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1.
Urol Clin North Am ; 46(2): 265-272, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30961859

RESUMO

Patients with nephrolithiasis are exposed to significant quantities of ionizing radiation with the potential to cause secondary malignancy. This risk is magnified by the high recurrence rate of nephrolithiasis. In this article, we identify the risks of ionizing radiation as they pertain to patients with nephrolithiasis. We then identify evidence-based techniques for mitigating patient radiation exposure in the preoperative, intraoperative, and postoperative settings. Key factors include limiting the use of computed tomographic imaging, appropriate modulation of fluoroscopy settings, and minimizing rates of stone recurrence.


Assuntos
Cálculos Renais/diagnóstico por imagem , Doses de Radiação , Exposição à Radiação/efeitos adversos , Exposição à Radiação/prevenção & controle , Lesões por Radiação/prevenção & controle , Fluoroscopia/efeitos adversos , Humanos , Cuidados Intraoperatórios/efeitos adversos , Cálculos Renais/cirurgia , Nefrolitíase/diagnóstico por imagem , Nefrolitíase/cirurgia , Cuidados Pós-Operatórios/efeitos adversos , Lesões por Radiação/etiologia , Fatores de Risco , Tomografia Computadorizada por Raios X/efeitos adversos
2.
Urol Clin North Am ; 46(2): 273-285, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30961860

RESUMO

This article reviews new advances in ultrasound technology for urinary stone disease. Recent research to facilitate the diagnosis of nephrolithiasis, including use of the twinkling signal and posterior acoustic shadow, have helped to improve the use of ultrasound examination for detecting and sizing renal stones. New therapeutic applications of ultrasound technology for stone disease have emerged, including ultrasonic propulsion to reposition stones and burst wave lithotripsy to fragment stones noninvasively. The safety, efficacy, and evolution of these technologies in phantom, animal, and human studies are reviewed herein. New developments in these rapidly growing areas of ultrasound research are also highlighted.


Assuntos
Litotripsia/métodos , Nefrolitíase/diagnóstico por imagem , Nefrolitíase/cirurgia , Terapia por Ultrassom/métodos , Ultrassonografia/métodos , Humanos , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Cálculos Urinários/diagnóstico por imagem , Cálculos Urinários/cirurgia
3.
J Urol ; 201(5): 996-1004, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30694933

RESUMO

PURPOSE: The Image Gently® campaign was launched by several radiological societies in 2007 to promote safe imaging in children. A goal of the campaign was to reduce ionizing radiation exposure in children. Given the recurrent nature of kidney stones, affected children are at risk for unnecessary ionizing radiation exposure from computerized tomography. We sought to determine whether the Image Gently campaign led to a decrease in the use of computerized tomography for evaluating children with nephrolithiasis. We hypothesized that the campaign was the primary cause of a reduction in the use of computerized tomography. MATERIALS AND METHODS: We analyzed medical claims data from 2001 to 2015 identifying children with nephrolithiasis covered by the same commercial insurance provider. Using a difference in differences design, we estimated changes in computerized tomography use after the campaign started among patients less than 18 years old compared to a control group age 18 years or older with nephrolithiasis. RESULTS: We identified 12,734 children and 787,720 adults diagnosed with nephrolithiasis. Before 2007 quarterly rates of computerized tomography use during a stone episode (per 1,000 patients) were increasing at a parallel rate in children and adults (5.1 in children vs 7.2 in adults, p = 0.123). After the Image Gently campaign started the use of computerized tomography decreased in both groups but at a slightly higher rate in adults (difference in differences 2.96, 95% CI 0.00 to 5.91, p = 0.050). CONCLUSIONS: Although there has been a reduction in the use of computerized tomography among children with nephrolithiasis, given a similar trend seen in adults this change cannot be primarily attributed to the Image Gently campaign.


Assuntos
Nefrolitíase/diagnóstico por imagem , Exposição à Radiação/efeitos adversos , Exposição à Radiação/prevenção & controle , Proteção Radiológica/métodos , Tomografia Computadorizada por Raios X/efeitos adversos , Adolescente , Adulto , Fatores Etários , Estudos de Casos e Controles , Criança , Feminino , Seguimentos , Humanos , Revisão da Utilização de Seguros , Masculino , Pediatria , Doses de Radiação , Estudos Retrospectivos , Medição de Risco , Tomografia Computadorizada por Raios X/métodos
5.
Urology ; 124: e1-e3, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30472257

RESUMO

Diaphragmatic herniations of the ureter are a rare occurrence overall, with fewer than 10 cases reported. Obstructing nephrolithiasis in the setting of diaphragmatic ureteral herniation has sparsely been documented. Management options to consider include ureteroscopy and laser lithotripsy to alleviate obstruction in herniated ureters. The abnormal path of the ureter and surrounding structures pose unique risks that require careful attention and a high level of operator skill. We present imaging of an 84-year-old woman incidentally found to have right ureteral herniation through the diaphragm with an obstructing 8 mm stone in the right proximal ureter with moderate hydronephrosis.


Assuntos
Hérnia Diafragmática/complicações , Hérnia/complicações , Nefrolitíase/complicações , Obstrução Ureteral/etiologia , Idoso de 80 Anos ou mais , Feminino , Hérnia/diagnóstico por imagem , Hérnia Diafragmática/diagnóstico por imagem , Humanos , Nefrolitíase/diagnóstico por imagem , Doenças Ureterais/complicações , Doenças Ureterais/tratamento farmacológico , Obstrução Ureteral/diagnóstico por imagem
6.
J Urol ; 201(4): 794-801, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30316895

RESUMO

PURPOSE: Imaging following surgical intervention for nephrolithiasis is important to define operative success and ensure the absence of silent obstruction. We assessed nationwide postoperative imaging patterns in children undergoing ureteroscopy and shock wave lithotripsy. MATERIALS AND METHODS: We reviewed the MarketScan® Commercial Claims and Encounters database from 2007 to 2013 for patients 1 to 18 years old undergoing ureteroscopy or shock wave lithotripsy. We assessed imaging exposure following index procedure within 90 days as a primary analysis and 180 days as a secondary analysis of the index procedure. Univariate and multivariate statistical analyses were performed to assess factors associated with undergoing postoperative imaging. RESULTS: A total of 4,251 children met inclusion criteria, of whom 1,647 had undergone shock wave lithotripsy and 2,604 had undergone ureteroscopy. Postoperative imaging was performed in 57.5% of the cohort, with a higher proportion of children undergong imaging following shock wave lithotripsy compared to ureteroscopy (73% vs 47.8%, p <0.001). Noncomputerized tomographic imaging modalities were most common following ureteroscopy (70.8%) and shock wave lithotripsy (84.6%). Younger children and those with complex medical conditions or complicated postoperative courses were more likely to undergo followup imaging. Computerized tomography was more commonly used in older children and females. At 180-day followup 63% of the cohort had undergone any imaging, again more frequently following shock wave lithotripsy (77.0%) vs ureteroscopy (45.0%). CONCLUSIONS: A large percentage of children with nephrolithiasis do not undergo followup imaging after shock wave lithotripsy, and even fewer undergo imaging after ureteroscopy. Most followup imaging is done within 90 days of surgery. Further work is needed to define appropriate postoperative imaging practices in this population.


Assuntos
Litotripsia , Nefrolitíase/diagnóstico por imagem , Nefrolitíase/cirurgia , Ureteroscopia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Cuidados Pós-Operatórios , Melhoria de Qualidade
7.
BMC Nephrol ; 19(1): 172, 2018 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-29996796

RESUMO

BACKGROUND: Nephrolithiasis is a risk factor for Osteopenia and osteoporosis. Receptor activator of nuclear factor kappaB ligand (RANKL) and osteoprotegerin (OPG) regulate bone remodeling and osteoclastogenesis. This study aimed to evaluate the relation between serum OPG, RANKL concentration, and bone mineral density (BMD) in patients with kidney stone disease. METHODS: Forty-four nephrolithiasis patients with either low bone mass or normal BMD (considered control group) were enrolled in this study. BMD was measured at lumbar spine (L1-L4) and femoral neck by dual-energy X-ray absorptiometry (DEXA). The serum OPG and RANKL were determined using the ELISA method. RESULTS: The median levels of serum OPG were significantly higher in nephrolithiasis patients with low bone mass compared to the nephrolithiasis patients with normal BMD (3.9 pmol/l versus 3.1 pmol/l; P = 0.03), respectively. Negative correlation was detected between bone densities of femoral neck and OPG in patients with nephrolithiasis (r = -.0344, P = 0.02). CONCLUSION: The present study showed that high serum fasting OPG levels may be indicative of femoral neck BMD in patients with nephrolithiasis.


Assuntos
Densidade Óssea/fisiologia , Colo do Fêmur/diagnóstico por imagem , Nefrolitíase/sangue , Nefrolitíase/diagnóstico por imagem , Osteoprotegerina/sangue , Ligante RANK/sangue , Absorciometria de Fóton/métodos , Adulto , Biomarcadores/sangue , Remodelação Óssea/fisiologia , Feminino , Colo do Fêmur/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade
8.
Actas urol. esp ; 42(5): 316-322, jun. 2018. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-174717

RESUMO

Objetivos: Evaluar la efectividad y seguridad de la nefrolitotomía percutánea bilateral simultánea realizada en pacientes afectados de litiasis renales bilaterales. Material y métodos: Estudio prospectivo, período de septiembre de 2012 a noviembre de 2016. Se incluyeron pacientes diagnosticados de litiasis renales bilaterales por TC abdominal. Técnica quirúrgica posición en prono, punción renal guiada por fluoroscopia y dilatación del tracto hasta 24Ch. Se revisaron las características demográficas y de las litiasis, la tasa libre de litiasis, el éxito clínico, las complicaciones y el seguimiento. Resultados: Durante el período de estudio, se realizaron 732 nefrolitotomías percutáneas. Dieciocho pacientes (36 unidades renales; 2,5%), 13 hombres y 5 mujeres con una mediana de edad de 58 años y un rango intercuartílico (RIC) de 40-66. Tamaño de la litiasis mediana de 228 mm2 (RIC 134-389), tiempo operativo mediana de 150 min (RIC 97-180) y una estancia hospitalaria mediana de 5 días (RIC 5-15). La tasa libre de litiasis fue del 80%. Se reportaron litiasis residuales en 8 unidades renales (22,2%) que requirieron técnicas complementarias para su completa resolución, 4 litotricias extracorpóreas por ondas de choque, una ureterolitotomía por laparotomía, 2 ureteroscopias y un segundo procedimiento. Complicaciones mayores incluyeron 4 hemorragias manejadas mediante embolización por angiografía. Mediana de seguimiento 36 meses (rango 26-46). Conclusiones: La nefrolitotomía percutánea bilateral simultánea es un procedimiento eficaz y seguro en pacientes afectados con cálculos renales bilaterales. Es un desafío quirúrgico que debe realizarse en pacientes seleccionados y en centros con experiencia


Objectives: To evaluate the effectiveness and safety of simultaneous bilateral percutaneous nephrolithotomy performed in patients affected with bilateral renal calculi. Materials and methods: This is a prospective study from September 2012 to November 2016. Patients diagnosed of bilateral kidney stones with abdominal CT scan were included. Surgical technique prone position, renal puncture guided by fluoroscopy and tract dilation up to 24Ch. We reviewed demographic and stone characteristics, stone free rate, clinical success, complications and follow-up. Results: During the study period, 732 percutaneous nephrolithotomies were performed. Eighteen patients were included (36 renal units, 2.5%), 13 men and 5 women, with a median age of 58 years and an interquartile range (IQR) of 40-66. Median stone burden was 22 8mm2 (IQR 134-389); median operative time, 150 minutes (IQR 97-180); and median hospital stay, 5 days (IQR 5-15). Stone free rate was 80%. Residual calculi were encountered in 8 renal units (22.2%) and required other complementary techniques for their complete tesolution 4 external shockwave lithotripsies, one open ureterolithotomy, 2 ureteroscopies and one second look. Major complications included 4 cases of severe hemorrhage managed with angiographic embolization. The median follow-up was 36 months (range 26-46). Conclusions: Simultaneous bilateral percutaneous nephrolithotomy is an effective and safe procedure in patients affected with bilateral renal calculi. It is a surgical challenge that should be performed in selected patients and in centers with experience


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Nefrostomia Percutânea/métodos , Resultado do Tratamento , Nefrolitíase/diagnóstico por imagem , Nefrolitíase/cirurgia , Cálculos Renais/diagnóstico por imagem , Estudos Prospectivos , Cálculos Renais/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos
9.
BMC Urol ; 18(1): 33, 2018 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-29739380

RESUMO

BACKGROUND: To observe the efficacy of self-help position therapy (SHPT) after holmium laser lithotripsy via flexible ureteroscopy (FURS). METHODS: From January 2010 to November 2015, 736 nephrolithiasis patients who had received FURS lithotripsy were analyzed retrospectively. In position group, 220 cases accepted SHPT after lithotripsies, and 428 cases as control, coming from another independent inpatient area in the same center. The stone-free status (SFS) between two groups were compared at the 2nd, 4th and 12th week ends by X-ray examinations. RESULTS: The preoperative incidence of hydronephrosis (25.9% vs. 18.0%, p = 0.018) or lower calyceal seeper (33.6% vs. 24.3%, p = 0.012) and the proportion of patients with > 2.0 cm stones (33.6% vs. 24.3%, p = 0.003) were all significantly higher in position group than in control group. There were no substantial difference between two groups in age, BMI, gender and medical histories. In postoperative followup, the incidence of hydronephrosis in position group was significantly lower than in control group (9.5% vs. 15.7%, p = 0.032) after removing double-J stents. In position group, the SFS of the 2nd week end (60.9% vs. 47.2%, p = 0.001), the 4th week end (74.1% vs. 62.8%, p = 0.004) and the 12th week end (86.9% vs. 79.4%, p = 0.021) were all significantly higher than those in control group. CONCLUSIONS: SHPT after holmium laser lithotripsy via FURS may increase postoperative SFS, accelerate stone fragment clearance, and decrease the incidence of hydronephrosis after removal of double-J stents. The therapy does not require professional assistance and is economical, simple, and effective.


Assuntos
Hólmio , Litotripsia a Laser/métodos , Nefrolitíase/terapia , Posicionamento do Paciente/métodos , Autocuidado/métodos , Ureteroscopia/métodos , Adulto , Feminino , Seguimentos , Humanos , Litotripsia a Laser/instrumentação , Masculino , Pessoa de Meia-Idade , Nefrolitíase/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscópios/estatística & dados numéricos , Ureteroscopia/instrumentação
10.
Am J Physiol Renal Physiol ; 315(2): F231-F237, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29631356

RESUMO

Dietary and urinary risk factors have been implicated in conditions favoring ammonium urate nephrolithiasis in managed dolphins compared with free-ranging dolphins. In this study, urine samples were collected from 16 dolphins (8 cases, 8 controls) from the U.S. Navy Marine Mammal Program for the purposes of assessing changes in urinary biomarkers after a large meal. Urinary biomarkers and nephrolithiasis presence were assessed opportunistically in 15 long-term resident free-ranging dolphins living in Sarasota Bay, Florida. Additionally, the total purine contents of fish commonly consumed by each dolphin population were measured to evaluate potential dietary risk factors. Populations were compared for total dietary purine composition, recently fed status, nephrolithiasis presence, and differences in urinary biochemical, acid-base, and physicochemical parameters via Wilcoxon rank sum analysis and least square means. Managed dolphins had higher urinary pH and ammonium ([Formula: see text]) in both pre- and postprandial conditions and higher urinary uric acid and saturation indices of NH4U in the postprandial condition compared with free-ranging dolphins ( P < 0.05). The purine content was greater ( P < 0.0001) in the diet consumed by managed dolphins [7 mmol/Mcal metabolizable energy (ME)] than in the free-ranging dolphin diet (4 mmol/Mcal ME). Free-ranging dolphins did not show evidence of nephrolithiasis. Observed differences in urinary biomarkers and dietary purine content in these two dolphin populations suggest a pathophysiologic basis for the role of fish types on the risk of NH4U stone formation. Future research should investigate fish type and feeding frequency, inhibitors and promoters, and alkalinizing therapy for reducing NH4U nephrolithiasis in dolphins.


Assuntos
Compostos de Amônio/urina , Golfinho Nariz-de-Garrafa/urina , Dieta/veterinária , Peixes/metabolismo , Nefrolitíase/veterinária , Purinas/metabolismo , Ácido Úrico/urina , Animais , Animais Selvagens , Dieta/efeitos adversos , Feminino , Masculino , Nefrolitíase/diagnóstico por imagem , Nefrolitíase/etiologia , Nefrolitíase/urina , Período Pós-Prandial , Purinas/efeitos adversos , Fatores de Risco , Ultrassonografia
11.
Can J Urol ; 25(2): 9238-9244, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29680000

RESUMO

INTRODUCTION: To determine the clinical yield of stone culture in patients undergoing percutaneous nephrolithotomy (PCNL), and to identify patients who may benefit from this test. MATERIALS AND METHODS: We queried our database for all patients who underwent PCNL from 2005 to 2017, from whom urine culture (UC) and stone culture (SC) were obtained. Study endpoint was systemic inflammatory response syndrome (SIRS) within 48 hours of PCNL. Risk factors for SIRS and for stone colonization with highly resistant pathogens were evaluated. Based on UC and SC results, we determined the proportion of patients in whom SC may alter the treatment, had SIRS occurred, with respect to the initial empiric treatment. RESULTS: The study group comprised of 512 patients with a median age of 53, of whom 323 (63%) were male. Positive UC were found in 137 (26.7%) patients, and positive SC in 117 (22.8%) patients. UC did not identify pathogens isolated from SC in 66 (12.8%) patients. Postoperative SIRS occurred in 50 (9.8%) patients. On multivariate analysis only SC was associated with postoperative SIRS. SC pathogens resistance rates ranged from 67% for treatment with 2nd generation cephalosporins to 9% for treatment with meropenem, and may alter the choice of antibiotics in 73 to 12 patients (14.2%-2.3% of the whole cohort), respectively. CONCLUSIONS: In similar and earlier studies, we found substantial discordance between SC and UC results, and an association between stone colonization and SIRS. However, the practical yield of this test varies with the type of antibiotic given, and is limited when broad spectrum antibiotic is used.


Assuntos
Cuidados Intraoperatórios/métodos , Cálculos Renais/química , Cálculos Renais/cirurgia , Nefrolitíase/cirurgia , Nefrolitotomia Percutânea/métodos , Síndrome de Resposta Inflamatória Sistêmica/patologia , Adulto , Idoso , Análise de Variância , Antibioticoprofilaxia/métodos , Estudos de Coortes , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nefrolitíase/diagnóstico por imagem , Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/terapia , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Medição de Risco , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Resultado do Tratamento
12.
Curr Opin Nephrol Hypertens ; 27(4): 236-242, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29697409

RESUMO

PURPOSE OF REVIEW: Kidney stones form as a result of heterogeneous nucleation on a calcium phosphate lesion in the renal papilla known as Randall's plaque. Stone disease has plagued humans for millennia with relatively little progress made in the realm of prevention. An understanding of the historical aspects of research into Randall's plaque is necessary to interpret novel correlative imaging discoveries. Focus for the past several decades has been on the distal papillary tip, and the overlooked Anderson-Carr-Randall progression is revitalized with novel supporting evidence. RECENT FINDINGS: Novel correlative techniques of three-dimensional micro-XCT imaging combined with electron and light microscopy techniques have revealed that the earliest mineralization event in the papilla is a distinct event that occurs proximal to the region where Randall's plaque has traditionally been identified. SUMMARY: The history of Randall's plaque research and the Anderson-Carr-Randall progression is reviewed. Proximal intratubular mineral deposits in normal and Randall's plaque affected papillae may be a target for future therapeutic interventions for nephrolithiasis. Further collaboration between nephrologists and urologists is necessary to cure this debilitating disease.


Assuntos
Medula Renal/metabolismo , Nefrolitíase/diagnóstico por imagem , Nefrolitíase/metabolismo , Pesquisa Biomédica , Fosfatos de Cálcio/metabolismo , Cristalização , Humanos , Cálculos Renais/metabolismo , Cálculos Renais/ultraestrutura , Medula Renal/diagnóstico por imagem , Microscopia Eletrônica , Microtomografia por Raio-X
13.
An. pediatr. (2003. Ed. impr.) ; 88(4): 204-208, abr. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-172990

RESUMO

Introducción: Las infecciones de la vía urinaria (IVU) causadas por Escherichia coli (E. coli) son frecuentes en pacientes con hipercalciuria idiopática. Al ser tanto IVU como hipercalciuria (prelitiasis) de origen genético, planteamos si la historia familiar de urolitiasis es más frecuente en niños con IVU causada por E. coli. Secundariamente, planteamos si las cicatrices renales son más frecuentes en niños con prelitiasis. Material y métodos: Estudio ambispectivo con datos de 104 pacientes (40 masculinos y 64 femeninos) seguidos tras haber sido diagnosticados, al menos una vez, de IVU por E. coli. Se preguntó por la existencia de urolitiasis en familiares (primer y segundo grado). En 80 pacientes se determinó la eliminación urinaria de calcio y citrato. Resultados: En toda la muestra, la historia familiar de urolitiasis fue positiva en una frecuencia significativamente mayor de estos niños (n = 71; 68,3%) que en la población de control del mismo área (el 29,7% según datos previos publicados). La frecuencia de prelitiasis en niños con IVU fue del 47,5% (38/80). Se observó asociación entre prelitiasis tanto con la historia familiar de urolitiasis (p = 0,030) como con el reflujo vesicoureteral (p = 0,034). Además, los pacientes que desarrollaron cicatrices renales tenían más prelitiasis (OR 5,3; p = 0,033). Conclusiones: La frecuencia de historia familiar de urolitiasis en niños con IVU causada por E. coli es muy alta. Basándonos en nuestros resultados, sugerimos la hipótesis de que la predisposición a litiasis involucra una defensa alterada contra E. coli y, consecuentemente, una mayor posibilidad de cicatrices renales


Introduction: Urinary tract infections (UTI) caused by Escherichia coli (E. coli) are common in patients with idiopathic hypercalciuria. As both UTI and hypercalciuria (prelithiasis) have a genetic basis, we wanted to know whether the family history of urolithiasis is more common in children with UTIs caused by E. coli. Secondarily, we wondered if the renal scars are more common in children with prelithiasis. Material and methods: Ambispective study with collected data from 104 patients (40 male, 64 female) followed after having been diagnosed of UTI by E. coli at least once. These patients were asked about the existence of urolithiasis in relatives. The calcium and citrate urinary elimination was qunatified in 80 children. Results: In the total sample, family history was positive for urolithiasis in a significantly higher frequency in those children (n = 71; 68.3%) than in the control population in our area (29.7%; previously published data). Prelithiasis frequency in children with UTI was 47.5% (38/80). An association was observed between the diagnosis of prelithiasis both with family history of urolithiasis (P=.030) and the diagnosis of vesicoureteral reflux (P=.034). Children who developed renal scarring had an increased risk of prelithiasis (OR 5.3; P=.033). Conclusions: The frequency of family history of urolithiasis in children with UTI caused by E. coli is very high. Based on our results we hypothesize that the predisposition to lithiasis can involve a constitutively altered defense to E. coli and, therefore, a greater possibility for renal scars


Assuntos
Humanos , Masculino , Feminino , Criança , Nefrolitíase/diagnóstico por imagem , Infecções Urinárias/etiologia , Infecções Urinárias/microbiologia , Escherichia coli/isolamento & purificação , Anamnese/métodos , Hipercalciúria/complicações , Infecções Urinárias/diagnóstico por imagem , Colorimetria/métodos , Modelos Logísticos
14.
Can J Urol ; 25(1): 9154-9160, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29524969

RESUMO

INTRODUCTION: The risks of exposure to medical ionizing radiation is of increasing concern both among medical professionals and the general public. Patients with nephrolithiasis are exposed to high levels of ionizing radiation through both diagnostic and therapeutic modalities. Endourologists who perform a high-volume of fluoroscopy guided procedures are also exposed to significant quantities of ionizing radiation. The combination of judicious use of radiation-based imaging modalities, application of new imaging techniques such as ultra-low dose computed tomography (CT) scan, and modifying use of current technology such as increasing ultrasound and pulsed fluoroscopy utilization offers the possibility of significantly reducing radiation exposure. We present a review of the literature regarding the risks of medical ionizing radiation to patients and surgeons as it pertains to the field of endourology and interventions that can be performed to limit this exposure. MATERIALS AND METHODS: A review of the current state of the literature was performed using MEDLINE and PubMed. Interventions designed to limit patient and surgeon radiation exposure were identified and analyzed. Summaries of the data were compiled and synthesized in the body of the text. RESULTS: While no level 1 evidence exists demonstrating the risk of secondary malignancy with radiation exposure, the preponderance of evidence suggests a dose and age dependent increase in malignancy risk from ionizing radiation. Patients with nephrolithiasis were exposed to an average effective dose of 37mSv over a 2 year period. Multiple evidence-based interventions to limit patient and surgeon radiation exposure and associated risk were identified. CONCLUSION: Current evidence suggest an age and dose dependent risk of secondary malignancy from ionizing radiation. Urologists must act in accordance with ALARA principles to safely manage nephrolithiasis while minimizing radiation exposure.


Assuntos
Endossonografia/efeitos adversos , Nefrolitíase/diagnóstico por imagem , Exposição Ocupacional/efeitos adversos , Exposição à Radiação/efeitos adversos , Proteção Radiológica/métodos , Endossonografia/métodos , Feminino , Humanos , Masculino , Nefrolitíase/terapia , Saúde do Trabalhador , Segurança do Paciente , Doses de Radiação , Exposição à Radiação/prevenção & controle , Tomografia Computadorizada por Raios X/efeitos adversos , Tomografia Computadorizada por Raios X/métodos , Ureteroscopia/efeitos adversos , Ureteroscopia/métodos , Urografia/efeitos adversos , Urografia/métodos , Urologia/métodos
15.
J Urol ; 199(2): 500-507, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28941916

RESUMO

PURPOSE: The study of diagnostic imaging after procedural intervention for nephrolithiasis is limited. We sought to characterize actual national imaging patterns and longitudinal trends after ureteroscopic or shock wave lithotripsy. MATERIALS AND METHODS: We analyzed the MarketScan® database and identified a nationally representative sample of insured, employed patients, 17 to 64 years old who underwent ureteroscopic or shock wave lithotripsy for nephrolithiasis between 2007 and 2014. Patients were excluded from study if they lacked at least 1 year of postoperative database enrollment or underwent a repeat nephrolithiasis procedure of any type within 90 days after the initial procedure. We identified and tracked postoperative imaging modalities by medical billing codes. RESULTS: We identified 101,554 patients treated with ureteroscopy, of whom 55% and 39% underwent no postoperative imaging within 3 and 12 months, respectively. Of the 101,590 patients treated with shock wave lithotripsy 23% and 16% underwent no postoperative imaging within 3 and 12 months, respectively. Abdominal x-ray was the most common imaging modality after either procedure type. Ultrasound use increased with time while computerized tomography decreased. In about 25% of ureteroscopy and shock wave lithotripsy cases at least 1 postoperative computerized tomography was done within a year. Female gender and older age were associated with higher imaging rates. Ultrasound was more commonly performed in the northeast region and in more densely populated areas. CONCLUSIONS: A notable portion of patients treated with ureteroscopy and a smaller percent treated with shock wave lithotripsy do not undergo any followup imaging within 1 year. In the majority who undergo imaging abdominal x-ray is done, precluding the ability to screen for hydronephrosis or silent obstruction in almost 75% of patients treated with ureteroscopy.


Assuntos
Litotripsia , Nefrolitíase/diagnóstico por imagem , Cuidados Pós-Operatórios/métodos , Padrões de Prática Médica/tendências , Adolescente , Adulto , Bases de Dados Factuais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Nefrolitíase/cirurgia , Cuidados Pós-Operatórios/estatística & dados numéricos , Cuidados Pós-Operatórios/tendências , Padrões de Prática Médica/estatística & dados numéricos , Radiografia Abdominal , Tomografia Computadorizada por Raios X , Ultrassonografia , Estados Unidos , Ureteroscopia , Adulto Jovem
16.
Urology ; 114: 49-55, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29288788

RESUMO

OBJECTIVE: To determine the efficacy of intercostal nerve block and nephrostomy tract infiltration (NTI) with ropivacaine in patients undergoing tubeless percutaneous nephrolithotomy (TPCNL). MATERIALS AND METHODS: From February 2015 to March 2017, a total of 226 patients undergoing TPCNL were enrolled. After excluding 130 patients who failed to meet the inclusion criteria, a total of 96 eligible patients were randomized into 3 groups: group I, control group (n = 32); group II, intercostal nerve block with 15 mL of 0.5% ropivacaine and epinephrine (n = 32); and group III, NTI with 20 mL of 0.25% ropivacaine and epinephrine (n = 32). Pain status was assessed at postoperative 2, 8, and 24 hours and at discharge by visual analog scale score at rest (RVAS) and on deep breathing and coughing. RESULTS: Patient demographics and perioperative data between groups were comparable except for length of stay. Mean RVAS scores at postoperative 2 and 8 hours for group III were significantly less than those for group I (RVAS at 2 hours: 2.6 vs 4.9, P = .001; RVAS at 8 hours: 1.7 vs 3.3, P = .007). Mean RVAS scores at postoperative 24 hours had borderline significance (P = .050) among the 3 groups. Differences in mean deep breathing and coughing scores among groups were statistically significant (P = .002) only in the first 2 hours. All postoperative complications (5.4%, 5 per 92) were of grade 1 and not significantly different among groups. CONCLUSION: NTI is safe and effective in alleviating early postoperative pain for patients who underwent TPCNL.


Assuntos
Nervos Intercostais/efeitos dos fármacos , Nefrolitíase/diagnóstico por imagem , Nefrolitotomia Percutânea/métodos , Nefrostomia Percutânea/métodos , Bloqueio Nervoso/métodos , Ropivacaina/administração & dosagem , Adulto , Idoso , Análise de Variância , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrolitíase/cirurgia , Nefrostomia Percutânea/instrumentação , Medição da Dor , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/prevenção & controle , Posicionamento do Paciente/métodos , Prognóstico , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia Doppler/métodos
17.
Am J Kidney Dis ; 71(1): 35-41, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28823586

RESUMO

BACKGROUND: Although recent studies suggest an association between nephrolithiasis and clinical cardiovascular events, this association has been underexplored. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: 62,091 asymptomatic adults without known coronary heart disease who underwent a screening health examination that included cardiac tomography. PREDICTOR: Nephrolithiasis. OUTCOME: Coronary artery calcification (CAC). MEASUREMENTS: Nephrolithiasis assessed using ultrasonography of the abdomen. CAC scoring assessed using cardiac computed tomography. RESULTS: The prevalence of CAC scores > 0 was 13.1% overall. Participants with nephrolithiasis had a higher prevalence of coronary calcification than those without (19.1% vs 12.8%). In Tobit models adjusted for age and sex, the CAC score ratio comparing participants with nephrolithiasis with those without nephrolithiasis was 1.56 (95% CI, 1.19-2.05). After further adjustment for screening center, year of screening examination, physical activity, alcohol intake, smoking status, education level, body mass index, family history of cardiovascular disease, total energy intake, glucose concentration, systolic blood pressure, triglyceride concentration, high-density lipoprotein cholesterol concentration, uric acid concentration, and estimated glomerular filtration rate, the CAC score ratio was attenuated, but remained significant (CAC score ratio, 1.31; 95% CI, 1.00-1.71). LIMITATIONS: Computed tomographic diagnosis of nephrolithiasis was unavailable. CONCLUSIONS: Nephrolithiasis was associated with the presence of CAC in adults without known coronary heart disease, supporting the hypothesis that these 2 health conditions share a common pathophysiology.


Assuntos
Doença da Artéria Coronariana , Vasos Coronários , Nefrolitíase , Adulto , Idoso , Doenças Assintomáticas/epidemiologia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrolitíase/diagnóstico por imagem , Nefrolitíase/epidemiologia , República da Coreia/epidemiologia , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/etiologia
18.
Urolithiasis ; 46(2): 149-155, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28260226

RESUMO

We previously developed an animal model of calcium oxalate (CaOx) deposition on the Malphigian tubules of Drosophila melanogaster as a model of urolithiasis. Here, we introduce a new tool for the study of anatomical structure for Drosophila. As a consequence of technical development, the invention of micro-computerized tomography (CT) has been introduced to the small animal, such as rat and mice. We used Drosophila as a model organism and fed the flies 0.5% lithogenic agent ethylene glycol for 3 weeks. Samples were simply prepared for further scanned by micro-CT to scan samples at 800 nm resolution. CT scanning was performed at 40 kVp of voltage, 250 µA of current, and 1750 ms of exposure time and without filter. Reconstruction of sections was carried out with the GPU-based scanner software. Specific region of interests was further analyzed by DataViewer software. Area with high radiologic density level was defined as CaOx deposition for further 3D analysis. Image of whole lithogenic Drosophila was compared with control. High radiologic density level was detected in the region of Malphigian tubules which can be identified as CaOx stones. There was no stone image in the control group. The image was the same as human non-contrast CT for the diagnosis of stone disease. Micro-CT clearly demonstrated the calcium oxalate calcifications in the Malphigian tubules of fruit fly. The image system provides that a new vision on study animal will facilitate further study of stone disease. With the development of new technology on micro-CT, more delicate and advanced image will be presented in the future.


Assuntos
Oxalato de Cálcio/metabolismo , Drosophila melanogaster , Túbulos de Malpighi/diagnóstico por imagem , Nefrolitíase/diagnóstico por imagem , Microtomografia por Raio-X/métodos , Animais , Modelos Animais de Doenças , Etilenoglicol/toxicidade , Humanos , Processamento de Imagem Assistida por Computador , Túbulos de Malpighi/patologia , Nefrolitíase/induzido quimicamente , Nefrolitíase/patologia , Software
19.
Kidney Int ; 93(1): 204-213, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28893421

RESUMO

The incidence of nephrolithiasis continues to rise. Previously, we showed that a monogenic cause could be detected in 11.4% of individuals with adult-onset nephrolithiasis or nephrocalcinosis and in 16.7-20.8% of individuals with onset before 18 years of age, using gene panel sequencing of 30 genes known to cause nephrolithiasis/nephrocalcinosis. To overcome the limitations of panel sequencing, we utilized whole exome sequencing in 51 families, who presented before age 25 years with at least one renal stone or with a renal ultrasound finding of nephrocalcinosis to identify the underlying molecular genetic cause of disease. In 15 of 51 families, we detected a monogenic causative mutation by whole exome sequencing. A mutation in seven recessive genes (AGXT, ATP6V1B1, CLDN16, CLDN19, GRHPR, SLC3A1, SLC12A1), in one dominant gene (SLC9A3R1), and in one gene (SLC34A1) with both recessive and dominant inheritance was detected. Seven of the 19 different mutations were not previously described as disease-causing. In one family, a causative mutation in one of 117 genes that may represent phenocopies of nephrolithiasis-causing genes was detected. In nine of 15 families, the genetic diagnosis may have specific implications for stone management and prevention. Several factors that correlated with the higher detection rate in our cohort were younger age at onset of nephrolithiasis/nephrocalcinosis, presence of multiple affected members in a family, and presence of consanguinity. Thus, we established whole exome sequencing as an efficient approach toward a molecular genetic diagnosis in individuals with nephrolithiasis/nephrocalcinosis who manifest before age 25 years.


Assuntos
Mutação , Nefrocalcinose/genética , Nefrolitíase/genética , Sequenciamento Completo do Exoma , Adolescente , Idade de Início , Criança , Pré-Escolar , Progressão da Doença , Feminino , Estudos de Associação Genética , Marcadores Genéticos , Predisposição Genética para Doença , Hereditariedade , Humanos , Lactente , Masculino , Nefrocalcinose/diagnóstico por imagem , Nefrocalcinose/epidemiologia , Nefrolitíase/diagnóstico por imagem , Nefrolitíase/epidemiologia , Linhagem , Fenótipo , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Tomografia Computadorizada por Raios X , Ultrassonografia , Adulto Jovem
20.
Pediatr. aten. prim ; 19(76): 367-371, oct.-dic. 2017. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-169604

RESUMO

La incidencia de litiasis renal se ha multiplicado por cinco en las últimas décadas, siendo la modificación de los patrones alimenticios una de las principales causas. La recurrencia de la enfermedad es muy frecuente si no se diagnostican las causas y se tratan precozmente. La hipercalciuria es la causa más frecuente de litiasis en la infancia, pero existen otras alteraciones metabólicas implicadas que deben descartarse (AU)


Renal lithiasis incidence has increased in recent decades, being one of the main causes the changes of eating paterns. Recurrence of the disease is very frequent if the causes are not diagnosed and treated early. Hypercalciuria is the most frequent cause of childhood lithiasis, but there are other metabolic alterations involved that should be ruled out (AU)


Assuntos
Humanos , Feminino , Pré-Escolar , Nefrolitíase/diagnóstico por imagem , Hipercalciúria/complicações , Litotripsia , Vômito/etiologia , Dor Abdominal/etiologia
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