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1.
Ann Biol Clin (Paris) ; 77(4): 381-389, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31418699

RESUMO

The SFBC working group aimed to deal with biological tests outside the french nomenclature that may be useful in the context of urinary exploration of metabolism. This section will be divides into three parts: 1) nutritional assessment using urinary urea; 2) metabolic assessment of urolithiasis; 3) exploration of tubulopathies. National and international recommendations support the evaluation of nutritional status from urea measurements in urine and dialysate with the following indications: primary metabolic evaluation of urolithiasis patients, monitoring of protein intake in chronic renal failure stage 3 or stage 5D with residual diuresis. For the management of the urolithiasis disease, biomedical tests recommended by the national and international guidelines are the measurement of the urinary density using refractometry in the primary metabolic evaluation as well as the determination of oxalemia in the diagnosis (patients with GFR< 30 mL/min/1.73 m2) and follow-up (patients with GFR< 60 mL/min/1.73 m2) of primary hyperoxaluria. The determination of the bicarbonaturia is retained for the in depth exploration of urolithiasis and tubular acidosis. The measure of chlore in urine is used to evaluate the volume status during metabolic alkalosis and to calculate the urinary anionic gap during metabolic acidosis.


Assuntos
Metabolismo Energético/fisiologia , Nefropatias/diagnóstico , Avaliação Nutricional , Urinálise/métodos , Urolitíase/diagnóstico , Humanos , Nefropatias/patologia , Nefropatias/urina , Túbulos Renais/patologia , Padrões de Referência , Refratometria/métodos , Refratometria/normas , Urinálise/normas , Urolitíase/urina
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.
J Vet Intern Med ; 33(2): 758-763, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30851134

RESUMO

BACKGROUND: There are abnormalities in vitamin D metabolism in people with calcium nephrolithiasis, but limited data are available on vitamin D status in dogs with calcium oxalate (CaOx) urolithiasis. OBJECTIVE: To compare serum concentrations of vitamin D metabolites in dogs with and without hypercalciuric CaOx urolithiasis. ANIMALS: Thirty-eight dogs with (n = 19) and without (n = 19) a history of CaOx urolithiasis and hypercalciuria. METHODS: Retrospective cross-sectional study. Serum 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)2 D], and 24,25-dihydroxyvitamin D [24,25(OH)2 D] were measured. The ratios of 25(OH)D/24,25(OH)2 D and 1,25(OH)2 D/25(OH)D were compared between cases and controls. RESULTS: There were no significant differences between cases and controls when comparing 25(OH)D, 24,25(OH)2 D, 1,25(OH)2 D, or 1,25(OH)2 D/25(OH)D. Cases had higher 25(OH)D/24,25(OH)2 D (median = 1.40, range = 0.98-1.58) compared to controls (median = 1.16, range = 0.92-2.75; P = .01). There was overlap in the ranges for 25(OH)D/24,25(OH)2 D between cases and controls, but 6 cases (32%) had ratios above the control dog range. There was a moderate positive correlation between the ratio of 25(OH)D/24,25(OH)2 D and urinary calcium-to-creatinine ratios (r = 0.40, 95% confidence interval = 0.10-0.64; P = .01). CONCLUSIONS AND CLINICAL IMPORTANCE: These data suggest that decreased conversion of 25(OH)D to 24,25(OH)2 D occurs in a subset of dogs with CaOx urolithiasis. Abnormalities in vitamin D metabolism might contribute to stone risk in dogs.


Assuntos
Doenças do Cão/sangue , Urolitíase/veterinária , Vitamina D/sangue , Animais , Cálcio/urina , Oxalato de Cálcio/química , Estudos de Casos e Controles , Estudos Transversais , Doenças do Cão/urina , Cães , Feminino , Masculino , Estudos Retrospectivos , Urolitíase/metabolismo , Urolitíase/urina , Vitamina D/análogos & derivados , Vitamina D/metabolismo
4.
Int Braz J Urol ; 45(2): 340-346, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30735332

RESUMO

PURPOSE: Hypercalciuria is one of the risk factors for calcium kidney stone formation (the most common type of urinary stones). Although vitamin D deficiency is prevalent among urolithiasis patients, the effect of vitamin D supplementation on urine calcium in these patients is still unclear. MATERIALS AND METHODS: In this retrospective study, medical and laboratory tests records of 26 patients with recurrent calcium kidney stones and vitamin D deficiency treated with 50000IU vitamin D per week for 8-12 weeks were analyzed. The changes in 24-hour urine calcium (24-h Ca), serum 25-hydroxyvitamin D (25 (OH) D), serum parathormone (PTH), other 24-hour urine metabolites and calculated relative supersaturations of calcium oxalate (CaOxSS), calcium phosphate (CaPSS) and uric acid (UASS) were assessed. Moreover, correlations between changes in 24-h Ca and other aforementioned variables were assessed. RESULTS: Serum 25 (OH) D and 24-h Ca increased after vitamin D supplementation, while serum PTH decreased (p < 0.001, for all analyses). The levels of 24-hour urine sodium and urea increased significantly (p = 0.005 and p = 0.031, respectively). The levels of CaOxSS and CaPSS increased, but the changes were not significant (p = 0.177, and p = 0.218, respectively). There were no correlations between the changes in 24-h Ca and serum 25 (OH) D or PTH. CONCLUSIONS: The result of current study suggests that although urine Ca increased in vitamin D supplemented patients, this increase was not associated with the increase in serum vitamin D and may be due to other factors such as dietary factors. Further randomized clinical trials considering other factors associated with urine Ca are warranted.


Assuntos
Cálcio/urina , Urolitíase/urina , Deficiência de Vitamina D , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , Idoso , Suplementos Nutricionais , Feminino , Humanos , Hipercalciúria/complicações , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Estudos Retrospectivos , Vitamina D/administração & dosagem , Vitamina D/sangue , Deficiência de Vitamina D/tratamento farmacológico , Deficiência de Vitamina D/etiologia
5.
PLoS One ; 14(1): e0208893, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30677034

RESUMO

BACKGROUND: To explore the differences of 24-hour urine compositions associated with urolithiasis between non- and postmenopausal females. METHODS: The 24-hour urine samples of female participants were collected from May 2013 to July 2014 along with national cross-sectional study of urolithiasis among adults aged ≥18 years in China. The exclusion criteria for the participants were: serum creatinine > 133µmol/L, with urinary tract infection, gout, hyperthyroidism, malignancy, had a history of cancer, kidney stones, enterectomy, had taken thiazide diuretics, allopurinol, vitamin supplement, potassium citrate or calcium supplements during the past two weeks. The compositions associated with urinary stone in 24-hour urine were measured and compared between non-and postmenopausal women. RESULTS: A total of 603 24-hour urine samples of female participants were analyzed. 354 women with a mean age of 52.5± 14.03 (range 19-84) years met the criteria, including 160 non-menopausal women and 194 postmenopausal women. Compared to the non-menopausal women, postmenopausal women had a lower secretion of citrate (p = 0.043), magnesium (p = 0.001) and creatinine (p = 0.001) in 24h urine. Multivariate linear regression analysis showed that the menopause status was associated with the changes in magnesium (p = 0.003) and creatinine (p = 0.002) secretion, whereas not with the changes in citrate (p = 0.402) secretion. CONCLUSIONS: Postmenopausal women have a significant lower secretion of magnesium in their 24-hour urine than non-menopausal ones. We suppose that might be associated with increased risk of urinary stone formation among postmenopausal women.


Assuntos
Cálculos Renais/etiologia , Cálculos Renais/urina , Pós-Menopausa/urina , Cálculos Urinários/etiologia , Cálculos Urinários/urina , Adulto , Idoso , Idoso de 80 Anos ou mais , Ácido Cítrico/urina , Creatinina/urina , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Magnésio/urina , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Urolitíase/etiologia , Urolitíase/urina
6.
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
7.
Ann Biol Clin (Paris) ; 76(3): 345-351, 2018 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-29862974

RESUMO

The study of the crystalluria is the search and the identification for crystals in urines. This multi-parametric study brings a precious help in the diagnosis and/or the follow-up of acquired or congenital lithiasis. The lack of the internal urinary quality control (IQC) makes the accreditation of this analysis, according to the NF EN ISO 15189 standard, particularly delicate. After a presentation of the three steps (pre-analytical, analytical and post-analytical) performed in the laboratory, the authors present some insights in order to mitigate the lack of the urinary IQC. These insights, particularly concern by the "misappropriation" of IQC, the elaboration of an "in house" IQC as well as by the evaluation of the external evaluation of the quality. Thanks to the implementation of these tools, it becomes easier to prove that the laboratory of medical biology masters the qualification, the authorization and the continuous preservation of the skills of the operators performing the study of the crystalluria.


Assuntos
Laboratórios/normas , Controle de Qualidade , Urinálise/normas , Urolitíase/diagnóstico , Acreditação , Cristalização , França , Humanos , Período Pós-Prandial , Guias de Prática Clínica como Assunto/normas , Fase Pré-Analítica/métodos , Fase Pré-Analítica/normas , Urinálise/métodos , Urolitíase/urina
8.
Urologiia ; (2): 5-8, 2018 May.
Artigo em Russo | MEDLINE | ID: mdl-29901287

RESUMO

RELEVANCE: The prevalence of urolithiasis and osteoporosis (OP) indicates that these diseases may be found concurrently in the same patient. The detection of risk factors for OP and disorders of calcium metabolism in patients with urolithiasis is of interest in the context of primary stone formation and metaphylaxis. AIM: To identify risk factors for osteoporosis and disorders of calcium metabolism in patients with urolithiasis. MATERIALS AND METHODS: Osteoporosis risk factors were studied in 45 urolithiasis patients undergoing surgical treatment. Patients were asked to fill out the osteoporosis risk factor questionnaire, and urinary calcium excretion was measured in 24-h collections. RESULTS: Risk factors for osteoporosis were detected in 20 (44.4%) urolithiasis patients. Patients with osteoporosis risk factors identified by the questionnaire were statistically significantly older (p=0.032). Osteoporosis risk factors were found in 20% of patients with newly diagnosed urolithiasis and 24.4% of patients with recurrent urolithiasis. The study patients showed increased urinary calcium excretion and decreased diuresis. The negative correlation between urinary calcium excretion and 24-h diuresis was greater in patients who had than in those who did not have osteoporosis. CONCLUSION: An increase in urinary calcium excretion and a decrease in diuresis can be a predisposing factor for the recurrence of urolithiasis. In patients with risk factors for osteoporosis, it can provide a rationale for administering drugs aimed at preventing stone formation (thiazide diuretics).


Assuntos
Cálcio/urina , Osteoporose/urina , Urolitíase/urina , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
9.
BMC Urol ; 18(1): 45, 2018 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-29783970

RESUMO

BACKGROUND: Urinary tract infection (UTI) is very common in patients with urolithiasis, which makes the treatment of urolithiasis complicated, even dangerous. The objective of this study was to determine the risk factors for UTI in patients with urolithiasis. METHODS: Eight hundred six patients with urolithiasis were retrospectively evaluated in the fourth affiliated hospital of China Medical University. All patients admitted to the study were divided into either a UTI infection group or a non-infection group. Sex, age, smoking, stone shape, alcohol consumption, position of stones, and presence of obstruction were used as exposure factors for the cross-sectional study. RESULTS: One hundred seventy-eight patients (22.0%) had UTI. Through a urine culture test, gram-negative bacilli were the most common pathogen, followed by gram-positive bacilli and fungi. CONCLUSIONS: Sex, age, obstruction, stone shape, and multiple sites of stones could be considered the independent factors for UTI in patients with urolithiasis; smoking and drinking had no statistically significant correlation with the condition. Gram-negative bacilli are the most common pathogen in UTI in patients with urolithiasis.


Assuntos
Infecções Urinárias/diagnóstico por imagem , Infecções Urinárias/epidemiologia , Urolitíase/diagnóstico por imagem , Urolitíase/epidemiologia , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Feminino , Humanos , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/epidemiologia , Cálculos Renais/urina , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Infecções Urinárias/urina , Urolitíase/urina
10.
Saudi J Kidney Dis Transpl ; 29(2): 462-465, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29657221

RESUMO

Adenine phosphoribosyltransferase deficiency is a rare, inherited autosomal recessive disease presenting with 2,8-dihydroxyadenine (DHA) urolithiasis, DHA nephropathy, and chronic kidney disease. The presence of DHA crystals in urine and renal biopsy is pathognomonic of the disease. We report a 23-year-old female with acute renal failure and nephrotic proteinuria. Urinalysis showed reddish brown, round crystals with dark outline, and central spicules consistent with 2,8-DHA crystals. Renal biopsy showed membranous nephropathy and 2,8-DHA nephropathy. Our patient improved with liberal fluid intake, restriction of high adenine content foods, and oral xanthine dehydrogenase inhibitor febuxostat. Early diagnosis and initiation of treatment prevent renal complications.


Assuntos
Adenina Fosforribosiltransferase/deficiência , Adenina/análogos & derivados , Glomerulonefrite Membranosa/etiologia , Erros Inatos do Metabolismo/complicações , Síndrome Nefrótica/etiologia , Urolitíase/etiologia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/urina , Adenina/urina , Biomarcadores/urina , Biópsia , Cristalização , Feminino , Glomerulonefrite Membranosa/diagnóstico , Glomerulonefrite Membranosa/urina , Humanos , Erros Inatos do Metabolismo/diagnóstico , Erros Inatos do Metabolismo/terapia , Síndrome Nefrótica/diagnóstico , Síndrome Nefrótica/terapia , Síndrome Nefrótica/urina , Proteinúria/diagnóstico , Proteinúria/etiologia , Proteinúria/urina , Urinálise , Urolitíase/complicações , Urolitíase/diagnóstico , Urolitíase/terapia , Urolitíase/urina , Adulto Jovem
11.
Urologiia ; (1): 15-19, 2018 Mar.
Artigo em Russo | MEDLINE | ID: mdl-29634128

RESUMO

The study aimed to investigate the changes in the concentration of bikunin, osteopontin, and nephrocalcin, depending on the changes in the renal stone-forming activity in patients with recurrent urolithiasis. MATERIALS AND METHODS: The study comprised 152 patients with recurrent calcium oxalate stones at various localizations. Patients of the study group (n=78) were administered complex preventive treatment (water load, Blamaren, thiazide diuretics, oral calcium supplementation) aimed at reducing the activity of urolithiasis. Patients of the control group (n=74) received no treatment. The studied parameters included concentrations of urine bikunin, osteopontin, and nephrocalcin in using ELISA. The follow-up period was six months. RESULTS: By the end of the follow-up, the bikunin concentration in the control group was significantly higher than in the study group (7.0+/-0.81 mg/ml vs. 3.28+/-0.86 mg/ml, respectively, p<0.05) while osteopontin level was significantly lower (2.4+/-0.39 mg/ml vs. 3.4+/-0.36 mg/ml, p<0.05). The nephrocalcin concentrations during the follow-up period did not change significantly (p>0.05). The presence of hypercalciuria did not lead to significant changes in the concentration of stone formation inhibitors. DISCUSSION: The increase in bikunin concentration in control patients is associated with an increase in the expression of this stone formation inhibitor due to the rise in the urolithiasis activity. Reduction in the osteopontin concentration in patients with high urolithiasis activity is a consequence of osteopontin being a constituent of calcium oxalate stones. CONCLUSION: In patients with calcium oxalate urolithiasis, testing for urine concentrations of bikunin and osteopontin as potential markers can be used to estimate the risk of stone recurrence.


Assuntos
alfa-Globulinas/urina , Glicoproteínas/urina , Osteopontina/urina , Urolitíase/urina , Biomarcadores/urina , Diagnóstico Precoce , Feminino , Humanos , Masculino , Prognóstico , Recidiva
12.
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
13.
Emerg Radiol ; 25(5): 455-460, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29675722

RESUMO

PURPOSE: In the emergency setting, flank pain commonly leads to a noncontrast CT despite a significant percentage of patients having alternative diagnoses, often difficult to characterize without contrast. We investigated the combined utility of urinalysis and history of urolithiasis in identifying patients who are unlikely to have urolithiasis and may benefit from a contrast-enhanced study. METHODS: Retrospective review of 350 patients from May 2013 to May 2016 was performed for patients in the emergency department with renal colic that underwent noncontrast CT and urinalysis testing. RESULTS: Urolithiasis was present in 282 of the 350 patients reviewed (81%), of which 175 (62%) had an obstructing calculus. RBC-positive urinalysis was present in 231 patients with calculi on CT (sensitivity 82%). Patient history of urolithiasis plus urinalysis had a sensitivity of 94% for detecting calculi. Thirty-five patients (10%) had alternative diagnoses, 33 of which were in patients without obstructing calculi. Sixty-seven patients underwent noncontrast CT despite no history of urolithiasis and a negative urinalysis, 10 of which (15%) had alternative diagnoses. Only three cases in this subset (4%) had nonobstructing 1-2-mm calculi, potentially missed with contrast. In this subset, the projected proportion of optimally characterized cases with intravenous contrast is 96%, compared to 85% without contrast (p = .03). DISCUSSION: Given the high combined sensitivity of urinalysis and patient history (94%), this simple analysis can confidently direct clinicians to a contrast-enhanced CT in "rule-out" cases of flank pain in patients with a negative history and negative urinalysis, particularly given that 15% of these patients had alternative diagnoses.


Assuntos
Emergências , Cólica Renal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Urolitíase/diagnóstico por imagem , Adulto , Meios de Contraste , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Cólica Renal/urina , Estudos Retrospectivos , Sensibilidade e Especificidade , Urinálise , Urolitíase/urina
14.
Biol Trace Elem Res ; 185(2): 266-274, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29488068

RESUMO

Lifestyle, food intake, and exposure to chemicals are potential risk factors for the development of calcium urolithiasis. Pb, Cd, and Hg have been proved to cause renal illness, and urinary tract stones might be caused by exposure to metals. Therefore, this study aimed to measure the concentration of metals in urinary tract stones and blood simultaneously in urolithiasis patients. Moreover, we intended to determine whether urinary tract stones can be regarded as a biomarker of exposure or an effect marker in a population with environmental exposure to metals. Thirty-five urolithiasis patients (case) and 34 healthy inhabitants (control) were recruited in this study. The contents of Pb, Cd, Cr, Cu, Ni, As, Zn, and Hg were determined in urinary stones and blood in the case and control groups. The most abundant metals were Zn and Cu in blood and Zn and Ni in urinary stones. Significantly higher levels of Zn, Ni, and As were found in calcium phosphate stones than in calcium oxalate or uric acid stones. The majority of metals were not present at consistent levels in both blood and urinary stones, except for Zn. Urinary stones might be explained as providing another metabolic pathway for metal contamination. Moreover, as the metals with the highest content in urinary stones were Ni and Zn, and Ni content was very much higher than in other countries, contamination by Ni should be further taken into consideration if there is any serious contamination in Taiwan.


Assuntos
Metais Pesados/sangue , Metais Pesados/urina , Cálculos Urinários/química , Urolitíase/sangue , Urolitíase/urina , Monitoramento Ambiental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Poluentes Químicos da Água/sangue , Poluentes Químicos da Água/urina
15.
Int Urol Nephrol ; 50(5): 799-806, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29569213

RESUMO

The formation of urinary stone, urolithiasis, is one the oldest known disease affecting human throughout different civilizations and times. The exact pathophysiological mechanism of urolithiasis is not yet clear, as these calculi are of various types and too complex for simple understanding. A single theory cannot explain its formation; therefore, different theories are presented in various times for its explanation like free particle, fixed particle, Randall's plaque theory. In addition, various factors and components are identified that play an important role in the formation of these urinary calculi. In this review, composition of kidney stones, its prevalence/incidence, explanation of pathophysiological mechanisms and role of various factors; urinary pH, uric acid, parathyroid hormone, citrate, oxalate, calcium and macromolecules; osteopontin, matrix Gla protein, kidney injury molecules, urinary prothrombin fragment-1, Tamm-Horsfall protein, inter-α-inhibitors, have been discussed in detail.


Assuntos
Ácido Cítrico/urina , Hiperoxalúria/urina , Osteopontina/urina , Urolitíase/epidemiologia , Urolitíase/urina , alfa-Globulinas/urina , Animais , Proteínas de Ligação ao Cálcio/metabolismo , Proteínas da Matriz Extracelular/metabolismo , Receptor Celular 1 do Vírus da Hepatite A/metabolismo , Humanos , Concentração de Íons de Hidrogênio , Hipercalciúria/urina , Fragmentos de Peptídeos/urina , Prevalência , Fatores de Proteção , Precursores de Proteínas/urina , Protrombina/urina , Fatores de Risco , Ácido Úrico/urina , Urina/química , Urolitíase/metabolismo , Uromodulina/urina
16.
Nefrologia ; 38(3): 267-272, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29454539

RESUMO

BACKGROUND: Various genetic and environmental factors are involved in urolithiasis. The 2 most common metabolic abnormalities are the increase in urinary calcium and low urinary citrate excretion. The ratio calculated between the concentrations of both substances is a good risk marker for the formation of calcium stones. OBJECTIVES: To determine whether the risk of urinary calcium stone formation changes throughout the day in the same patient. METHODS: We studied 56 children (23V, 33M) to check if they had prelithiasis. Calcium, citrate, and creatinine concentrations were determined in two urine samples collected one before dinner and the other in the morning. It was collected if they had ultrasound stones and if there was a history of urolithiasis in first and/or second degree relatives. RESULTS: In 25 patients (44.6%), renal ultrasound was positive for lithiasis (stones [n=9] and microlithiasis [n=16]). Forty of the 56 families (71.4%) had a history of urolithiasis. The percentage of abnormal urinary calcium (28.6%) concentrations and an abnormal calcium/citrate ratio (69.6%) was higher in the first urine of the day. The calcium/citrate ratio was the only studied parameter that was related to a family history of urolithiasis. There were no differences in urinary parameters between patients with and without ultrasound-confirmed kidney stones. CONCLUSIONS: Urinary concentrations of calcium and the calcium/citrate ratio vary throughout the day. Urine produced at night has a higher risk of urinary calcium stone formation.


Assuntos
Cálcio , Urolitíase/diagnóstico , Urolitíase/urina , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Urinálise/métodos , Urolitíase/epidemiologia
17.
Urolithiasis ; 46(6): 523-533, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29423725

RESUMO

To study the impact of body mass index (BMI) on quantitative 24-h urine chemistries in stone forming patients and to explore how overweight and obesity contribute to urolithiasis. A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science was performed in July 2017 and updated in October 2017 to detect relevant studies. After that, we screened all the relevant articles in accordance with the predetermined inclusion and exclusion criteria. Data of eligible studies were extracted, and then, a meta-analysis was conducted via RevMan 5.3 software. Nine studies, involving 5965 stone forming patients who underwent 24-h urine collection for chemistry analysis, were included in our analysis. BMI was used to clarify the body size. BMI ≥ 25 kg/m2 group, including overweight and obesity patients, erected more calcium (WMD 34.44 mg; 95% CI 11.33-57.55; p = 0.003), oxalate (WMD 3.44 mg; 95% CI 1.40-5.49; p = 0.001), urate (WMD 97.71 mg; 95% CI 63.05-132.38; p < 0.00001), and sodium (WMD 26.64 mg; 95% CI 18.23-35.05; p < 0.00001) in 24 h than BMI < 25 kg/m2 group. However, the BMI < 25 kg/m2 group showed higher pH of urine (WMD 0.12; 95% CI 0.04-0.20; p = 0.004). There was no significant difference in 24-h urine volume (WMD - 29.30 ml; 95% CI - 122.03 to - 63.42; p = 0.54), citrate (WMD - 34.03 mg; 95% CI - 72.88 to 4.82; p = 0.09), magnesium (WMD - 4.50 mg; 95% CI - 10.48 to 1.48; p = 0.14), phosphate (WMD - 89.38 mg; 95% CI - 219.23 to 40.47; p = 0.18), and creatinine (WMD - 191.98 mg; 95% CI - 395.35 to 11.38; p = 0.06) between the two groups. All the results kept the same tendency when gender was taken in consideration. Sensitivity analysis generated similar results. The current evidence suggested that patients with BMI ≥ 25 kg/m2 erected more promotions but not inhibitors of urolithiasis than those with BMI < 25 kg/m2, which increased the risk of urolithiasis in overweight and obesity individuals.


Assuntos
Índice de Massa Corporal , Sobrepeso/complicações , Urina/química , Urolitíase/urina , Cálcio/urina , Ácido Cítrico/urina , Creatinina/urina , Humanos , Magnésio/urina , Obesidade , Sobrepeso/urina , Oxalatos/urina , Fosfatos/urina , Fatores de Risco , Ácido Úrico/urina , Urolitíase/etiologia
18.
Urol J ; 15(5): 231-237, 2018 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-29353465

RESUMO

PURPOSE: The aim of the study was assessment of four selected macromolecules level: osteopontin, calgranulin, uromodulin and bikunin in fresh morning urine sample in children with nephrolithiasis in the course of idiopathic hypercalciuria. MATERIALS AND METHODS: The study included 90 subjects aged from 12 months to 18 years. The study group comprised 57 subjects- children with urinary tract lithiasis in the course of idiopathic hypercalciuria and the control group - 33 healthy children with no history of urolithiasis. Determinations of osteopontin, calgranulin, uromodulin and bikunin levels in the first morning urine were performed. RESULTS: The study group had a significantly decreased osteopontin excretion and significantly increased bikuninexcretion, and increased, however statistically nonsignificant, calgranulin excretion in comparison with the control group. Uromodulin excretion did not differ between groups. In both groups a statistically significant positive correlation was observed between uromodulin and bikunin levels. CONCLUSION: Children with urinary tract lithiasis in the course of idiopathic hypercalciuria reveal a different distribution of the study proteins than a healthy population.


Assuntos
alfa-Globulinas/urina , Hipercalciúria/urina , Complexo Antígeno L1 Leucocitário/urina , Osteopontina/urina , Urolitíase/urina , Uromodulina/urina , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino
19.
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
20.
Clin Exp Nephrol ; 22(1): 133-141, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28653226

RESUMO

BACKGROUND: To investigate relationships among urinary biomarkers [kidney injury molecule-1 (KIM-1), N-acetyl-ß-glucosaminidase (NAG)], neutrophil gelatinase-associated lipocalin (NGAL) levels and renal tubular injury in childhood urolithiasis. METHODS: Seventy children [36 girls, mean age: 7.3 ± 5.0 years (0.5-18.2)] with urolithiasis/microlithiasis and 42 controls [18 girls, mean age: 8.5 ± 3.8 years (0.9-16.2)] were included in this multicenter, controlled, prospective cohort study. Patients were evaluated three times in 6-month intervals (0, 6 and 12th months). Anthropometric data, urinary symptoms, family history and diagnostic studies were recorded. Urine samples were analyzed for metabolic risk factors (urinary calcium, uric acid, oxalate, citrate, cystine, magnesium, and creatinine excretion), and the urinary KIM-1, NAG, and NGAL levels were measured. RESULTS: Stones were mostly located in the upper urinary system (82.9%), and six patients (8.6%) had hydronephrosis. Thirty patients (42.9%) had several metabolic risk factors, and the most common metabolic risk factor was hypocitraturia (22.9%). Urinary KIM-1/Cr, NAG/Cr and NGAL/Cr ratios were not significantly different between patients and controls. Furthermore, no significant changes in their excretion were shown during follow-up. Notably, the urinary KIM-1/Cr, NAG/Cr, and NGAL/Cr levels were significantly higher in children under 2 years of age (p = 0.011, p = 0.006, and 0.015, respectively). NAG/Cr and NGAL/Cr ratios were significantly increased in patients with hydronephrosis (n = 6, p = 0.031 and 0.023, respectively). CONCLUSIONS: The results of this study suggest that none of the aforementioned urinary biomarkers (KIM-1, NAG and NGAL levels) may be useful for the early detection and/or follow-up of renal tubular injury and/or dysfunction in childhood urolithiasis.


Assuntos
Biomarcadores/urina , Túbulos Renais/patologia , Urolitíase/complicações , Urolitíase/urina , Adolescente , Antropometria , Criança , Pré-Escolar , Estudos de Coortes , Diagnóstico Precoce , Feminino , Seguimentos , Receptor Celular 1 do Vírus da Hepatite A/análise , Humanos , Hidronefrose/etiologia , Lactente , Lipocalina-2/urina , Masculino , Proteínas de Neoplasias/urina , Estudos Prospectivos , Fatores de Risco , Urolitíase/patologia
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