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1.
Urologe A ; 58(11): 1304-1312, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31506761

RESUMO

The increase of medical knowledge and technical innovations together with the demographic change represent a challenge for the new conception of guidelines and clinical studies. The present S2k guidelines, which are exclusively concerned with kidney and ureteral stones, should support the treatment of urolithiasis in hospitals and private practices and provide information on urolithiasis for patients. Increasing interdisciplinary collaboration in stone treatment is also demonstrated in the number of professional and working groups participating in the update of the new guidelines. The present S2k guidelines emerged from a consensus process and demonstrate the current recommendations in step with actual practice. They provide decision-making guidance for diagnostics, treatment and metaphylactic measures based on expert opinions and available published fundamental evidence from the literature.


Assuntos
Litotripsia/normas , Guias de Prática Clínica como Assunto , Ureteroscopia/normas , Urolitíase/cirurgia , Procedimentos Cirúrgicos Urológicos/normas , Urologia/normas , Tratamento por Ondas de Choque Extracorpóreas , Humanos , Cálculos Renais , Nefrolitotomia Percutânea , Resultado do Tratamento , Cálculos Ureterais , Urolitíase/diagnóstico , Urolitíase/prevenção & controle , Procedimentos Cirúrgicos Urológicos/instrumentação
2.
Nutrients ; 11(8)2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31344950

RESUMO

Our purpose was to study the relationship of adherence to the Mediterranean diet (MedDiet) with urinary factors that favor the formation of renal calcium and uric acid stones in overweight and obese participants who had metabolic syndrome. This cross-sectional study examined 267 participants. A well-known MedDiet score (range 0-9) was calculated for each patient, and patients were then categorized has having low (≤3), medium (4-5), or high (≥6) adherence to the MedDiet. Baseline characteristics and urinary parameters were also analyzed. High calcium salt urinary crystallization risk (CaUCR) and high uric acid urinary crystallization risk (UrUCR) were calculated from urinary parameters using pre-defined criteria. More than half of patients with MedDiet scores ≤3 had high UrUCR (55.4%) and high CaUCR (53.8%). In contrast, fewer patients with high adherence (≥6) to the MedDiet had high UrUCR (41.2%) and high CaUCR (29.4%). Relative to those with low adherence, individuals with high adherence had a prevalence ratio (PR) of 0.77 for a high UrUCR (95% CI: 0.46-1.12; p for trend: 0.069) and a PR of 0.51 for a high CaUCR (95% CI: 0.26-0.87; p for trend: 0.012) after adjusting for age, sex, body mass index, type 2 diabetes, and total energy intake. Our findings indicate that greater adherence to the MedDiet was associated with a reduced CaUCR and a reduced UrUCR. This suggests that adequate dietary management using the MedDiet patterns may prevent or reduce the incidence and recurrence of calcium salt and uric acid renal stones.


Assuntos
Dieta Mediterrânea , Síndrome Metabólica/dietoterapia , Sobrepeso/dietoterapia , Cooperação do Paciente , Urolitíase/prevenção & controle , Idoso , Biomarcadores/urina , Estudos Transversais , Comportamento Alimentar , Feminino , Humanos , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/urina , Pessoa de Meia-Idade , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Sobrepeso/urina , Prevalência , Fatores de Proteção , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Medição de Risco , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Urolitíase/diagnóstico , Urolitíase/epidemiologia , Urolitíase/urina
3.
Int Urol Nephrol ; 51(7): 1129-1135, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31089946

RESUMO

PURPOSE: To determine the value of 24-h urine osmolality (UOsm) as a representative index of adequate hydration and predictor of stone recurrence in patients with urolithiasis. METHODS: Medical records of consecutive patients presenting with renal or ureteric stones between 1994 and 2017 were retrospectively reviewed. Patients were grouped according to the results of 24-h UOsm (low ≤ 564 mOsm/kg H2O, high > 564 mOsm/kg H2O). Metabolic parameters and risk of stone recurrence were compared between the two groups. RESULTS: The low urine concentration group were more likely to be older, to be female, and to have a lower body mass index and higher glomerular filtration rate than the high concentration group (each P < 0.005). A positive correlation was seen between 24-h UOsm and urinary calcium, sodium, uric acid, and magnesium excretion and 24-h specific gravity; a negative correlation was seen with 24-h urine volume. Stone-forming constituents, such as calcium and uric acid, were significantly higher in the high urine concentration group. Kaplan-Meier estimates showed that the low urine concentration group had a significantly longer stone recurrence-free period than the high urine concentration group (log-rank test, P < 0.001). In multivariate Cox regression analyses, 24-h UOsm was seen to be an independent risk factor for stone recurrence. CONCLUSIONS: UOsm is a promising approach to assessing hydration and predicting stone recurrence in patients with urolithiasis. Maintaining UOsm < 564 mOsm/kg H2O may reduce the risk of stone recurrence.


Assuntos
Estado de Hidratação do Organismo , Prevenção Secundária/métodos , Urolitíase , Fatores Etários , Índice de Massa Corporal , Correlação de Dados , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , República da Coreia , Medição de Risco/métodos , Fatores Sexuais , Urinálise/métodos , Urolitíase/diagnóstico , Urolitíase/metabolismo , Urolitíase/prevenção & controle , Urolitíase/terapia
4.
Int J Health Care Qual Assur ; 32(1): 2-10, 2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30859863

RESUMO

PURPOSE: Adherence to preventive recommendations improves clinical outcomes and is compulsory for long-term prevention in urolithiasis patients. Service quality can affect patients' adherence to treatment and care. The purpose of this paper is to compare perceived service quality, using the SERVQUAL model, between urolithiasis patients who were nonadherent to their follow-up visits and those who were adherent, in a stone prevention clinic, Tehran, Iran. DESIGN/METHODOLOGY/APPROACH: This was a cross-sectional study on patients with urolithiasis referred to the Shahid-Labbafinejad Hospital stone prevention clinic between 2010 and 2014. All patients withdrawing from follow-up visits were selected as the nonadherent group. Patients with follow-up visits were randomly selected and appointed as the adherent group. Data included demographic, service quality (assessed using the SERVQUAL) and a questionnaire about the reason for withdrawal from follow-up visits. Man-Whitney U test, χ2 and binary logistic regression were used for data analyses. FINDINGS: In total, 531 nonadherent and 51 adherent patients entered the study. SERVQUAL results revealed that patients' expectations were significantly higher than their perceptions in all five service quality dimensions in both groups. The adherent group had better-quality scores. Responsibility, assurance and empathy scores significantly increased patient adherence odds. RESEARCH LIMITATIONS/IMPLICATIONS: Uni-center design; missing data, such as socioeconomic status and disease severity, which may influence treatment adherence; and missing data regarding adherence to medication and dietary advice were limitations. PRACTICAL IMPLICATIONS: Service quality needs to be improved in all dimensions. ORIGINALITY/VALUE: Since responsiveness, assurance and empathy dimensions determined patients' adherence, giving special attention to these dimensions could improve patient adherence.


Assuntos
Assistência Ambulatorial/organização & administração , Atitude Frente a Saúde , Cooperação do Paciente/estatística & dados numéricos , Prevenção Primária/organização & administração , Qualidade da Assistência à Saúde , Urolitíase/prevenção & controle , Centros Médicos Acadêmicos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas
5.
Crit Rev Food Sci Nutr ; 59(13): 2125-2135, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29432040

RESUMO

In the urinary system, urolithiasis is the third prevalent disorder which causes severe pain in individuals. Urinary stones are composed of calcium oxalate (CaOx) and calcium phosphate in approximately 80% of patients. Although various drugs and surgery operations are used to treat the disease, side effects of drugs and the high recurrence after therapy in patients cannot be ignored. Flavonoids are a large group of plant polyphenols with presumed beneficial effects on several common diseases. Whereas, a very few have reached clinical use. The results of recent studies have shown that the plant flavonoids could effectively inhibit the formation of CaOx stones in vitro and in vivo, correlating with their diuretic, antioxidant, anti-inflammatory, antibacterial properties and other protective effects. Thus, the flavonoids or flavonoid-rich plant extracts endowed with anti-urolithiasis activities and probable mechanisms of actions were reviewed. In addition, we also put forward some issues needed to be concerned in future investigations as well as offered prospects and challenges for developing the plant flavonoids into drugs for stone prevention.


Assuntos
Flavonoides/farmacologia , Cálculos Renais/prevenção & controle , Extratos Vegetais/farmacologia , Urolitíase/prevenção & controle , Antibacterianos/farmacologia , Anti-Inflamatórios/farmacologia , Antioxidantes/farmacologia , Oxalato de Cálcio , Fosfatos de Cálcio , Flavonoides/química , Flavonoides/classificação , Frutas/química , Humanos , Rim/efeitos dos fármacos , Fitoterapia , Folhas de Planta/química , Polifenóis/farmacologia , Sementes/química
6.
Nephrology (Carlton) ; 24(1): 17-20, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29055055

RESUMO

AIM: This case/control study aimed to assess the impact of two single nucleotide polymorphisms (SNPs) in the promoter region of CDH1 gene (-160C>A and -347G>GA) on urinary stone formation in a sample of Iraqi children. METHODS: Forty-seven children with urolithiasis and 50 age- and gender-matched healthy controls were included in the study. DNA was isolated from peripheral blood and direct sequencing was used for genotyping. RESULTS: The homozygous genotype of the SNP CHD1 -160C>A was more frequent in control than cases (18% vs. 6.38%) with significant difference (OR = 0.229, 95%CI = 0.056-0.943, P = 0.041). Furthermore, cases showed significantly less frequency of the mutant allele (allele A) of this SNP (OR = 0.403, 95%C = 0.210-0.776, P = 0.007). CONCLUSION: These results strongly indicate a protective role of allele A of the SNP CHD1 -160C>A against urinary calculi formation in children.


Assuntos
Antígenos CD/genética , Caderinas/genética , Polimorfismo de Nucleotídeo Único , Urolitíase/genética , Fatores Etários , Estudos de Casos e Controles , Criança , Feminino , Frequência do Gene , Estudos de Associação Genética , Predisposição Genética para Doença , Heterozigoto , Homozigoto , Humanos , Iraque/epidemiologia , Masculino , Fenótipo , Regiões Promotoras Genéticas , Fatores de Proteção , Fatores de Risco , Urolitíase/diagnóstico , Urolitíase/epidemiologia , Urolitíase/prevenção & controle
7.
Acta Biomed ; 89(9-S): 76-80, 2018 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-30561398

RESUMO

BACKGROUND AND AIM OF THE WORK: Historical studies have demonstrated that the prevalence of symptomatic nephrolithiasis is higher in patients with inflammatory bowel disease (IBD), compared to general population. The aim of the review was to analyze literature data in order to identify the main risk conditions described in literature and the proposed treatment. METHODS: A research on the databases PubMed, Medline, Embase and Google Scholar was performed by using the keywords "renal calculi/lithiasis/stones" and "inflammatory bowel diseases". A research on textbooks of reference for Pediatric Nephrology was also performed, with focus on secondary forms of nephrolithiasis. RESULTS: Historical studies have demonstrated that the prevalence of symptomatic nephrolithiasis is higher in patients with inflammatory bowel disease (IBD), compared to general population, typically in patients who underwent extensive small bowel resection or in those with persistent severe small bowel inflammation. In IBD, kidney stones may arise from chronic inflammation, changes in intestinal absorption due to inflammation, surgery or intestinal malabsorption. Kidney stones are more closely associated with Crohn's Disease (CD) than Ulcerative Colitis (UC) in adult patients for multiple reasons: mainly for malabsorption, but in UC intestinal resection may be an additional risk. Nephrolithiasis is often under-diagnosed and might be a rare but noticeable extra-intestinal presentation of pediatric IBD. Secondary enteric hyperoxaluria the main risk factor of UL in IBD, this has been mainly studied in CD, whether in UC has not been completely explained. In the long course of CD recurrent urolithiasis and calcium-oxalate deposition may cause severe chronic interstitial nephritis and, as a consequence, chronic kidney disease. ESRD and systemic oxalosis often develop early, especially in those patients with multiple bowel resections. Even if we consider that many additional factors are present in IBD as hypomagnesuria, acidosis, hypocitraturia, and others, the secondary hyperoxaluria seems to finally have a central role. Some medications as parenteral vitamin D, long-term and high dose steroid treatment, sulfasalazine are reported as additional risk factors. Hydration status may also play an important role in this process. Intestinal surgery is a widely described independent risk factor. Patients with ileostomy post bowel resection may have relative dehydration from liquid stool, which, added to the acidic pH from bicarbonate loss, is responsible for this process. In this acidic pH, the urinary citrate level excretion reduces. The stones most commonly seen in these patients contain uric acid or are mixed. In addition, the risk of calcium containing stones also increases with ileostomy. The treatment of UL in IBD involves correction of the basic gastrointestinal tract inflammation, restricted dietary oxalate intake, and, at times, increased calcium intake. Citrate therapy that increases both urine pH and urinary citrate could also provide an additional therapeutic benefit. Finally, patients with IBD in a pediatric study had less urologic intervention for their calculosis compared with pediatric patients without IBD.


Assuntos
Doenças Inflamatórias Intestinais/complicações , Urolitíase/etiologia , Bicarbonatos/uso terapêutico , Criança , Citratos/uso terapêutico , Desidratação/complicações , Suscetibilidade a Doenças , Humanos , Inflamação , Doenças Inflamatórias Intestinais/fisiopatologia , Doenças Inflamatórias Intestinais/cirurgia , Síndromes de Malabsorção/etiologia , Síndromes de Malabsorção/fisiopatologia , Oxalatos/metabolismo , Risco , Urolitíase/tratamento farmacológico , Urolitíase/prevenção & controle
8.
PLoS One ; 13(8): e0198881, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30157195

RESUMO

OBJECTIVE: To identify in vitro inhibitors of xanthine crystallization that have potential for inhibiting the formation of xanthine crystals in urine and preventing the development of the renal calculi in patients with xanthinuria. METHODS: The formation of xanthine crystals in synthetic urine and the effects of 10 potential crystallization inhibitors were assessed using a kinetic turbidimetric system with a photometer. The maximum concentration tested for each compound was: 20 mg/L for 3-methylxanthine (3-MX); 40 mg/L for 7-methylxanthine (7-MX), 1-methylxanthine (1-MX), theobromine (TB), theophylline, paraxanthine, and caffeine; 45 mg/L for 1-methyluric acid; 80 mg/L for 1,3-dimethyluric acid; and 200 mg/L for hypoxanthine. Scanning electron microscopy was used to examine the morphology of the crystals formed when inhibitory effects were observed. RESULTS: Only 7-MX, 3-MX, and 1-MX significantly inhibited xanthine crystallization at the tested concentrations. Mixtures of inhibitors had an additive effect rather than a synergistic effect on crystallization. CONCLUSION: Two of the inhibitors identified here-7-MX and 3-MX-are major metabolites of TB. In particular, after TB consumption, 20% is excreted in the urine as TB, 21.5% as 3-MX, and 36% as 7-MX. Thus, consumption of theobromine could protect patients with xanthinuria from the development of renal xanthine calculi. Clinical trials are necessary to demonstrate these effects in vivo.


Assuntos
Precipitação Química/efeitos dos fármacos , Cálculos Renais/química , Cálculos Renais/prevenção & controle , Urolitíase , Xantina/química , Xantinas/farmacologia , Aldeído Oxidase/deficiência , Aldeído Oxidase/urina , Cristalização , Regulação para Baixo/efeitos dos fármacos , Humanos , Técnicas In Vitro , Erros Inatos do Metabolismo/prevenção & controle , Erros Inatos do Metabolismo/urina , Erros Inatos do Metabolismo da Purina-Pirimidina/prevenção & controle , Erros Inatos do Metabolismo da Purina-Pirimidina/urina , Urolitíase/prevenção & controle , Urolitíase/urina , Xantina/antagonistas & inibidores , Xantina/urina , Xantina Desidrogenase/deficiência , Xantina Desidrogenase/urina
9.
Curr Opin Urol ; 28(5): 408-413, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29894322

RESUMO

PURPOSE OF REVIEW: Urolithiasis is a very common condition, which can be accompanied by serious complications. Diagnosis, treatment, and prevention are of great cost for national health systems. Many studies have been published about the role of diet in both stone formation and prevention. The aim of this review is to summarize the most recent developments that correlate diet to lithiasis. RECENT FINDINGS: Recurrent stone formers should undergo metabolic evaluation and stone chemical analysis. Current evidence propose difference approaches based on the metabolic disorder that is diagnosed. Diet could have a detrimental role in the prevention of recurrences. Prevention advises include increased fluid uptake, vegetables and fruit intake but decreased sugar, salt, and meat consumption. SUMMARY: The analysis of the food contents and their role to lithogenesis prevention are of great importance. Modifying diet to prevent stones could help many people who suffer from lithiasis to avoid recurrence and the consequences. Furthermore, the cost for diagnosis and treatment could be significantly reduced. Therefore, the field of dietary factors in lithogenesis should be further investigated.


Assuntos
Dieta/estatística & dados numéricos , Urolitíase/epidemiologia , Cálcio na Dieta , Citratos , Comportamento de Ingestão de Líquido , Humanos , Magnésio , Proteínas de Carne , Oxalatos , Fatores de Risco , Sódio na Dieta , Urolitíase/dietoterapia , Urolitíase/prevenção & controle
10.
Med Sci Monit ; 24: 1924-1929, 2018 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-29605825

RESUMO

BACKGROUND Urine solute supersaturation leads to the formation of urinary tract caliceal stones. Many parameters can be involved in the supersaturation of solutes in urine, such as pH. Uric acid has pKa ≤5.5, and it is solubilized at pH ≥5.5. The objective of the study was to evaluate the effects of potassium citrate and lemonade supplementation in pediatric patients with urolithiasis. MATERIAL AND METHODS A total of 126 children who had lower ureteral stones calculi and fragments with severe colic pain participated in this cross-over study. Children drank lemonade (2 mEq/kg/day citrate) in 3 divided doses for 5 days. After a 15-day washout period, children drank 2 mEq/kg/day of potassium citrate in 3 divided doses for 5 days. On the sixth of the day of individual intervention, a 24-h urine sample was collected and evaluated for pH, urine volume, citrate level, uric acid level, magnesium, phosphorus, potassium, and sodium. Urinary parameters for 1-day urine collection measurements after each supplementation were compared with baseline using the Mann-Whitney test following Tukey post hoc test at 95% confidence level. RESULTS Potassium citrate supplementation resulted in reduction of sodium concentration (p=0.0337; q=3.76) and increased pH of urine (p=0.0118; q=4.389). However, urine volume, citrate level, and uric acid level, as well as elemental magnesium, phosphorus, and potassium, remained unchanged after 5 days of supplementation with potassium citrate or lemonade. CONCLUSIONS Potassium citrate supplementation is an effective therapy for preventing pediatric urolithiasis, with acceptable adverse effects.


Assuntos
Sucos de Frutas e Vegetais , Citrato de Potássio/uso terapêutico , Urolitíase/prevenção & controle , Criança , Citrus , Estudos Cross-Over , Feminino , Humanos , Concentração de Íons de Hidrogênio , Cálculos Renais/prevenção & controle , Masculino , Ácido Úrico/urina , Urolitíase/urina
12.
Int J Mol Sci ; 19(3)2018 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-29518971

RESUMO

Kidney stones are one of the oldest known and common diseases in the urinary tract system. Various human studies have suggested that diets with a higher intake of vegetables and fruits play a role in the prevention of kidney stones. In this review, we have provided an overview of these dietary plants, their main chemical constituents, and their possible mechanisms of action. Camellia sinensis (green tea), Rubus idaeus (raspberry), Rubia cordifolia (common madder), Petroselinum crispum (parsley), Punica granatum (pomegranate), Pistacia lentiscus (mastic), Solanum xanthocarpum (yellow-fruit nightshade), Urtica dioica (stinging nettle), Dolichos biflorus (horse gram), Ammi visnaga (khella), Nigella sativa (black-cumin), Hibiscus sabdariffa (roselle), and Origanum vulgare (oregano) have received considerable interest based on scientific evidence. Beside these dietary plants, phytochemicals-such as catechin, epicatechin, epigallocatechin-3-gallate, diosmin, rutin, quercetin, hyperoside, and curcumin-as antioxidant dietary phyto-phenols were found to be effective for the prevention of urolithiasis (the process of stone formation in the urinary tract). The main underlying mechanisms of these dietary plants and their isolated phytonutrients in the management of urolithiasis include diuretic, antispasmodic, and antioxidant activity, as well as an inhibitory effect on crystallization, nucleation, and aggregation of crystals. The results as presented in this review demonstrate the promising role of dietary plants and phytophenols in the prevention and management of kidney stones. Further investigations are required to confirm the safety and efficacy of these compounds.


Assuntos
Dieta , Cálculos Renais/prevenção & controle , Cálculos Renais/terapia , Plantas Comestíveis , Animais , Estudos Clínicos como Assunto , Suplementos Nutricionais , Gerenciamento Clínico , Avaliação Pré-Clínica de Medicamentos , Frutas , Humanos , Cálculos Renais/etiologia , Compostos Fitoquímicos/química , Compostos Fitoquímicos/farmacologia , Extratos Vegetais/química , Extratos Vegetais/farmacologia , Plantas Medicinais/química , Prevenção Primária , Urolitíase/etiologia , Urolitíase/prevenção & controle , Urolitíase/terapia , Verduras
13.
J Endourol ; 32(5): 387-392, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29444590

RESUMO

In this review, a simplified straightforward algorithmic approach to the metabolic evaluation and treatment of the at-risk or recurrent urolithiasis patient is provided. Eight diagnoses and eight therapies are provided, which cover over 95% of renal stone disease.


Assuntos
Urolitíase/terapia , Algoritmos , Humanos , Recidiva , Fatores de Risco , Prevenção Secundária/métodos , Urolitíase/diagnóstico , Urolitíase/metabolismo , Urolitíase/prevenção & controle
14.
J Nephrol ; 31(2): 189-196, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29368300

RESUMO

Hyperuricosuric calcium urolithiasis is a condition of mixed calcium oxalate stones characterized by hyperuricosuria either in isolation or in conjunction with other risk factors for calcium oxalate stones such as hypercalciuria, hyperoxaluria, and hypocitraturia. There are three proposed physicochemical models of pathogenesis where urate in its crystalline phase via heterogeneous nucleation, in its colloidal phase via removal of crystallization inhibitors, and in solution via precipitation crystallization, can all increase propensity to calcium oxalate precipitation. Regardless of the model, the phenomenologic observation of urate increasing calcium oxalate precipitation appears solid. Another supporting factor are retrospective data analysis and prospective trials showing uric acid lowering reduces stones events in hyperuricosuric calcium stone formers. Due to the heterogeneity of pathogenesis of calcium oxalate stones in the unselected stone-formers, association cannot be demonstrated between uric acid excretion rate and risk of kidney stone the general population. In calcium oxalate stoners with isolated hyperuricosuria or hyperuricosuria in combination with other calcium stone risks where treatment of these traditional risks fails to reduce stone formation, urate acid lowering should be cautiously attempted. More refinement of pathogenic models and prospective controlled trials in phenotypically defined subgroups of subjects with calcium oxalate urolithiasis will be informative.


Assuntos
Oxalato de Cálcio/química , Ácido Úrico/química , Ácido Úrico/urina , Urolitíase/etiologia , Urolitíase/urina , Alopurinol/uso terapêutico , Fenômenos Químicos , Supressores da Gota/uso terapêutico , Humanos , Hipercalciúria/complicações , Fatores de Risco , Urolitíase/prevenção & controle
15.
Am J Emerg Med ; 36(4): 699-706, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29321112

RESUMO

BACKGROUND: Urolithiasis is a common condition in the U.S. Patients frequently present to the emergency department (ED) for care, including analgesia and treatments to facilitate stone passage. OBJECTIVE: With the new evidence concerning the evaluation and treatment of urolithiasis, this review summarizes current literature regarding the ED management of urolithiasis. DISCUSSION: Urolithiasis occurs primarily through supersaturation of urine and commonly presents with flank pain, hematuria, and nausea/vomiting. History, examination, and assessment with several laboratory tests are cornerstones of evaluation. Urinalysis is not diagnostic, but it may be used in association with other assessments. Risk assessment tools and advanced imaging can assist with diagnosis. Computed tomography (CT) is often considered the gold standard. Newer low-dose CT imaging may reduce radiation. Recent studies support ultrasound as an alternate diagnostic modality, especially in pediatric and pregnant patients. Nonsteroidal anti-inflammatory drugs remain first-line therapy, with opioids or intravenous lidocaine reserved for refractory pain. Tamsulosin can increase passage in larger stones but has not demonstrated benefit in smaller stones. Nifedipine and intravenous fluids are not recommended to facilitate passage. Surgical intervention is based upon stone size, duration, and modifying factors. Patients who are discharged should be advised on dietary changes. CONCLUSION: Urolithiasis is a common disease increasing in prevalence with the potential for significant morbidity. Focused evaluation with history, examination, and testing is important in diagnosis and management. Understanding the clinical features, risk assessment tools, imaging options, and treatment options can assist emergency physicians in the management of urolithiasis.


Assuntos
Serviço Hospitalar de Emergência , Urolitíase/diagnóstico , Urolitíase/terapia , Humanos , Manejo da Dor , Educação de Pacientes como Assunto , Medição de Risco , Tomografia Computadorizada por Raios X , Urinálise , Urolitíase/fisiopatologia , Urolitíase/prevenção & controle
16.
J Relig Health ; 57(1): 26-32, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27342410

RESUMO

The aim of this study was to compare the compliance for water intake and rate of recurrence between spiritually motivated and non-motivated patients of renal tract stone disease. It is a multi centric prospective cohort study, conducted in Department of Urology, Institute of Kidney Diseases and Peshawar Medical College, from January 10, 2009 to December 2012. A total of 180 patients with comparable demographic, IQ, EQ and BMI after achieving complete stone clearance were divided into two equal groups. Both groups were instructed to increase the water intake timetable according to AUA guidelines. Group 'A' comprising of 90 patients who were identified as spiritually motivated patients based on questioner of FICA 12 is also instructed that increasing the water intake is mentioned in contemporary Islamic medicine. No spiritual instruction was given to Group B. The instructed guidelines and practice for amount and timing of water intake were recalled from participants at the end of 6 and 12 months. The data were recorded on structured proforma and was analyzed using SPSS version 17. The mean age of the patient in Group A was 37.5 years (18-70 years), while in Group B it was 34 years (18-65 years). Urolithiasis affected predominantly male gender in both groups. Sixty-five patients (72.2 %) in Group A have significant compliance (p < 0.001) for water intake over Group B (46 %). The spiritually motivated Group A has significantly reduced rate of recurrence of stones in 23 patients versus 37 in Group B. The spiritually motivated patients had significantly better compliance for water intake and reduced rate of recurrence versus non-motivated individuals in urolithiasis.


Assuntos
Ingestão de Líquidos/fisiologia , Cooperação do Paciente/psicologia , Espiritualidade , Urolitíase/prevenção & controle , Adulto , Humanos , Masculino , Paquistão/epidemiologia , Cooperação do Paciente/etnologia , Estudos Prospectivos , Recidiva , Urolitíase/epidemiologia , Urolitíase/psicologia
17.
Int Urol Nephrol ; 50(2): 231-236, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29197934

RESUMO

PURPOSE: To investigate whether atorvastatin has favorable effects on urinary metabolic risk factors associated with urolithiasis. METHODS: Sixteen male Sprague-Dawley rats were randomly divided into two groups, and baseline spot and 24-h urine samples were collected. Distilled water and atorvastatin were administered to rats during 4 weeks in the control and atorvastatin groups, respectively. At the end of the experimental procedure, spot and 24-h urine samples were collected again. Citrate, oxalate, cystine, uric acid, calcium and magnesium levels were determined in 24-h urine samples. Citrate/creatinine, oxalate/creatinine, uric acid/creatinine, calcium/creatinine and magnesium/creatinine ratios were also calculated in spot urine samples. Comparison of the baseline and post-experimental levels of these parameters was made in each group. RESULTS: The majority of the parameters were similar before and after the experimental procedure in each group. In the atorvastatin group, uric acid and calcium levels were affected. Administration of atorvastatin was significantly decreased the levels of uric acid, whereas increased the levels of calcium (P = 0.025 and P = 0.017, respectively). CONCLUSIONS: Our study revealed that atorvastatin has decreasing effect on UUa levels, whereas increasing effect on UCa levels. We think it cannot certainly be deduced that atorvastatin could be beneficial on overall urinary metabolic risk factors. Contrarily, atorvastatin may lead to an increased risk of calcium stones, but when considering its UUa decreasing effect, it may help in reducing the uric acid stone recurrence.


Assuntos
Atorvastatina/farmacologia , Cálcio/urina , Ácido Úrico/urina , Urolitíase , Animais , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Masculino , Ratos , Ratos Sprague-Dawley , Fatores de Risco , Resultado do Tratamento , Urinálise/métodos , Urolitíase/metabolismo , Urolitíase/prevenção & controle
18.
Prog Urol ; 27(16): 1058-1067, 2017 Dec.
Artigo em Francês | MEDLINE | ID: mdl-29102377

RESUMO

OBJECTIVE: In Morocco, as in many countries, a large number of patients use medicinal plants to treat their disease including urinary lithiasis. The aim of the present work is to study the antilithiasic effect of Erica multiflora aqueous extract, purported for its antilithiasic effect in the oriental region of Morocco. METHODS: E. multiflora aqueous extract was studied in two oxalo-calcic models of rats rendered experimentally lithiasic. Urinary biochemistry parameters were measured and histological slides of kidneys were analyzed. The effect of the extract was also tested in a magnesium ammonium phosphate crystallization model in vitro. The number of crystals and their size in presence and absence of extract were compared. RESULTS: E. multiflora extract did not inhibit the development of parenchymal and papillary calcifications and therefore did not prevent calcium oxalate crystallization into kidneys. Even if there was an increase in urinary pH and diuresis, the plant extract did not show a significant inhibitory activity against calcium oxalate crystallization. However, the plant extract exerted an efficient antilithiasic activity toward struvite crystallization inhibiting the formation of crystals by reduction of their size and numbers as well as their aggregation. CONCLUSION: E. multiflora aqueous extract need to be used in the inhibition and elimination of magnesium ammonium phosphate crystals rather than calcium oxalate ones. LEVEL OF EVIDENCE: 3.


Assuntos
Oxalato de Cálcio , Ericaceae , Fitoterapia , Extratos Vegetais/uso terapêutico , Estruvita , Urolitíase/prevenção & controle , Animais , Masculino , Ratos , Ratos Wistar
19.
J Med Life ; 10(3): 188-193, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29075349

RESUMO

Urolithiasis is a significant social and financial problem. According to contemporary literature data, 1-5% of the global population suffers from urolithiasis. The prevalence of this disease is about 10% of the population of the Republic of Moldova. Scientific and practical researches in the field of urology, and especially those devoted to renal lithiasis, focus on the diagnosis and treatment process, giving little importance to the cause of formation, metabolic disturbances, and especially to prophylaxis and metaphylaxis of the disease recurrence. However, the impact of this disease may be diminished by specialized or general metaphylaxis treatment. The article presents results of the analysis of different methods of metaphylaxis of recurrent urolithiasis. The implementation of metaphylaxis measures significantly reduces the rate and risk of recurrence in patients with recurrent urolithiasis. Specialized metaphylaxis treatment reduces the risk of lithiasis recurrence 5 times and general metaphylaxis - 2 times compared to the lack of metaphylaxis, which requires this treatment to prevent the recurrence of urolithiasis.


Assuntos
Urolitíase/prevenção & controle , Urolitíase/terapia , Adolescente , Adulto , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Recidiva , Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
Medicine (Baltimore) ; 96(42): e6933, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29049166

RESUMO

RATIONALE: Urinary lithiasis is one of severe postoperative complications in patients undergoing renal transplantation, possibly leading to anuria, urinary infection, or even acute renal failure. Potassium sodium hydrogen citrate (PSHC), a potassium-bearing citrate, is commonly prescribed to prevent stone formation. PATIENT CONCERNS: A 25-year-old man (patient 1) and a 31-year-old man (patient 2) receiving renal transplantation for end-stage renal disease (ESRD) were enrolled in this study. They were given 10 g/day of PSHC granules from the ninth day to the 17th day after surgery. Patient 1 presented chest tightness, nausea, muscle weakness, and ascending paralysis on the 10th day. Patient 2 presented weak waves on EGG on the 17th day. Moreover, their serum potassium concentrations (SPCs) were 7.67 and 6.05 mmol/L, respectively. DIAGNOSIS: Acute hyperkalemia. INTERVENTIONS: Hemo-filtration was performed for patient 1, while patient 2 received 10% calcium gluconate 10 mL, 5% NaHCO3 125 mL, and 10% glucose 500 mL with the addition of 10 units of insulin through intravenous drip. OUTCOMES: Their SPCs dropped to the normal range. LESSONS: Physicians should pay close attentions to potential risks caused by PSHC, and monitor the SPCs to minimize the occurrence of hyperkalemia.


Assuntos
Diuréticos/efeitos adversos , Hiperpotassemia/induzido quimicamente , Complicações Pós-Operatórias/prevenção & controle , Citrato de Potássio/efeitos adversos , Urolitíase/prevenção & controle , Adulto , Diuréticos/administração & dosagem , Humanos , Transplante de Rim/efeitos adversos , Masculino , Complicações Pós-Operatórias/etiologia , Citrato de Potássio/administração & dosagem , Urolitíase/etiologia
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