urinálise/métodos
12.
G Ital Nefrol ; 35(3)2018 May.
Artigo em Italiano | MEDLINE | ID: mdl-29786188

RESUMO

Mutations of the CYP24A1 gene are associated with alterations in the activity of the enzyme 25-OH-D-24-hydroxylase, resulting in dysfunction of the metabolism of vitamin D. This enzymatic deficiency may cause hypercalcemia, low parathyroid hormone levels, hypercalciuria, nephrolithiasis and nephrocalcinosis. The clinical case of a young woman with recurrent renal lithiasis, hypercalcemia and hypercalciuria is described. These features are linked to deficiency of the enzyme 25-OH-D-24-hydroxylase, therefore to a biallelic mutation of the CYP24A1 gene.


Assuntos
Hipercalcemia/genética , Cálculos Renais/genética , Vitamina D3 24-Hidroxilase/genética , Adulto , Cálcio/sangue , Cálcio/urina , Colecalciferol/sangue , Citratos/urina , Feminino , Genótipo , Humanos , Hipercalcemia/complicações , Hipercalciúria/etiologia , Hipercalciúria/genética , Cálculos Renais/sangue , Cálculos Renais/etiologia , Cálculos Renais/urina , Mutação de Sentido Incorreto , Hormônio Paratireóideo/sangue , Fósforo/sangue , Recidiva , Deleção de Sequência , Vitamina D/metabolismo , Vitamina D3 24-Hidroxilase/deficiência
13.
Urolithiasis ; 46(6): 503-514, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29353409

RESUMO

Nephrolithiasis is a common urological disease with high prevalence and recurrence rates. Characterizing gut microbiome profiles of nephrolithiasis patients may provide valuable insights and potential biomarkers for the disease. Therefore, we explored the relation between gut microbiome and nephrolithiasis using 16S ribosomal RNA (rRNA) gene sequencing. 13 patients with multiple kidney stones and 13 matched healthy controls were recruited. A decreasing trend in number of observed species in nephrolithiasis patients was detected, although statistical significance was not reached (p = 0.086). The inter-group variability in community structure by beta diversity analysis showed a clear separation between nephrolithiasis patients and healthy controls. Twenty genera differentiated significantly in relative abundance between nephrolithiasis patients and healthy controls (all p < 0.05). Among the 20 genera, Phascolarctobacterium, Parasutterella, Ruminiclostridium_5, Erysipelatoclostridium, Fusicatenibacter and Dorea were correlated with the concentration of the trace elements in blood, including potassium, sodium, calcium and chlorinum. Characteristic microbiome in nephrolithiasis patients was also identified by linear discriminant analysis effect size (LEfSe). These findings may provide novel and non-invasive potential diagnostic biomarkers for nephrolithiasis, and contribute to prevention and treatment of nephrolithiasis from the perspective of maintaining micro-ecological equilibrium in gut.


Assuntos
Disbiose/microbiologia , Microbioma Gastrointestinal/genética , Cálculos Renais/microbiologia , RNA Bacteriano/isolamento & purificação , RNA Ribossômico 16S/isolamento & purificação , Biomarcadores/análise , Estudos de Casos e Controles , Disbiose/sangue , Disbiose/diagnóstico , Feminino , Humanos , Cálculos Renais/sangue , Cálculos Renais/prevenção & controle , Masculino , Pessoa de Meia-Idade , Análise de Sequência de DNA
14.
Int Urol Nephrol ; 50(3): 419-425, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29374814

RESUMO

PURPOSE: To determine whether androgen blockade produces metabolic changes in urine and increases the risk of calculi after 1 year of treatment. MATERIALS AND METHODS: The study included 38 patients, from the period April 2015 to June 2016, diagnosed with locally advanced prostate cancer or lymph node metastasis, and with an indication of androgen blockade. Androgen blockade was started with luteinising hormone-releasing hormone (LHRH) analogues, and a blood specimen, a fasting urine and 24-h urine were collected at the time of inclusion, and then at 1 year of follow-up. A study was performed at baseline and at 1 year with imaging tests. An analysis of the variables was performed with a p ≤ 0.05 considered as statistically significant. RESULTS: The mean age of the patients included in the study was 72.26 ± 6.75 years. As regards the biochemistry parameters, an increase in osteocalcin (from 16.28 ± 9.48 to 25.56 ± 12.09 ng/ml; p = 0.001) and an increase in ß-crosslaps (from 0.419 ± 0.177 to 0.743 ± 0.268 ng/ml; p = 0.0001) were observed. In the urinary parameters, a significant increase was observed in the fasting calcium/creatinine ratio (from 0.08 ± 0.06 to 0.13 ± 0.06; p = 0.002) and in the 24-h calcium renal excretion (from 117.69 ± 66.92 to 169.42 ± 107.18 mg; p = 0.0001). Calculi formation was observed in 12 of the 38 patients included (31.6%), with a mean size of 3.33 ± 1.31 mm. CONCLUSION: Treatment with LHRH analogues, as well as increasing the appearance of metabolic syndrome and speeding up the loss bone mineral density, causes an increase in fasting urine calcium.


Assuntos
Cálcio/urina , Colágeno Tipo I/sangue , Creatinina/urina , Hormônio Liberador de Gonadotropina/análogos & derivados , Cálculos Renais/sangue , Cálculos Renais/urina , Osteocalcina/sangue , Peptídeos/sangue , Neoplasias da Próstata/tratamento farmacológico , Idoso , Biomarcadores/sangue , Biomarcadores/urina , Densidade Óssea , Jejum/urina , Humanos , Cálculos Renais/etiologia , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/urina , Osteoporose/sangue , Osteoporose/urina , Estudos Prospectivos , Neoplasias da Próstata/patologia , Curva ROC , Fatores de Risco
15.
Urolithiasis ; 46(4): 313-323, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28718073

RESUMO

Primary hyperoxaluria (PH) patients overproduce oxalate because of rare genetic errors in glyoxylate metabolism. Recurrent urolithiasis and/or progressive nephrocalcinosis are PH hallmarks and can lead to kidney damage, systemic oxalosis and death. Based on previous studies, we hypothesised that treatment with the oxalate-metabolizing bacterium Oxalobacter formigenes would mediate active elimination of oxalate from the plasma to the intestine of PH patients, thereby reducing urinary oxalate excretion (Uox). The efficacy and safety of O. formigenes (Oxabact™ OC3) were evaluated for 24 weeks in a randomised, placebo-controlled, double-blind study. The primary endpoint was reduction in Uox. Secondary endpoints included change in plasma oxalate (Pox) concentration, frequency of stone events, number of responders, and Uox in several subgroups. Additional post hoc analyses were conducted. Thirty-six patients were randomised; two patients withdrew from placebo treatment. Both OC3 and placebo groups demonstrated a decrease in Uox/urinary creatinine ratio, but the difference was not statistically significant. No differences were observed with respect to change in Pox concentration, stone events, responders' number or safety measures. In patients with estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m2, Pox increased by 3.25 µmol/L in the placebo group and decreased by -1.7 µmol/L in the OC3 group (p = 0.13). After 24 weeks, eGFR had declined to a greater degree in the placebo than in the OC3 group: -8.00 ± 2.16 versus -2.71 ± 2.50; p = 0.01. OC3 treatment did not reduce urinary oxalate over 24 weeks of treatment compared with placebo in patients with PH. The treatment was well tolerated.


Assuntos
Terapia Biológica/métodos , Oxalato de Cálcio/metabolismo , Hiperoxalúria Primária/terapia , Cálculos Renais/epidemiologia , Oxalobacter formigenes/metabolismo , Adolescente , Adulto , Terapia Biológica/efeitos adversos , Oxalato de Cálcio/sangue , Criança , Pré-Escolar , Creatinina/sangue , Método Duplo-Cego , Feminino , Taxa de Filtração Glomerular , Humanos , Hiperoxalúria Primária/sangue , Hiperoxalúria Primária/complicações , Hiperoxalúria Primária/metabolismo , Cálculos Renais/sangue , Cálculos Renais/etiologia , Cálculos Renais/metabolismo , Testes de Função Renal , Masculino , Placebos/administração & dosagem , Eliminação Renal , Resultado do Tratamento , Adulto Jovem
16.
Urolithiasis ; 46(2): 167-172, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28246885

RESUMO

The aim of this study was to compare the clinical characteristics of "pure" uric acid renal stone formers (UA-RSFs) with that of mixed uric acid/calcium oxalate stone formers (UC-RSFs) and to identify which urinary and dietary risk factors predispose to their formation. A total of 136 UA-RSFs and 115 UC-RSFs were extracted from our database of renal stone formers. A control group of 60 subjects without history of renal stones was considered for comparison. Data from serum chemistries, 24-h urine collections and 24-h dietary recalls were considered. UA-RSFs had a significantly (p = 0.001) higher body mass index (26.3 ± 3.6 kg/m2) than UC-RSFs, whereas body mass index of UA-RSFs was higher but not significantly than in controls (24.6 ± 4.7) (p = 0.108). The mean urinary pH was significantly lower in UA-RSFs (5.57 ± 0.58) and UC-RSFs (5.71 ± 0.56) compared with controls (5.83 ± 0.29) (p = 0.007). No difference of daily urinary uric acid excretion was observed in the three groups (p = 0.902). Daily urinary calcium excretion was significantly (p = 0.018) higher in UC-RSFs (224 ± 149 mg/day) than UA-RSFs (179 ± 115) whereas no significant difference was observed with controls (181 ± 89). UA-RSFs tend to have a lower uric acid fractional excretion (0.083 ± 0.045% vs 0.107+/-0.165; p = 0.120) and had significantly higher serum uric acid (5.33 ± 1.66 vs 4.78 ± 1.44 mg/dl; p = 0.007) than UC-RSFs. The mean energy, carbohydrate and vitamin C intakes were higher in UA-SFs (1987 ± 683 kcal, 272 ± 91 g, 112 ± 72 mg) and UC-SFs (1836 ± 74 kcal, 265 ± 117, 140 ± 118) with respect to controls (1474 ± 601, 188 ± 84, 76 ± 53) (p = 0.000). UA-RSFs should be differentiated from UC-RSFs as they present lower urinary pH, lower uric acid fractional excretion and higher serum uric acid. On the contrary, patients with UC-RSFs show urinary risk factors more similar to those for calcium oxalate stones. The dietary approach in patients forming uric acid stones should be reconsidered with more attention to the quantity and quality of carbohydrate intake.


Assuntos
Oxalato de Cálcio/metabolismo , Dieta da Carga de Carboidratos/efeitos adversos , Cálculos Renais/etiologia , Ácido Úrico/metabolismo , Adulto , Idoso , Índice de Massa Corporal , Cálcio/sangue , Cálcio/urina , Oxalato de Cálcio/urina , Feminino , Humanos , Cálculos Renais/sangue , Cálculos Renais/química , Cálculos Renais/urina , Masculino , Pessoa de Meia-Idade , Eliminação Renal , Estudos Retrospectivos , Fatores de Risco , Ácido Úrico/sangue , Ácido Úrico/urina
17.
Int J Rheum Dis ; 21(3): 705-709, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27456670

RESUMO

AIM: The main objective of this study is to elucidate the clinical significance of the SLC2A9/GLUT9 rs11722228 polymorphism among male gout patients. METHOD: We consecutively recruited all newly diagnosed male gout patients who were treatment-naive from the rheumatology outpatient clinics of two Malaysian hospitals. Age-matched healthy male adults were employed as controls. All subjects were tested for the SLC2A9/GLUT9 rs11722228 genotypes, serum uric acid (SUA), urine uric acid and creatinine levels. All gout subjects were examined for the presence of tophi and sonographically screened for renal calculi. RESULTS: A total of 73 male gout patients and 73 age-matched healthy male adults were recruited in this study. The genotypic frequencies of SLC2A9/GLUT9 rs1172228 did not differ significantly between the gout cases and the healthy controls. The gout subjects with the CC genotype had significantly higher SUA levels (P = 0.002), family history of gout (P < 0.050) and the occurrence of renal calculi (P = 0.026). The SUA-adjusted odds ratios (OR) of the occurrence of renal calculi in the CC genotype (OR = 1 [reference]) was significantly higher than the CT genotype (OR = 0.338, 95%CI: 0.141-0.813) and the TT genotype (OR = 0.271, 95%CI: 0.086-0.854). CONCLUSIONS: The genotypic distribution of SLC2A9/GLUT9 rs1172228 in male gout patients did not differ significantly from that of healthy male controls. However, the CC genotype in gout had significant associations with higher levels of SUA, renal calculi and a positive family history of gout.


Assuntos
Proteínas Facilitadoras de Transporte de Glucose/genética , Gota/genética , Cálculos Renais/genética , Polimorfismo de Nucleotídeo Único , Adulto , Idoso , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Creatinina/urina , Frequência do Gene , Estudos de Associação Genética , Marcadores Genéticos , Predisposição Genética para Doença , Proteínas Facilitadoras de Transporte de Glucose/metabolismo , Gota/sangue , Gota/diagnóstico por imagem , Gota/urina , Hereditariedade , Heterozigoto , Homozigoto , Humanos , Cálculos Renais/sangue , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/urina , Modelos Logísticos , Malásia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Linhagem , Fenótipo , Fatores de Risco , Ultrassonografia , Ácido Úrico/sangue , Ácido Úrico/urina
18.
PLoS One ; 12(7): e0179599, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28683066

RESUMO

BACKGROUND: Currently there is limited research documenting the changes in blood parameters, following Flexible Ureterorenoscopy. This study aims to determine whether there are any changes in haematology and biochemistry parameters, following Flexible Ureterorenoscopy for the treatment of kidney stones. METHODS: 40 consecutive patients aged between 27-87 years (median 49 years) undergoing Flexible Ureterorenoscopy for the treatment of kidney stones were recruited (26 male, 14 female). Blood samples were collected from each patient at four time points: baseline (pre-operatively) followed by 30 minutes, 120 minutes and 240 minutes post-operatively. On these samples, routine haematological and biochemistry tests were carried out. In addition to the assessment of clinical parameters prospectively from the medical notes. RESULTS: There was a significant decrease observed following Flexible Ureterorenoscopy in the following parameters: lymphocytes (p = 0.007), eosinophils (p = 0.001), basophils (p = 0.001), haemoglobin (p = 0.002), red blood cells (p = 0.001), platelet count (p = 0.001), fibrinogen concentration (p = 0.001), von Willebrand factor (p = 0.046), C reactive protein (p = 0.01), total protein (p = 0.001), albumin (p = 0.001), globulin (p = 0.001) and alkaline phosphatase (p = 0.001). In addition, there was a significant increase observed in the following parameters: white blood cells (p = 0.001), neutrophils (p = 0.001), activated partial thromboplastin time (p = 0.001), total bilirubin (p = 0.012), creatinine (p = 0.008), sodium (p = 0.002) and potassium (p = 0.001). Limiting factors for this study were the sample size, and restriction on the recruitment time points. CONCLUSIONS: Significant changes were noted to occur in haematology and biochemistry parameters following Flexible Ureterorenoscopy. Some of the data presented in this study may represent the 'normal' post-operative response following FURS, as no major complications occurred, in the majority of our patients. This data on the 'normal response' will need to be validated but may ultimately aid clinicians in distinguishing patients at risk of complications, if reproduced in larger multi-centre studies.


Assuntos
Cálculos Renais/sangue , Rim/cirurgia , Litotripsia a Laser/métodos , Ureteroscopia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Fosfatase Alcalina/sangue , Contagem de Células Sanguíneas , Proteína C-Reativa/metabolismo , Índices de Eritrócitos , Feminino , Fibrinogênio/metabolismo , Humanos , Rim/patologia , Cálculos Renais/patologia , Cálculos Renais/cirurgia , Litotripsia a Laser/instrumentação , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Albumina Sérica/metabolismo , Ureteroscopia/instrumentação , Fator de von Willebrand/metabolismo
19.
Eur Rev Med Pharmacol Sci ; 21(11): 2567-2571, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28678329

RESUMO

OBJECTIVE: To investigate the safety and efficacy of extracorporeal shock wave lithotripsy (ESWL) combined with percutaneous nephrolithotomy (PCNL) for treatment of complex renal calculus. PATIENTS AND METHODS: Seventy-eight patients diagnosed with complex renal calculus and who accepted treatment in our hospital were consecutively selected. Patients were divided randomly into the observation group (n=40) treated by combined ESWL and PCNL and the control group (n=38) treated by PCNL. The effect of treatment between the two groups was compared. RESULTS: The stone-free rate at 3 months after surgery was higher in the observation group than in the control group. There were no differences in the rates of complications (including infection, hemorrhage, collection system perforation and laceration, peripheral organ impairment, and urination extravasation). There were gradual decreases of serum creatinine in the observation group at 4 weeks after extubation of the double J catheter and at 3 months after surgery, while there were no apparent decreases in the control group. The levels of cysteine protease inhibitor and neutrophil gelatinase-associated lipocalin in both groups increased at 4 weeks after extubation of the double J catheter, and decreased at 3 months after surgery. The decreases were more apparent in the observation group compared with the control group, and the differences were statistically significant (p<0.05). CONCLUSIONS: Combined use of ESWL and PCNL to treat complex renal calculus can improve the stone-free rate and renal function, and does not increase the complication rate. It is, therefore, safe and effective.


Assuntos
Tratamento por Ondas de Choque Extracorpóreas/métodos , Cálculos Renais/cirurgia , Litotripsia/métodos , Nefrolitotomia Percutânea/métodos , Adulto , Terapia Combinada , Cisteína/sangue , Inibidores de Cisteína Proteinase/sangue , Tratamento por Ondas de Choque Extracorpóreas/efeitos adversos , Feminino , Humanos , Cálculos Renais/sangue , Lipocalina-2/sangue , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Distribuição Aleatória , Resultado do Tratamento
20.
PLoS One ; 12(4): e0174854, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28384169

RESUMO

Serum concentrations of symmetric dimethylarginine (SDMA) correlate with renal function in cats and SDMA has been shown to be a more reliable and earlier marker for chronic kidney disease (CKD) compared with serum creatinine (Cr). Calcium oxalate uroliths tend to develop in mid-to-older aged cats and kidney stones may cause a reduction in renal function with increased SDMA, but normal serum Cr. The purpose of this retrospective study was to determine if cats with kidney stones had increased serum SDMA concentrations, and whether SDMA increased earlier than serum creatinine concentrations. Cats in the colony with kidney stones diagnosed between August 2010 and December 2015 (n = 43) were compared with healthy geriatric cats (n = 21) without kidney stones. Serum SDMA concentrations were determined by liquid chromatography-mass spectrometry and serum Cr concentrations were determined by enzymatic colorimetry. Cats with kidney stones were diagnosed antemortem by radiographic imaging (n = 12) or by postmortem necropsy (n = 31). Retrospectively, serum SDMA was found to be increased above the upper reference limit in 39 of 43 cats with kidney stones. Serum Cr was increased above the upper reference limit in 18 of 43 cats; 6 of these 18 cats had terminal azotemia only. The mean time that serum SDMA was increased before serum Cr was increased was 26.9 months (range 0 to 60 months). Kidney stones were composed of calcium oxalate in 30 of 34 cats. The lifespan for cats with kidney stones (mean, 12.5 years; range, 6.1 to 18.1 years) was shorter (P < 0.001) than for control cats (mean, 15.2 years; range, 13.0 to 17.2 years), suggesting that non-obstructive kidney stones have an effect on mortality rate or rate of CKD progression. In conclusion, if SDMA concentrations are elevated in mid-to-older aged cats, further imaging studies are warranted to check for the presence of kidney stones.


Assuntos
Arginina/análogos & derivados , Doenças do Gato/sangue , Creatinina/sangue , Cálculos Renais/veterinária , Animais , Arginina/sangue , Biomarcadores/sangue , Gatos , Cromatografia Líquida , Feminino , Cálculos Renais/sangue , Masculino , Espectrometria de Massas , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/veterinária
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