
Calcium Oxalate Nephrolithiasis and Gut Microbiota: Not just a Gut-Kidney Axis. A Nutritional Perspective.
Ticinesi Andrea,Nouvenne Antonio,Chiussi Giulia,Castaldo Giampiero,Guerra Angela,Meschi Tiziana
Nutrients
Recent studies have shown that patients with kidney stone disease, and particularly calcium oxalate nephrolithiasis, exhibit dysbiosis in their fecal and urinary microbiota compared with controls. The alterations of microbiota go far beyond the simple presence and representation of , a well-known symbiont exhibiting a marked capacity of degrading dietary oxalate and stimulating oxalate secretion by the gut mucosa. Thus, alterations of the intestinal microbiota may be involved in the pathophysiology of calcium kidney stones. However, the role of nutrition in this gut-kidney axis is still unknown, even if nutritional imbalances, such as poor hydration, high salt, and animal protein intake and reduced fruit and vegetable intake, are well-known risk factors for kidney stones. In this narrative review, we provide an overview of the gut-kidney axis in nephrolithiasis from a nutritional perspective, summarizing the evidence supporting the role of nutrition in the modulation of microbiota composition, and their relevance for the modulation of lithogenic risk.
10.3390/nu12020548
Effect of calcium restriction on renal excretion of oxalate and the probability of stones in the various pathophysiological groups with calcium stones.
Bataille P,Charransol G,Gregoire I,Daigre J L,Coevoet B,Makdassi R,Pruna A,Locquet P,Sueur J P,Fournier A
The Journal of urology
To evaluate the adequacy of simple calcium restriction for patients with idiopathic calcium stones the effect of 5 days of calcium restriction without oxalate restriction on renal excretion of calcium and oxalate, and the corresponding probability of stones were assessed in 50 controls and 48 patients. Renal excretion of calcium decreased and that of oxalate increased significantly in all groups but the importance of the changes was critically dependent upon the underlying pathophysiological condition. The probability of stones decreased only in patients with absorptive hypercalciuria type II owing to the usual excessive calcium intake and increased in those with absorptive hypercalciuria type I and renal hypercalciuria, which are associated with true hyperabsorption of calcium and represent the 2 forms of idiopathic hypercalciuria. We believe that simple calcium restriction is beneficial for patients with idiopathic calculi only when the hypercalciuria is caused by exaggerated intake of calcium, since it increases the probability of stones in patients with idiopathic hypercalciuria. Calcium restriction always is associated with an increase in oxalate excretion, suggesting that simultaneous oxalate restriction should be added in all cases to decrease the probability of stones.
10.1016/s0022-5347(17)51073-3
Assessment of metabolic risk factors for nephrolithiasis in patients with autosomal dominant polycystic kidney disease: a cross-sectional study.
Clinical and experimental nephrology
BACKGROUND:Nephrolithiasis is more common in autosomal dominant polycystic kidney disease (ADPKD) than in the normal population. We aimed to investigate the anatomical and metabolic factors that may be associated with nephrolithiasis in patients with ADPKD METHODS: In this cross-sectional study, a total of 180 participants were included. Eighty-five patients with ADPKD [42 patients with nephrolithiasis (PKD N +) and 43 without nephrolithiasis (PKD N -)] were recruited. Forty-seven nephrolithiasis patients without ADPKD (N) and 48 healthy controls (HC) were selected as control groups. 24-h urine collections were measured in all participants. 24-h urine citrate, calcium, urate, oxalate, magnesium and sodium, serum electrolytes, and eGFRs were compared. RESULTS:Total kidney volumes were not different between patients with PKD N + and PKD N -. Hypocitraturia was common in all patients with ADPKD (69.4%), and it was not different between PKD N + (76.2%) and PKD N- (62.8%). However, hypocitraturia was statistically higher in PKD N + and PKD N - than in N (38.3%) and HC (12.5%) (p<0.05). 24-h urine calcium, urate, and oxalate levels were similar between PKD N + and PKD N - CONCLUSIONS: Hypocitraturia was found to be significantly higher in patients with ADPKD than in healthy adults and other kidney stone patients.
10.1007/s10157-023-02378-2
Urinary Lithogenic Risk Profile in ADPKD Patients Treated with Tolvaptan.
Clinical journal of the American Society of Nephrology : CJASN
BACKGROUND AND OBJECTIVES:Nephrolithiasis is a common health problem in autosomal dominant polycystic kidney disease (ADPKD) and significantly contributes to patient morbidity. Recently, Tolvaptan has been introduced for the treatment of ADPKD, but whether it is associated with alterations of the urinary lithogenic risk profile remains unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:We conducted an analysis of participants enrolled in the Bern ADPKD registry, a prospective observational cohort study. Twenty-four-hour urine analyses were performed at baseline and then at yearly follow-ups. Relative supersaturation ratios for calcium oxalate, brushite, and uric acid were calculated with the program EQUIL2. Unadjusted and multivariable mixed-effects linear regression models, adjusted for age, sex, body mass index, eGFR, net acid excretion, and height-adjusted total kidney volume, were used to assess the association of Tolvaptan with urinary parameters relevant for kidney stone formation. The maximum individual follow-up time was 3 years, median follow-up time 1.9 years, and cumulative follow-up time 169 years. RESULTS:In total, 125 participants (38 with and 87 without Tolvaptan treatment) were included in the analysis. In multivariable analysis, Tolvaptan treatment was associated [adjusted estimate of the difference between Tolvaptan and no Tolvaptan; 95% confidence interval (CI)] with lower urine relative supersaturation ratios for calcium oxalate (-0.56; 95% CI, -0.82 to -0.3; <0.001), brushite (-0.33; 95% CI, -0.54 to -0.11; =0.004), and uric acid (-0.62; 95% CI, -0.88 to -0.37; <0.001), and with higher urine citrate in mmol/mmol creatinine per day (0.25; 95% CI, 0.05 to 0.46; =0.02) and calcium in mmol/mmol creatinine per day (0.31; 95% CI, 0.09 to 0.53; =0.006) excretion. In addition, Tolvaptan treatment was associated with lower net acid excretion in mEq/mmol creatinine per day (-0.54; 95% CI, -0.90 to -0.17; =0.004) and higher net gastrointestinal alkali absorption in mEq/mmol creatinine per day (0.57; 95% CI, 0.26 to 0.88; <0.001). CONCLUSIONS:Tolvaptan treatment is associated with a significantly improved urinary lithogenic risk profile in patients with ADPKD.
10.2215/CJN.13861119
Renal oxalate stones in children with Zellweger spectrum disorders.
Alhazmi Hamdan Hammad
Saudi journal of anaesthesia
Peroxisomal biogenesis disorders due to PEX gene defects are classified into many subgroups, of which Zellweger spectrum disorders (ZSDs) represent the major subgroup. The ZSDs are clinical and biochemical disorders divided into three phenotypes: neonatal, adolescence, or adult. Clinical presentations vary with severity of the condition. Metabolic abnormalities occur due to functional peroxisomal defects that could be detected in blood and urine. No cure or definitive management exists to date; only supportive and palliative measures are applied to prevent worse sequelae. We experienced a case of oxalate renal stones in a patient with ZSD. This patient had hyperoxaluria and hyperglycolic aciduria with clinically associated clues that correlate with urinary oxalate load. Urinary oxalate and glycolate excretion were assessed. Radiological workup revealed renal involvement with urolithiasis and nephrocalcinosis. Urinalysis and ultrasonography for stones and hyperoxaluria should be used to screen patients with ZSD for early intervention to prevent renal damage.
10.4103/sja.SJA_699_17
Oxalate homeostasis.
Nature reviews. Nephrology
Oxalate homeostasis is maintained through a delicate balance between endogenous sources, exogenous supply and excretion from the body. Novel studies have shed light on the essential roles of metabolic pathways, the microbiome, epithelial oxalate transporters, and adequate oxalate excretion to maintain oxalate homeostasis. In patients with primary or secondary hyperoxaluria, nephrolithiasis, acute or chronic oxalate nephropathy, or chronic kidney disease irrespective of aetiology, one or more of these elements are disrupted. The consequent impairment in oxalate homeostasis can trigger localized and systemic inflammation, progressive kidney disease and cardiovascular complications, including sudden cardiac death. Although kidney replacement therapy is the standard method for controlling elevated plasma oxalate concentrations in patients with kidney failure requiring dialysis, more research is needed to define effective elimination strategies at earlier stages of kidney disease. Beyond well-known interventions (such as dietary modifications), novel therapeutics (such as small interfering RNA gene silencers, recombinant oxalate-degrading enzymes and oxalate-degrading bacterial strains) hold promise to improve the outlook of patients with oxalate-related diseases. In addition, experimental evidence suggests that anti-inflammatory medications might represent another approach to mitigating or resolving oxalate-induced conditions.
10.1038/s41581-022-00643-3
Pathophysiology and Management of Hyperoxaluria and Oxalate Nephropathy: A Review.
American journal of kidney diseases : the official journal of the National Kidney Foundation
Hyperoxaluria results from either inherited disorders of glyoxylate metabolism leading to hepatic oxalate overproduction (primary hyperoxaluria), or increased intestinal oxalate absorption (secondary hyperoxaluria). Hyperoxaluria may lead to urinary supersaturation of calcium oxalate and crystal formation, causing urolithiasis and deposition of calcium oxalate crystals in the kidney parenchyma, a condition termed oxalate nephropathy. Considerable progress has been made in the understanding of pathophysiological mechanisms leading to hyperoxaluria and oxalate nephropathy, whose diagnosis is frequently delayed and prognosis too often poor. Fortunately, novel promising targeted therapeutic approaches are on the horizon in patients with primary hyperoxaluria. Patients with secondary hyperoxaluria frequently have long-standing hyperoxaluria-enabling conditions, a fact suggesting the role of triggers of acute kidney injury such as dehydration. Current standard of care in these patients includes management of the underlying cause, high fluid intake, and use of calcium supplements. Overall, prompt recognition of hyperoxaluria and associated oxalate nephropathy is crucial because optimal management may improve outcomes.
10.1053/j.ajkd.2021.07.018
Hyperoxaluria: a gut-kidney axis?
Robijn Stef,Hoppe Bernd,Vervaet Benjamin A,D'Haese Patrick C,Verhulst Anja
Kidney international
Hyperoxaluria leads to urinary calcium oxalate (CaOx) supersaturation, resulting in the formation and retention of CaOx crystals in renal tissue. CaOx crystals may contribute to the formation of diffuse renal calcifications (nephrocalcinosis) or stones (nephrolithiasis). When the innate renal defense mechanisms are suppressed, injury and progressive inflammation caused by these CaOx crystals, together with secondary complications such as tubular obstruction, may lead to decreased renal function and in severe cases to end-stage renal failure. For decades, research on nephrocalcinosis and nephrolithiasis mainly focused on both the physicochemistry of crystal formation and the cell biology of crystal retention. Although both have been characterized quite well, the mechanisms involved in establishing urinary supersaturation in vivo are insufficiently understood, particularly with respect to oxalate. Therefore, current therapeutic strategies often fail in their compliance or effectiveness, and CaOx stone recurrence is still common. As the etiology of hyperoxaluria is diverse, a good understanding of how oxalate is absorbed and transported throughout the body, together with a better insight in the regulatory mechanisms, is crucial in the setting of future treatment strategies of this disorder. In this review, the currently known mechanisms of oxalate handling in relevant organs will be discussed in relation to the different etiologies of hyperoxaluria. Furthermore, future directions in the treatment of hyperoxaluria will be covered.
10.1038/ki.2011.287
Hyperoxaluria - A Major Metabolic Risk for Kidney Stone Disease.
Rhode Island medical journal (2013)
Hyperoxaluria is a clinically relevant metabolic entity that portends a high morbidity burden. Primarily manifesting as kidney stone disease and chronic kidney disease, advanced hyperoxaluria can also affect major organs, including the brain, heart, liver, bone, and the skin. It is categorized based on etiology into primary and secondary hyperoxaluria. Pathology is attributed to excess de novo oxalate production in the former and multifactorial exogenous oxalate absorption or excess intake of its precursors in the latter. Diagnosis often involves demonstrating elevated urinary oxalate levels, especially in patients with normal kidney function. Here in this review, we will perform an in-depth discussion of various causes of hyperoxaluria and describe treatment options. In view of the significant morbidity burden associated with hyperoxaluria, patients could benefit from heightened clinician awareness to aid in the timely diagnosis and management of this condition.
Frequency of metabolic abnormalities in urinary stones patients.
Ahmad Iftikhar,Pansota Mudassar Saeed,Tariq Muhammad,Tabassum Shafqat Ali
Pakistan journal of medical sciences
OBJECTIVE:To determine the frequency of metabolic abnormalities in the serum and urine of patients with urinary stones disease. METHODS:Two hundred patients with either multiple or recurrent urolithiasis diagnosed on ultrasonography and intravenous urography were included in this study. 24 hour urine sample were collected from each patient and sent for PH, specific gravity, Creatinine, uric acid, calcium, phosphate, oxalate, citrate and magnesium. In addition, blood sample of each patient was also sent for serum levels of urea, creatinine, uric acid, phosphate and calcium. RESULTS:Mean age of patients was 38 ± 7.75 years with male to female ratio of 2:1. The main presenting complaint was lumber pain and 82.5% patients were found to have calcium oxalate stones on chemical analysis. Metabolic abnormalities were found in 90.5% patients, whereas there were no metabolic abnormalities in 19 (9.5%) patients. Forty patients (21.5%) only had one metabolic abnormality and 157 (78.5%) patients had multiple metabolic abnormalities. Hyperoxaluria was the most commonly observed metabolic abnormality and was found in 64.5% patients. Other significant metabolic abnormalities were hypercalciuria, Hypercalcemia, hypocitraturia and hyperuricemia. CONCLUSION:This study concludes that frequency of metabolic abnormalities is very high in patients with urolithiasis and hyperoxaluria, hypercalciuria and hypocitraturia are the most important metabolic abnormalities observed in these patients.
10.12669/pjms.296.4007
Metabolic abnormalities associated with renal calculi in patients with horseshoe kidneys.
Raj Ganesh V,Auge Brian K,Assimos Dean,Preminger Glenn M
Journal of endourology
BACKGROUND AND PURPOSE:Horseshoe kidneys are a complex anatomic variant of fused kidneys, with a 20% reported incidence of associated calculi. Anatomic causes such as high insertion of the ureter on the renal pelvis and obstruction of the ureteropelvic junction are thought to contribute to stone formation via impaired drainage, with urinary stasis, and an increased incidence of infection. In this multi-institutional study, we evaluated whether metabolic factors contributed to stone development in patients with horseshoe kidneys. PATIENTS AND METHODS:A retrospective review of 37 patients with horseshoe kidneys was performed to determine if these patients had metabolic derangements that might have contributed to calculus formation. Stone compositions as well as 24-hour urine collections were examined. Specific data points of interest were total urine volume; urine pH; urine concentrations of calcium, sodium, uric acid, oxalate, and citrate; and number of abnormalities per patient per 24-hour urine collection. These data were compared with those of a group of 13 patients with stones in caliceal diverticula as well as 24 age-, race-, and sex-matched controls with stones in anatomically normal kidneys. RESULTS:Eleven (9 men and 2 women) of the 37 patients (30%) with renal calculi in horseshoe kidneys had complete metabolic evaluations available for review. All patients were noted to have at least one abnormality, with an average of 2.68 abnormalities per 24-hour urine collection (range 1-4). One patient had primary hyperparathyroidism and underwent a parathyroidectomy. Low urine volumes were noted in eight patients on at least one of the two specimens (range 350-1640 mL/day). Hypercalciuria, hyperoxaluria, hyperuricosuria, and hypocitraturia were noted in seven, three, six, and six patients, respectively. No patients were found to have gouty diathesis or developed cystine stones. Comparative metabolic analyses of patients with renal calculi in caliceal diverticula or normal kidneys revealed a distinct profile in patients with horseshoe kidneys, with a higher incidence of hypocitraturia. CONCLUSIONS:All patients with renal calculi in horseshoe kidneys were noted to have metabolic abnormalities predisposing to stone formation. In this initial series of 11 patients, hypovolemia, hypercalcuria and hypocitraturia were most common metabolic defects. These findings suggest that metabolic derangements play a role in stone formation in patients with a horseshoe kidney. Patients with calculi in anatomically abnormal kidneys should be considered for a metabolic evaluation to identify their stone-forming risk factors in order to initiate preventative selective medical therapy and reduce the risk of recurrent calculus formation.
10.1089/089277904322959798
Nephrolithiasis in medullary sponge kidney: evaluation of clinical and metabolic features.
McPhail E Fred,Gettman Matthew T,Patterson David E,Rangel Laureano J,Krambeck Amy E
Urology
OBJECTIVE:Medullary sponge kidney (MSK) is a disorder characterized by tubular dilation of renal collecting ducts and cystic dilation of medullary pyramids that has been associated with stone disease. The significance of nephrolithiasis and the mechanisms by which it occurs are incompletely understood. We describe clinical and metabolic features of nephrolithiasis in a cohort of patients with MSK. METHODS:Records were reviewed of 56 patients, all with radiographic diagnosis of medullary sponge kidney and data collected pertaining to presentation, stone events and recurrences, stone composition, and metabolic profile to perform a descriptive study with median 3.7 years follow-up. RESULTS:Nephrolithiasis was confirmed radiographically in 39/56 patients (69.6%). No patient without evidence of nephrolithiasis developed a stone event, whereas 13/39 (33%) of those with nephrolithiasis developed a recurrent stone event. Stones were composed of calcium oxalate monohydrate, calcium oxalate dihydrate, calcium phosphate apatite, and uric acid. Metabolic profile was obtained for 26 of 39 (67%) stone-forming patients demonstrating abnormalities in 22/26 (84.6%). These included hypercalciuria, 58% (15/26); low urine volume, 35% (9/26); hyperuricosuria, 27% (7/26); hypocitraturia, 19% (5/26); elevated urine sodium, 15% (4/26); and hyperoxaluria, 12% (3/26). CONCLUSION:Many patients with MSK have no evidence of nephrolithiasis. Among those who do, recurrence is common, and metabolic profile and composition are varied as in the general stone-forming population.
10.1016/j.urology.2011.07.1414
An inheritable anomaly of red-cell oxalate transport in "primary" calcium nephrolithiasis correctable with diuretics.
Baggio B,Gambaro G,Marchini F,Cicerello E,Tenconi R,Clementi M,Borsatti A
The New England journal of medicine
We measured the rate of oxalate flux across the red-cell membrane in the steady state in 114 patients with a history of calcium oxalate kidney stones and in 25 controls. Of the patients, 98 had recurrent, "idiopathic" kidney stones, 8 had primary hyperparathyroidism, 7 had renal or urinary tract malformations, and 1 had primary hyperoxaluria. Oxalate exchange was significantly higher in the 98 patients with idiopathic stone formation than in the controls (-1.10 +/- 0.95 [SD] X 10(-2) min-1 vs. -0.31 +/- 0.12 X 10(-2); P less than 0.001); it was above the upper limits of normal in 78 of these patients. All 8 patients with hyperparathyroidism and the patient with primary hyperoxaluria had values in the normal range; 2 of the patients with renal or urinary tract malformation had values at the upper normal limit. A study of five families indicated that the abnormality is an autosomal monogenic dominant trait with complete penetrance and variable expressivity. Oxalate-tolerance tests were carried out in five pairs of brothers. One brother in each pair had the abnormality in oxalate flux, and had a significantly higher percentage of oxalate excretion at two hours after oxalate loading (18.09 +/- 3.07 [SD] vs. 10.37 +/- 3.08 percent; t = 3.97; P less than 0.005) and four hours (14.87 +/- 2.91 vs. 9.89 +/- 2.93 percent; t = 2.70; P less than 0.05). Treatment with oral hydrochlorothiazide (50 mg per day) or amiloride (5 mg per day) or both restored normal or nearly normal red-cell oxalate exchange in all of 33 patients who initially had increased rates. We conclude that an inherited cellular defect in oxalate transport may be a factor in "primary" calcium oxalate stone formation and that this defect may be corrected with diuretics.
10.1056/NEJM198603063141002
Clinical and Metabolic Correlates of Calcium Oxalate Stone Subtypes: Implications for Etiology and Management.
Bamberger Jacob N,Blum Kyle A,Kan Kathleen M,Parkhomenko Egor,Gallante Blair,Gupta Mantu
Journal of endourology
Calcium oxalate (CaOx) is the predominate component within renal calculi and can be divided into two subtypes: CaOx-monohydrate (COM) and CaOx-dihydrate (COD). COM and COD form in differing urinary environments, which suggest differential underlying metabolic abnormalities associated with each subtype. We compared clinical and metabolic findings in CaOx stone formers to delineate factors differentiating COD and COM stone formers and the implication this holds in terms of etiology and treatment. We identified CaOx stone formers that had passed their stones or had undergone endoscopic extraction between October 2014 and December 2018. Only patients who had a predominant subtype (≥80% COM or COD) and who had a 24-hour urine evaluation before medical management were included. Clinical and metabolic factors were compared in the two subgroups. Out of 157 stone formers, 121 were COM and 36 were COD. COD formers were younger than COM formers with a mean age of 53 ± 16 59 ± 15, respectively ( = 0.038). There were no observable differences in gender, body mass index, hypertension, diabetes mellitus, or hyperlipidemia. COM formers exhibited higher rates of hypocitraturia and hyperoxaluria, = 0.022 and = 0.018, respectively. Conversely, COD formers had significantly higher rates of hypercalciuria (47% 28%, = 0.012). Multivariate analysis found hypercalciuria to independently predict COD ( = 0.043) and hyperoxaluria to predict COM stones ( = 0.016). COM formers are more likely to have hyperoxaluria, hypocitraturia, and elevated urinary oxalate levels compared to COD formers. COD formers exhibited higher incidence of hypercalciuria. These data suggest that all CaOx stones are not alike and that distinct metabolic and clinical etiological differences exist that may guide future management and prevention.
10.1089/end.2019.0245
Biochemical evaluation in renal stone disease.
Vitale Corrado,Croppi Emanuele,Marangella Martino
Clinical cases in mineral and bone metabolism : the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases
Renal stone disease may ensue from either derangements of urine biochemistries or anatomic abnormalities of kidneys and urinary tract. Genetic, environmental and dietary factors may also cooperate in the pathophysiology of nephrolithiasis. An adequate metabolic evaluation should focus on the urinary excretion of promoters and inhibitors of stone formation as well as on the occurrence of systemic diseases potentially related to secondary nephrolithiasis (i.e., endocrine disturbances, malabsorption, bone diseases). Moreover, metabolic investigations should provide reliable information on patient's dietary habits, guide towards the best therapeutic approach and enable the physician to verify patient's compliance to prescribed therapies.AN EXTENSIVE METABOLIC EVALUATION IS RECOMMENDED IN PATIENTS WITH ACTIVE STONE DISEASE (NAMELY, AT LEAST ONE NEW STONE WITHIN THE LAST TWO YEARS), OR IN THOSE HAVING HAD A SINGLE STONE EPISODE OCCURRED IN PECULIAR CONDITIONS: familial history of disease, childhood, menopause, pregnancy, systemic diseases. Simplified protocols may be adequate in non-active nephrolithiasis or in patients with single stone and no relevant risk factors.In our Stone Centre, a so-called "first level screening" is performed by routine, in order to assess urinary supersaturation with stone forming salts and evaluate the excretion of dietary-related metabolites in urine. Relative blood and urine determinations are reported below.IN VENOUS BLOOD: urea, creatinine, uric acid, Na, K, total and ionised Ca, Mg, P, Cl, alkaline phosphatase, gas analysis. In 24-hr urine samples: urea, creatinine, uric acid, Na, K, Ca, Mg, P, Cl, oxalate, inorganic sulphate, citrate, pH, ammonia and titratable acidity. IN FASTING URINE SAMPLES: Ca, citrate, creatinine, hydroxyproline, Brand's test for cistinuria, urine sediment, urine culture. If the first-level evaluation suggested an abnormal bone turnover, then further determinations are warranted, namely, calciotropic hormones (blood Vitamin D and PTH), markers of bone resorption (urine pyridinium crosslinks, serum crosslaps) and formation (serum osteocalcin) bone mineral density.EVENTUALLY, MORE SOPHISTICATED INVESTIGATIONS ARE REQUIRED TO IMPROVE THE DIAGNOSIS OF PECULIAR DISEASES: serum oxalate and glycolate, urine glycolate and L-glycerate, hepatic AGT activity (primary hyperoxalurias); genetic tests (hereditary nephrolithiasis); acidification tests (renal tubular acidosis).
Forming a stone in pelviureteric junction obstruction: Cause or effect?
Stasinou Theodora,Bourdoumis Andreas,Masood Junaid
International braz j urol : official journal of the Brazilian Society of Urology
OBJECTIVES:To investigate a possible causal relationship for stone formation in pelviureteric junction obstruction and to outline management options. MATERIALS AND METHODS:A literature search and evidence synthesis was conducted via electronic databases in the English language using the key words pelviureteric junction obstruction; urolithiasis; hyperoxaluria; laparoscopic pyeloplasty; flexible nephroscopy; percutaneous nephrolithotomy, alone or in combination. Relevant articles were analysed to extract conclusions. RESULTS:Concomitant pelviureteric junction obstruction (PUJO) and renal lithiasis has been reported only scarcely in the literature. Although PUJO has been extensively studied throughout the years, the presence of calculi in such a patient has not received equal attention and there is still doubt surrounding the pathophysiology and global management. CONCLUSIONS:Metabolic risk factors appear to play an important role, enough to justify metabolic evaluation in these patients. Urinary stasis and infection are well known factors predisposing to lithiasis and contribute to some extent. The choice for treatment is not always straightforward. Management should be tailored according to degree of obstruction, renal function, patient symptoms and stone size. Simultaneous treatment is feasible with the aid of minimally invasive operative techniques and laparoscopy in particular.
10.1590/S1677-5538.IBJU.2015.0515
[Study of renal function in infants diagnosed with renal pyelectasis in the first year of life].
León González J,García Nieto V,Hernández Rodríguez A,Fernández González L
Anales espanoles de pediatria
OBJECTIVE:To evaluate glomerular and tubular function in a group of infants diagnosed with pyelectasis. PATIENTS AND METHODS:We studied 14 patients diagnosed with renal pelvis dilatation in-utero or during the first year of life. Creatinine concentrations, urinary excretion of calcium, citrate, oxalate, N-acetyl-D-glucosaminidase (NAG), microalbumin and maximum urine osmolality after administration of intranasal desmopressin were determined. The latter three variables were determined at diagnosis and at the end of follow-up. RESULTS:In all patients creatinine levels were normal. In six patients (42.9%) maximum urine osmolality values were abnormal. In four patients NAG/creatinine concentrations were elevated and in another four patients (28.6%) albumin urinary excretion was elevated. These anomalies tended to return to normal but, at the end of the study, three patients (21.4%) showed increased albuminuria and one (7.1%) showed persistently defective renal concentrating capacity. Ten patients showed metabolic urinary anomalies, potentially leading to the formation of stones (isolated hypercalciuria in five [35,7%], hyperoxaluria in two and hypocitraturia in one, and hypercalciuria associated with hyperoxaluria in two). CONCLUSIONS:All patients showed normal glomerular function. Some patients presented increased albuminuria and moderate tubular function abnormalities, both of which tended to return to normal. Although studies with greater numbers of patients are needed, we propose that pyelectasis maybe a predictor of risk for lithiasis at later stages of life.
[Pathogenic factors in calcium oxalate stones: Epidemiological investigation].
Kaaroud El Jery H,Harzallah A,Chouchi S,Talbi E,Baccouch H,Abdelmoula J,Bouzouita A,Chebil M,Ben Hamida F,Ben Abdallah T
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie
INTRODUCTION:Calcium oxalate stones are the most common urolithiasis. Changes in dietary habits, socio-economic and health status of populations explain its progression. The aim of our study was to determine metabolic factors leading to lithiasis and clarify its causes. PATIENTS AND METHODS:This is a retrospective study of 100 patients with calcium oxalate stones identified by morpho-constitutional study, collected in our department over a period of 5 years (2008-2013). We analyzed clinical, radiological and metabolic data. RESULTS:They were 73 men and 27 women (gender ratio: 2.7), aged meanly of 44.8 years. Dietary survey revealed inadequate calcium intake in 87% of cases. Urinary abnormalities were hypocitraturia (34%), hypomagnesuria (32%) and outflow hypercalciuria (21%). Crystalluria was positive in 44% of cases. Whewellite was the most common crystalline form. Calculi were bilateral (53%), renal (85%) and mainly collected after urological procedures (74%). Infrared analysis showed that 81% of stones have a heterogeneous composition. Pure Whewellite or combined with other compounds was the most frequent (31%). Idiopathic calcium oxalate lithiasis was the most common etiology (69%). Among secondary etiologies, diabetes was most frequently found (10%). CONCLUSION:Our epidemiological study of calcium oxalate stones has allowed us to identify the high frequency of food hyperoxaluria partly explained by a low calcium intake and a diet rich in oxalate phytotherapy. LEVEL OF EVIDENCE:4.
10.1016/j.purol.2016.06.005
[Nephrocalcinosis in children].
D'Alessandro Maria Michela,Pavone Giovanni,Castiglione Maria Cristina,Tranchida Anna Maria,Sapia Maria Chiara,Cusumano Rosa,Corrado Ciro,Mongiovì Rosa,Maringhini Silvio
Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia
Nephrocalcinosis (NC) is a renal disease characterized by deposition of calcium salts into the renal medulla. There are several causes, organic, iatrogenic, hereditary and sometimes related to extrarenal diseases. We studied 34 children affected by NC, 21 M and 13 F (average age at diagnosis 7.8 months), with the aim of analyzing the associated diseases, clinical manifestations, metabolic abnormalities, growth and renal function at onset and after follow-up. At onset 70% of patients were asymptomatic and diagnosis was occasional. Renal function was normal in 33 patients. The most frequent clinical symptoms were failure to thrive (9%), abdominal pain (6%), proteinuria/hematuria (7%). The associated diseases were: tubulopathies (8 pcs - tubular acidosis, Dent, Bartter and Lowe Syndromes), medullary sponge kidney, policalicosis (3 pcs ), Short bowel Syndrome (3 pcs), hyperparathyroidism, hypothyroidism (2 pcs), thalassemia (1pc), tyrosinemia (1 pc.). We recognized two forms of hypervitaminosis D. In a pc NC would be correlated with prematurity, another one with lipid necrosis. Among the metabolic abnormalities, observed in 25% of pcs, hyperoxaluria is the most frequent (47%), hypercalciuria (20%), hypercalcemia (15%). In some cases we found endocrine non pathogenic alterations: hypovitaminosis D (2 pcs) and hypoparathyroidism (6 pcs). During follow-up the growth was normal in 87% of cases and glomerular function was stable in 90% of pcs; IRC developed in 3 cases. From our analysis, it appears that the treatment of the underlying condition of NC is associated with catch-up growth and stabilization of renal function in most patients, but not with the reduction of the degree of the NC.
[Nephrolithiasis: metabolic defects and terapeutic implications].
Tasca Andrea,Ammendola Ciro
Urologia
Over the past 10 years, major progress has been made in the knowledge of urinary lithogenesis, including the potential pathogenetic role of Randall's plaques and renal tubular crystal retention. Urine supersaturation is the driving force of this process and can be induced by some risk factors, including low urine volume, high urinary excretion of calcium oxalate and uric acid and low urinary excretion of citrate. Primary hypercalciuria can be due to intestinal overabsorption renal leak and bone reabsorption of calcium. Prophilaxis is mainly conducted with thiazides and low calcium diet which is indicated only in the intestinal form. Primary hyperoxaluria is treated with pyridoxine and may require in the severe forms simultaneous renal and liver transplantation. Enteric hyperoxaluria is secondary to fatty acids malabsorption and requires diet, oral calcium and cholestiramine. Hyperuricosuria is caused by diet endogenous overproduction, mainly due to enzymatic defects or high renal excretion of uric acid. Urine alkalinization with K or K and Mg citrate can prevent stone formation even in idiopathic uric acid nephrolithiasis, in which a defect of urine acidification is supposed to be the main abnormality, and in hypocitraturic patients. Cystinuria is a rare inherited defect with an intense clinical impact. It can be classified in three forms and urinary stone formation is the role. Increased solubility and conversion of cystine in a more soluble form are the main goals of the prophylaxis which includes K citrate and thiol agents administration. Tiopronin is preferred to D-penicillamine due to its lower side effects.
10.5301/uro.5000058
Oxalate synthesis, transport and the hyperoxaluric syndromes.
Williams H E,Wandzilak T R
The Journal of urology
This article reviews the mechanisms involved in the synthesis, absorption, excretion and transport of oxalic acid, and the factors controlling these processes in man. The clinical syndromes associated with hyperoxaluria and recurrent calcium oxalate stone disease are reviewed, including new studies that raise the possibility of a generalized oxalate transport abnormality in some patients with renal stone disease. The important role of oxalate in the determination of calcium oxalate solubility in patients with calcium oxalate stone disease is emphasized and future directions for research in the prevention of recurrent calcium oxalate stone disease are discussed.
10.1016/s0022-5347(17)40999-2
Metabolic Profile of Calcium Oxalate Stone Patients with Enteric Hyperoxaluria and Impact of Dietary Intervention.
Nutrients
This study investigated the risk profile and the impact of dietary intervention in calcium oxalate stone formers with enteric hyperoxaluria under controlled, standardized conditions. Thirty-seven patients were included in the study. Dietary and 24-h urinary parameters were obtained on the self-selected diet and a balanced, standardized diet. Tests for [C]oxalate absorption, calcium- and ammonium chloride-loading were performed. Mean [C]oxalate absorption was 18.8%. A significant positive association was observed between urinary oxalate excretion and intestinal oxalate absorption. In addition, urinary oxalate excretion was significantly correlated with dietary oxalate intake. Mean urinary oxalate excretion decreased from 0.841 mmol/24 h on the usual diet to 0.662 mmol/24 h on the balanced diet, corresponding to a reduction of 21.3%. Besides hyperoxaluria, hypocitraturia and hypomagnesuria were the most common urinary abnormalities at baseline, being present in 83.8% and 81.1% of patients, respectively. Urinary citrate increased by 50.9% and magnesium excretion increased by 25.2% on the balanced diet. As a result, the relative supersaturation of calcium oxalate declined significantly (by 36.2%) on the balanced diet. Since 41% of patients on the balanced diet still had a urine volume of less than 2.0 L/24 h, efforts should be made to increase urine volume by increasing fluid intake and reducing intestinal fluid losses. Dietary intervention proved to be effective in reducing urinary oxalate excretion and should be a cornerstone of the treatment of patients with enteric hyperoxaluria.
10.3390/nu16162688
Associations between Net Gastrointestinal Alkali Absorption, 24-Hour Urine Lithogenic Factors, and Kidney Stones.
Clinical journal of the American Society of Nephrology : CJASN
BACKGROUND:It is not clear whether kidney stone formers have an abnormal handling of alkali and acid precursors in the gut, which might affect urine composition and ultimately stone formation. In this study, we aimed to investigate the determinants of net gastrointestinal alkali absorption and its associations with key urinary parameters in a large group of stone formers and non-stone formers. METHODS:Data were collected from three independent cohorts with at least one 24-hour urine collection. We explored potential determinants of net gastrointestinal alkali absorption and the association between net gastrointestinal alkali absorption, urinary parameters, and stone former status. Finally, we estimated the proportion of the association between urine parameters and stone former status explained by differences in net gastrointestinal alkali absorption. RESULTS:The analysis included 6067 participants (1102 men and 4965 women; 698 and 1804 of whom were stone formers, respectively). Average net gastrointestinal alkali absorption values were consistently lower in stone formers across the three cohorts (from -15.0 to -4.9 mEq/d). Age was directly associated with net gastrointestinal alkali absorption, whereas body mass index and net endogenous acid production were inversely associated. Net gastrointestinal alkali absorption was inversely associated with supersaturation for calcium oxalate, uric acid, and renal net acid excretion and directly associated with supersaturation for calcium phosphate, urine pH, and citrate. The odds of being a stone former was 15% (13%-17%) lower per 10 mEq/24 hours higher net gastrointestinal alkali absorption. Differences in net gastrointestinal alkali absorption explained a modest amount of the differences between stone formers and non-stone formers for supersaturation for calcium oxalate (6.3%) and a sizable amount for supersaturation for uric acid (15.2%), urine pH (38.3%), citrate (26.2%), and renal net acid excretion (63.4%). CONCLUSIONS:Kidney stone formers have lower net gastrointestinal alkali absorption, and this explains differences in urine composition and the likelihood of stone formation.
10.2215/CJN.0000000000000195
Current Dietary and Medical Prevention of Renal Calcium Oxalate Stones.
International journal of general medicine
Kidney stones refer to abnormal crystal formation that occurs in the kidney. Among a variety of components of kidney stones, calcium oxalate (CaOx) is the most common type. Despite many efforts to investigate the pathogenesis of CaOx stones, the pathogenesis remains an issue of debate. With high occurrence and recurrence, individuals with stone formation are prone to frequently consult a doctor and to be hospitalized, and the treatment of kidney stones poses a heavy burden on the patients. Concerns should be focused not only on treatment but also on prevention. Herein, we reviewed the studies on prevention methods of CaOx stones through diet, lifestyle, and medication extending until the current time frame. As hyperoxaluria is the most common metabolic disorder among CaOx stone formations, we also included several studies on the treatment and prevention of hyperoxaluria. Our objective was to outline the effective methods to prevent renal CaOx stone formation.
10.2147/IJGM.S459155
Oxalate Nephropathy and the Mechanism of Oxalate-Induced Kidney Injury.
Kidney diseases (Basel, Switzerland)
Background:Hyperoxaluria is a major cause of oxalate nephropathy, which can lead to impaired renal function presenting as acute kidney injury, acute on chronic kidney disease, or chronic kidney disease. The Chronic Renal Insufficiency Cohort study showed that higher urinary oxalate is associated with renal outcome in patients with chronic kidney disease, supporting the nephrotoxicity of oxalate. Therefore, a better understanding of the role of oxalate in kidney injury is needed. This review describes the metabolism of oxalate and the clinical and pathology presentation of oxalate nephropathy. It also summarizes the available evidence for the underlying pathogenic mechanism and the development of treatments for oxalate-induced kidney injury. Summary:Disruption to any key step in the oxalate pathway including abnormal endogenous generation, ingestion of abnormally high dose of oxalate, increased absorption or attenuation of oxalate degradation in the gut, and reduced excretion through the kidney may lead to disrupted oxalate homeostasis. Oxalate nephropathy is mainly caused by hyperoxaluria. Oxalate crystal deposition in the kidney is usually accompanied with tubular toxicity, obstruction, interstitial fibrosis, and tubular atrophy. The mechanism of oxalate-induced renal injury has not been fully clarified. Evidence from both in vivo and in vitro studies shows that NLRP3 inflammasome activation and macrophage infiltration are involved in the processes of crystal adhesion, aggregation, and elimination and promote intrarenal inflammation and renal fibrosis. Novel treatment strategies have been developed and targeted therapies tested for oxalate nephropathy. Key Messages:Prompt diagnosis and management may help to reduce the deposition of calcium oxalate crystals in the kidney. Further studies are needed to clarify the underlying mechanisms to help develop more targeted therapies for oxalate nephropathy.
10.1159/000533295
Metabolic evaluation: is there really a future?
Current opinion in urology
PURPOSE OF REVIEW:To confirm the need for a metabolic evaluation in stone formers based on the latest information published in the last 24 months and in the current 2022 American and European urological guidelines. RECENT FINDINGS:Recent studies suggest that urolithiasis prevalence has been increasing since 1990. Along with it, metabolic abnormalities that contribute to the development of kidney stones are also increasing, such as hyperuricosuria, hyperoxaluria, hypocitraturia, hypomagnesuria, hypocalciuria, hypophosphaturia, and hyperuricemia. Those abnormalities can only be detected through a metabolic evaluation in patients with stone disease. SUMMARY:It is important for us, urologists, to have in mind the actual stone prevalence worldwide. As part of our initial evaluation of the patient with urolithiasis, we must not forget to perform the basic metabolic analysis and, according to the patient's risk classification, continue with a deep metabolic analysis. This extensive analysis includes blood and urine tests. The urinalysis covers 24-h urinalysis, and it would be accurate to also have an early fresh urine analysis. Moreover, identifying the stone type is intimately correlated with the search for other metabolic parameters.
10.1097/MOU.0000000000000993
Enteric and mild hyperoxaluria.
Sutton R A,Walker V R
Mineral and electrolyte metabolism
Enteric hyperoxaluria complicates extensive disease or resection of the small intestine in the presence of an intact colon, and is associated with calcium oxalate nephrolithiasis. In addition to hyperoxaluria these patients have a low urine volume, low urinary ionic strength and hypocitraturia. Many forms of treatment have been recommended, but none has been subjected to a prospective clinical trial. Mild idiopathic hyperoxaluria is reported in 8-50% of idiopathic calcium oxalate stoneformers. Several pathophysiological mechanisms have been proposed, including low dietary calcium and possible oxalate transport defects in the gut and/or the kidney. Mild hyperoxaluria, or a high oxalate:calcium ratio in the urine, may be particularly important risk factors for calcium oxalate stone formation; an approach to the correction of these abnormalities is proposed.
Lipid peroxidation and its correlations with urinary levels of oxalate, citric acid, and osteopontin in patients with renal calcium oxalate stones.
Huang Ho-Shiang,Ma Ming-Chieh,Chen Chau-Fong,Chen Jun
Urology
OBJECTIVES:To determine whether lipid peroxidation plays a role in patients with calcium oxalate kidney stones and to determine the correlation of lipid peroxidation with tubular damage and the major urinary risk factors. We also used the isoenzymes of glutathione S-transferase (GST) to examine which parts of the renal tubules were injured in patients with renal stones. METHODS:This clinical study included two study groups. Group 1 included 32 normal volunteers, and group 2 included 32 patients with calcium oxalate kidney stones. A 24-hour urine sample was collected from each subject, and the levels of Ca, P, Mg, oxalate, citrate, N-acetyl-beta-glucosaminidase (NAG), beta-galactosidase (GAL), alphaGST, piGST, osteopontin (OPN), thiobarbituric acid-reactive substances (TBARS), and malondialdehyde (MDA) were examined. RESULTS:Hyperoxaluria, hypocitraturia, and low urinary OPN were the major abnormalities found in the patients with stones. Elevated urinary alphaGST, NAG, and GAL were also noted in the patients with stones; however, urinary piGST showed no statistically significant difference compared with the controls. Urinary TBARS and MDA had statistically significant correlations with alphaGST, GAL, NAG, Ca, and oxalate, but had no correlation with piGST, citrate, OPN, Mg, and P. Urinary citrate had a negative, linear, and statistically significant correlation with alphaGST, GAL, and NAG. CONCLUSIONS:Lipid peroxidation correlated with hyperoxaluria and renal tubular damage, indicating that hyperoxaluria can induce tubular cell injury and that this injury may be due to the production of free radicals in patients with calcium oxalate stones. Renal tubular damage in patients with stones may be limited to the proximal tubules.
10.1016/s0090-4295(03)00764-7
Diet and hyperoxaluria in the syndrome of idiopathic calcium oxalate urolithiasis.
Smith L H
American journal of kidney diseases : the official journal of the National Kidney Foundation
Hyperoxaluria is an important risk factor in patients who form calcium oxalate stones within the urinary tract. It occurs in patients with primary hyperoxaluria, enteric hyperoxaluria, and the syndrome of idiopathic calcium oxalate urolithiasis. In the latter condition, the specific causes of the hyperoxaluria are not well defined. Diet and the availability of calcium and oxalate from the diet within the intestine are important factors in the hyperoxaluria that is present in some of these patients with idiopathic calcium oxalate urolithiasis. Other abnormalities in endogenous metabolism or transport of oxalate may play a role in the hyperoxaluria in some of these patients.
Pediatric Age-Related Distribution of Calcium Oxalate Monohydrate and Calcium Oxalate Dihydrate in Urinary Tract Stones: Metabolic, Gender, and Ethnic Correlates.
Journal of endourology
Previous studies of pediatric urolithiasis have suggested possible associations between the relative proportions of calcium oxalate dihydrate (COD) and calcium oxalate monohydrate (COM) stones with age, gender, and ethnicity. This study aimed to investigate the composition and distribution of calcium oxalate (CaOx) stones according to these clinical factors and the metabolic correlates of the different subtypes in pediatric stone formers (PSFs). We retrospectively reviewed the database of all first-time stone formers between 2014 and 2019. Infrared spectrometry was used to determine stone composition. Stones were categorized by their highest relative component and reported as a percentage of occurrences in the cohort as a whole and by patient gender, age (divided into three age groups: 1-5, 6-12, and 13-18 years), and ethnicity. Clinical and metabolic correlates were analyzed. Of 2479 consecutive stones submitted to our chemical stone laboratory, 220 first-time PSFs were identified. COD stones were the predominant subtype in the youngest group, and COM stones in the oldest group (odds ratio 0.39, 95% confidence interval: 0.18-0.86, = 0.036). In the intermediate-age group (6-12 years), COM stones were more prevalent in Arab boys, and COD stones in girls of either ethnicity. COD stones were associated with hypercalciuria ( < 0.0001), and COM stones with hyperoxaluria ( = 0.0024). Hypercalciuria and hypocitraturia were the most prevalent abnormalities at ages 1 to 5 and 13 to 18 years, respectively. Analysis of CaOx stone subtypes and their metabolic correlates in stone formers has significant clinical relevance, specifically in children. In the present study, COD stones and hypercalciuria were more common in younger children, and COM stones and hypocitraturia in adolescents. These findings suggest unique complex interactions driving stone formations in children that may guide a more practical, limited, and cost-effective approach to metabolic evaluations, choice of treatment, and preventive measures, particularly in first-time CaOx PSFs.
10.1089/end.2022.0526
Pathophysiology and clinical aspects of urinary lithiasis.
Vella M,Karydi M,Coraci G,Oriti R,Melloni D
Urologia internationalis
Urine is a complex balanced solution containing dissociated and non-dissociated solutes. Any variation in urine saturation grade (number of crystals dissolved in a volume of urine), urinary pH and the concentration of crystallization inhibitors can break the normal existing balance and lead to urolithiasis. In the present article we analyze the principal mechanisms (absorptive, renal, resorptive) of hypercalciuria. It will be also shown how heredity directly influences the clinical aspects of cystine, xanthine and oxalate lithiasis and how diet, in association with metabolic disorders, interferes in uric acid and oxalate stone formation. Finally, we report on the roles of urinary tract malformations, urinary tract infections and drugs in the clinical characterization of urolithiasis.
10.1159/000104438
Congenital and acquired diseases related to stone formation.
Veser Julian,Özsoy Mehmet,Seitz Christian
Current opinion in urology
PURPOSE OF REVIEW:To summarize the latest findings of congenital and acquired diseases related to stone formation and help understanding the multitude of cofactors related to urolithiasis. RECENT FINDINGS:Urolithiasis is related to a broad spectrum of congenital and acquired diseases and its management varies according to the stone type, underlying disease or recurrence rate, but it also changes according to recent findings and developments. As prevalence of urolithiasis is constantly increasing, identification of high-risk stone formers and early treatment is essential. Therefore, genetic evaluation like whole exome sequencing becomes a pertinent part of further diagnostics. SUMMARY:Stone formation is a very heterogeneous pathomechanism. This prompt us to look at every patient individually particularly in high-risk patients, including stone and 24-h-urine analysis and additional diagnostic work-up based on stone type or underlying disease.
10.1097/MOU.0000000000000522
Do kidney stone formers have a kidney disease?
Zisman Anna L,Evan Andrew P,Coe Fredric L,Worcester Elaine M
Kidney international
Nephrolithiasis is a highly prevalent disorder affecting approximately one in eleven people and is associated with multiple complications including hypertension, cardiovascular disease, and chronic kidney disease. Significant epidemiologic associations with chronic kidney disease and ESRD have been noted and are reviewed herein, but debate persists in the literature as to whether kidney stone formation is a pathogenic process contributing to kidney disease. Corroborating evidence supporting the presence of kidney disease in stone formers includes the variability of renal function by stone type, the positive association of stone size with renal dysfunction, the presence of markers of renal injury in the urine of even asymptomatic stone formers, and direct evidence of renal tissue injury on histopathology. Proposed pathogenic mechanisms include recurrent obstruction and comorbid conditions such as recurrent urinary tract infections and structural abnormalities. Recent work evaluating the renal histopathology of different groups of stone formers adds further granularity, suggesting variability in mechanisms of renal injury by stone type and confirming the pathogenic effects of crystal formation. Genetic abnormalities leading to stone formation including cystinuria and primary hyperoxaluria, among others, contribute to the burden of disease in the stone-forming population.
10.1038/ki.2015.254
[Assessment of oxalate concentration in serum and urine of children with renal stones].
Jadeszko Iwona,Porowski Tadeusz,Zoch-Zwierz Walentyna M,Wasilewska Anna M,Hackiewicz Lech
Wiadomosci lekarskie (Warsaw, Poland : 1960)
UNLABELLED:Oxalate crystals are the main component of renal stones and oxalate urolithiasis is the most common type both in adults and children. The aim of the work was the assessment of oxalate concentration in plasma and urine of children with renal stones. MATERIAL:The examined group (I) consisted of 29 children (12.0 +/- 3.87 years) with confirmed stones in caliceal-pelvic system. The control group (C) was composed of 30 healthy children. METHODS:The oxalate concentration in plasma and urine was measured using an enzymatic method after 3-4 days of hypooxalate diet. Children with congenital abnormalities of urinary tract were excluded. We found 1-5 stones, 0.35-1.5 in diameter. RESULTS:In I group mean plasma oxalate concentration (4.89 +/- 1.58 micromol/l) was higher than in control group (p<0,05). However urinary oxalate concentration exceeded 95 percentile of those obtained in healthy group only in 16 (55%) children, mainly with II and III degree of urolithiasis. In children with urolithiasis we also found hypercalciuria with normal serum calcium concentration. No correlation between plasma and urinary oxalate concentration was found. CONCLUSIONS:1. Plasma oxalate concentration in children with renal stones is higher than in healthy children. 2. Hyperoxaluria was found in 16 (55%) children with first attack of nephrolithiasis.
Possible link between vitamin D and hyperoxaluria in patients with renal stone disease.
Giannini S,Nobile M,Castrignano R,Pati T,Tasca A,Villi G,Pellegrini F,D'Angelo A
Clinical science (London, England : 1979)
1. Vitamin D seems to play an essential role in the pathogenesis of idiopathic hypercalciuria at least in part via intestinal hyperabsorption of calcium. Hyperabsorption of calcium, in turn, might enhance the intestinal uptake of free oxalate, thus leading to hyperoxaluria. To verify this hypothesis we studied 75 calcium-stone-formers subdivided as follows: group 1 (15 patients) with isolated hyperoxaluria; group 2 (25 patients) with hyperoxaluria and hypercalciuria; group 3 (22 patients) with isolated hypercalciuria; group 4 (12 patients) with no metabolic abnormalities. 2. As expected, urinary calcium excretion differed in the various groups (P < 0.001), being highest in groups 2 and 3; urinary oxalate excretion, by definition highest in groups 1 and 2, was even more pronounced in group 2 than in group 1 (P < 0.05). Although in the normal range, the serum 1,25-dihydroxyvitamin D concentration was higher (P < 0.001) in the two hypercalciuric groups (2 and 3), showing peak levels in group 2. 3. When the data from the 75 stone-formers were pooled, there was a positive correlation between the serum concentration of 1,25-dihydroxyvitamin D and urinary calcium excretion (P < 0.001) and urinary oxalate excretion (P < 0.003), the latter relationship also being present when only the two hypercalciuric groups (groups 2 and 3) were considered together (P < 0.05). 4. Our data seem to confirm a relevant role for the vitamin D system in the pathogenesis of calcium nephrolithiasis due to increased intestinal calcium absorption, but also because this in turn induces a greater intestinal absorption of oxalate, thus leading to the occurrence or exacerbation of hyperoxaluria.
Risk factors for recurrence in pediatric urinary stone disease.
Pediatric nephrology (Berlin, Germany)
BACKGROUND:Children's urinary system stones may develop from environmental, metabolic, anatomical, and other causes. Our objective is to determine the recurrence and prognosis, demographic, clinical, and etiological characteristics of children with urolithiasis. METHODS:Medical records of patients were evaluated retrospectively. Patients' demographic data and medical history, serum/urine biochemical and metabolic analysis, blood gas analysis, stone analysis, imaging findings, and medical/surgical treatments were recorded. RESULTS:The study included 364 patients (male 187). Median age at diagnosis was 2.83 (IQR 0.83-8.08) years. The most common complaints were urinary tract infection (23%) and urine discoloration (12%). Sixty-two percent had a family history of stone disease. At least one metabolic disorder was found in 120 (88%) of 137 patients having all metabolic analyses: hypercalciuria was found in 45%, hypocitraturia in 39%, and hyperoxaluria in 37%. Anatomical abnormalities were detected in 18% of patients. Of 58 stones analyzed, 65.5% were calcium and 20.6% were cystine stones. Stone recurrence rate was 15% (55/364). Older age (> 5 years), family history of stone disease, stone size (≥ 5 mm), and urinary system anatomical abnormalities were significantly associated with stone recurrence (p = 0.027, p = 0.031, p < 0.001, and p < 0.001, respectively). In adjusted logistic regression analysis, stone size ≥ 5 mm (OR 4.85, 95% CI 2.53-9.3), presence of urinary system anatomical abnormalities (OR 2.89, 95% CI 1.44-5.78), and family history of stone disease (OR 2.41, 95% CI 1.19-4.86) had increased recurrence rate. CONCLUSIONS:All children with urolithiasis should be evaluated for factors affecting stone recurrence. Children at higher risk of recurrence need to be followed carefully.
10.1007/s00467-024-06300-0
Primary obstructive megaureter in adults.
Hanna M K,Wyatt J K
The Journal of urology
The clinical features, diagnosis and treatment of 26 adults with primary obstructive megaureter have been reviewed. The histological features and the urodynamics of this disease are discussed. The clinical picture of primary obstructive megaureter in the adult may be deceivingly unimpressive. In this series 2 kidneys were destroyed because of progressive disease in the absence of clinical symptoms. We support Creevy's findings that the pathology involved is an obstructive segment of the ureter on the basis of a thickened muscularis and mild inflammation of the mucosa and submucosa. Urodynamic studies performed by one of us (M.K.H.) suggest that these ureters may remain in a balanced state indefinitely, owing to a low resting pressure. However, there may be relatively little reserve capacity and, with increased urine production rates, the pressure transmitted to the renal collecting system may produce renal atrophy. The radiologic features of the disease may reflect its clinical course, that is those showing a bulb and tail have a more benign course than ureters with a sharp cutoff. High dosage cine-pyelography is valuable in confirming the diagnosis and in studying the contractility of the ureter. Initially, we treated these cases conservatively. The presence of calculi and planned pregnancy are strong indication for surgical interference. Of the 26 patients 15 ultimatley required an operation. We recommend ureteral remodeling and reimplantation whenever possible since 11 of our cases had a most gratifying result from this procedure.
10.1016/s0022-5347(17)59473-2
Endoureterotomy for congenital primary obstructive megaureter: preliminary report.
Bapat S,Bapat M,Kirpekar D
Journal of endourology
BACKGROUND AND PURPOSE:Congenital obstructive megaureter (COMU) may be unilateral or bilateral and may present in later years of life. If the obstruction is not relieved in good time, deleterious effects on the proximal ureter and kidney are well known. Stones may complicate the situation further. So far, the only treatment that has been available is to disconnect the ureter proximal to the site of obstruction, remove any stone, and reimplant the ureter into the bladder after any necessary tailoring. After noticing the encouraging results of endopyelotomy for congenital ureteropelvic junction obstruction, we decided to use the same principle for the management of COMU, as similar functional pathology is present in both situations. PATIENTS AND METHODS:Our technique was applied in six ureters in five adult patients. After cystoscopic evaluation of the bladder and ureteral orifice, a guidewire was advanced up the ureter, and the lower ureter was dilated. A ureteroscope or other suitable endoscopic instrument was passed, and the obstructed segment of the ureter was incised at the 6 o'clock position with pure cutting current. All of the layers of the ureter were incised in the long axis through the entire obstructive segment, so as to expose the periureteral areolar tissue. If necessary, a similar cut was made at the 12 o'clock position. Utmost care was taken not to incise the bladder mucosa. A double-J stent was inserted for 3 weeks. RESULTS:Follow-up for 1 to 4 years showed free drainage of urine into the bladder, with marked reduction in proximal stasis and freedom from recurrent infection and pain. CONCLUSION:Although our series is small and follow- up is relatively short, it appears that endoureterotomy is a safe and effective treatment for COMU.
10.1089/end.2000.14.263
Urolithiasis in adults with congenital megaureter.
Rosenblatt Gregory S,Takesita Ken,Fuchs Gerhard J
Canadian Urological Association journal = Journal de l'Association des urologues du Canada
The primary presentation of congenital megaureter in adults is rare. Development of urolithiasis may lead to this unusual underlying diagnosis. Urinary tract stones can form either within the dilated ureteral segment or in a part of the upper urinary tract proximal to the abnormal ureteral segment. We report two cases of nephrolithiasis that occurred in adults found to have segmental megaureter. The first case is that of a 58-year-old man who presented with left lower quadrant pain. Computed tomography scan revealed a 2-cm stone in the distal left ureter within an area of isolated segmental distal ureteral dilation. The second case is a 48-year-old man who developed recurrent renal urolithiasis associated with isolated distal megaureter.Although a rare condition in adults, congenital megaureter may present when kidney stones develop as a result of the ureteral abnormality. Typically, stones will develop within the dilated segment of ureter. Atypically, stones may develop away from the site of the underlying abnormality. Congenital megaureter is a diagnosis that urologists and radiologists need to consider in the setting of isolated distal ureteral dilation, as the diagnosis of adult megaureter may require more involved surgical measures to prevent recurrence of adverse symptoms.
10.5489/cuaj.1185
[Obstructive uropathy in childhood].
Balster S,Schiborr M,Brinkmann O A,Hertle L
Aktuelle Urologie
"Obstructive uropathy" is a generic term which combines different diseases in infants and childhood. Both the upper and lower urinary tract may be affected. Diseases of the urinary tract can cause an intrinsic obstruction. Sometimes tumours may cause a compression and as secondary effect an obstruction (extrinsic). Ultrasound is the key diagnostic tool and shows dilatation of the obstructed urinary tract. But for the functional exploration of babies and toddlers, renal scanning and X-ray examinations are necessary. These examinations lead to an exposure to radiation which necessitates careful indication. Some of the congenital diseases (for example ureteropelvic junction obstruction, megaureter) show a maturation without any intervention. So one has to decide whether to wait and see or to operate. A percutaneous nephrostomy or a DJ-catheter is not often used in the treatment of obstruction in general. These forms of drainage are more often used in the treatment of stones or of extrinsic obstruction. A pyelocutaneostomy or ureterocutaneostomy is a special surgical procedure in pediatric urology for transient drainage of the upper urinary tract (megaureter). The operation of a seriously ill new-born should be done in a centre for pediatric urology and pediatric nephrology. When the upper urinary tract is dilated, patients may need an antibiotic prophylaxis, because the dilatation of the upper urinary tract increases the risk of urinary tract infections (UTI). The indication for antibiotic prophylaxis should by guided by the criteria of the APN-Consensus Paper. Long-term follow-up is necessary and should comprise ultrasound, physical examination, controlling the blood pressure, urine analysis and blood tests. The aims of diagnostics, treatment and long-term follow-up are the preservation of renal function and to protect the children from UTI. This goal must be reached under conditions that are appropriate for children and their parents.
10.1055/s-2005-870934
An 11-year-old child with autosomal dominant polycystic kidney disease who presented with nephrolithiasis.
Firinci Fatih,Soylu Alper,Kasap Demir Belde,Turkmen Mehmet,Kavukcu Salih
Case reports in medicine
Patients with autosomal dominant polycystic kidney disease become symptomatic and are diagnosed usually at adulthood. The rate of nephrolithiasis in these patients is 5-10 times the rate in the general population, and both anatomic and metabolic abnormalities play role in the formation of renal stones. However, nephrolithiasis is rare in childhood age group. In this paper, an 11-year-old child with autosomal dominant polycystic kidney disease presenting with nephrolithiasis is discussed.
10.1155/2012/428749
The association of nephrolithiasis and autosomal dominant polycystic kidney disease.
Torres V E,Erickson S B,Smith L H,Wilson D M,Hattery R R,Segura J W
American journal of kidney diseases : the official journal of the National Kidney Foundation
Despite the frequency and morbidity of nephrolithiasis in autosomal dominant polycystic kidney disease (ADPKD), this association has not been subject to a detailed study. One hundred fifty-one of 751 ADPKD patients seen at the Mayo Clinic between 1976 and 1986 had nephrolithiasis. Seventy-four had passed calculi or had stones surgically removed. Stone analysis was available in 30 patients: uric acid, calcium oxalate, calcium phosphate, and struvite were present in 56.6%, 46.6%, 20%, and 10%, respectively. Calculi were observed in 71 of 79 patients with excretory urograms available for review. Faintly opaque and bull's eye stones, probably containing uric acid, were present in 12.7% and 14.1% of these patients, respectively. Precaliceal tubular ectasia was observed in 15.5%. Ninety-seven patients had preserved renal function (serum creatinine less than 1.5 mg/dL) at the initial evaluation. Six were excluded because they had other known causes of stone disease. The most common metabolic abnormality in the remaining 91 patients was hypocitric aciduria (ten of 15 patients with measurements). The urine pH in the first voided morning specimens (5.66 +/- 0.05) was significantly lower than that of an unselected control population (5.92 +/- 0.03, P less than 0.001). Hyperuricosuria, hyperoxaluria, and hypercalciuria were observed in six of 32 (18.8%), six of 31 (19.4%), and three of 39 (9.7%) patients with preserved renal function. The composition of the stones, the frequency of hypocitric aciduria, and the low urine pH (possibly related to the defect in excretion of ammonia described in ADPKD), suggest that metabolic, along with mechanical, factors are responsible for the frequent occurrence of nephrolithiasis in this disease.
The role of urinary supersaturations for lithogenic salts in the progression of autosomal dominant polycystic kidney disease.
Journal of nephrology
BACKGROUND:Autosomal dominant polycystic kidney disease (ADPKD) is associated with significant risk of forming kidney stones, especially those made of calcium oxalate and uric acid, compared with the general population. Since crystals are able to activate the inflammasome and lead to cell injury, crystalluria might worsen ADPKD natural history, acting as a third hit. METHODS:The Bern ADPKD registry is a prospective observational cohort study. Height-adjusted total kidney volume (ht-TKV) was measured at baseline and every 3 years. Twenty-four hour urinary solute excretions collected at baseline and eGFR measurements over time were included in this analysis. Twenty-four hour urinary supersaturations (SS) for calcium oxalate, calcium phosphate and uric acid were calculated using EQUIL-2. Linear regression models were used to assess linear and non-linear associations between slopes of ht-TKV and eGFR with SSs and 24 h urinary solute excretions. RESULTS:Seventy-seven participants (mean age 45.0 [SD 12.9] years, eGFR 76.4 [28.3] mL/min/1.73 m) were included, with a median follow-up of 4 years. The median slopes of ht-TKV and eGFR were 3.9 percent/year and 2.9 mL/min/1.73 m/year, respectively. SS for uric acid showed a direct, linear association (p value for linearity 0.035) with ht-TKV slope. When analyzing individual components, urinary uric acid, ammonium, magnesium and sulfate were all directly associated with ht-TKV slope. Urinary sulfate was also directly associated with eGFR slope. CONCLUSIONS:Uric acid supersaturation and several other urinary components are identified as predictors of cyst growth in patients with ADPKD. Future studies with a dedicated design are needed to investigate the pathophysiological mechanisms underlying these associations.
10.1007/s40620-022-01540-5
Polycystic kidney disease: etiology, pathogenesis, and treatment.
Martinez J R,Grantham J J
Disease-a-month : DM
Once viewed as hopelessly incurable disorders and the dustbin for careers in academic medicine, the polycystic kidney diseases have emerged as prime targets of pathophysiologic study and palliative and definitive treatment in the era of molecular medicine. Polycystic kidney disease (PKD) may be hereditary or acquired. The major inherited types are autosomal dominant (AD) and autosomal recessive (AR). ADPKD is caused by at least two (and possibly three) genes located on separate chromosomes, while ADPKD-1 is due to a 14 kb transcript in a duplicated region on the short arm of chromosome 16 very near the alpha-globin gene cluster and the gene for one form of tuberous sclerosis. ADPKD-2 has been assigned to the long arm of chromosome 4. ARPKD is due to a mutated gene on both copies of the long arm of chromosome 6. Cysts originate in renal tubules. Proliferation of tubule epithelial cells modulated by endocrine, paracrine, and autocrine factors is a major element in the pathogenesis of renal cystic diseases. In addition, fluid that is abnormally accumulated within the cysts is derived from glomerular filtrate and, to a greater extent, by transepithelial fluid secretion. Abnormal synthesis and degradation of matrix components associated with interstitial inflammation are additional features in the pathogenesis of renal cystic diseases. The ADPKD genotypes are characterized by bilateral kidney cysts, hypertension, hematuria, renal infection, stones, and renal insufficiency. ADPKD is a systemic disorder; cysts appear with decreasing frequency in the kidneys, liver, pancreas, brain, spleen, ovaries, and testis. Cardiac valvular disorders, abdominal and inguinal hernias, and aneurysms of cerebral and coronary arteries and aorta are also associated with ADPKD. Treatment is supportive: dietary regulation of salt and protein intake, control of hypertension and renal stones, and dialysis and transplantation at the end stage. ARPKD is a relatively rare disease that causes clinical symptoms at birth, with significant mortality in the first month of life. The cysts develop primarily in the collecting ducts because of a failure in the maturation process. Early complications include Potter's syndrome; excessive size of the kidneys, causing respiratory dysfunction; hypertension; and renal insufficiency. Hepatic fibrosis is an associated extrarenal problem that results in significant morbidity in young children and adolescents. Treatment includes supportive care, dialysis, and renal transplantation. Acquired cysts (solitary/simple) are commonplace in older persons. Multiple cysts may be seen in association with potassium deficiency, congenital disorders, metabolic diseases, and toxic renal injury.(ABSTRACT TRUNCATED AT 400 WORDS)
10.1016/s0011-5029(05)80007-0
Renal stone disease in autosomal dominant polycystic kidney disease.
Torres V E,Wilson D M,Hattery R R,Segura J W
American journal of kidney diseases : the official journal of the National Kidney Foundation
Nephrolithiasis is an important manifestation of autosomal dominant polycystic kidney disease (ADPKD), which occurs in approximately 20% of patients. It should always enter the differential diagnosis of flank pain in patients with ADPKD. The diagnosis is hindered by the distorted anatomy of the polycystic kidneys and the frequent occurrence of parenchymal and cyst wall calcifications, and requires demonstration of the relationship to the collecting system by intravenous urography and/or computed tomography. Computed tomography is the most sensitive imaging technique for detection of stones or calcifications, whereas intravenous urography is the most sensitive for visualization of the intrarenal collecting system. Precaliceal tubular ectasia can be detected in 15% of patients with ADPKD and nephrolithiasis, but this association may not be specific to ADPKD. The composition of the stones is most frequently uric acid and/or calcium oxalate. Metabolic factors are important in their pathogenesis. Distal acidification defects may be important in a few patients, while an abnormal transport of ammonium, low urine pH, and hypocitruria are the most common abnormalities. The treatment of nephrolithiasis in patients with ADPKD is not different from that in patients without ADPKD. Extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy in patients with early disease and normal renal function are not contraindicated.
Inherited renal diseases.
Leung Jocelyn C
Current pediatric reviews
Genetic disorders of the kidney include cystic diseases, metabolic diseases and immune glomerulonephritis. Cystic diseases include autosomal dominant and recessive polycystic kidney disease (ADPKD, ARPKD, respectively). Neonates with enlarged, cystic kidneys should be evaluated for PKD. Patients with ADPKD have cysts and renal enlargement. Most patients present with hypertension, hematuria or flank pain; the most common extrarenal manifestation is polycystic liver disease. Oligohydramnios, bilaterally enlarged kidneys and decreased urine are featured in utero in ARPKD. Medullary sponge kidney is uncommon and features nephrocalcinosis, recurrent calcium stones and a history of polyuria/nocturia and/or urinary tract infections. Alport syndrome (AS) is an inherited disease of the glomerular basement membrane that is usually inherited as an X-linked dominant trait. Most patients with AS present in the first two decades of life with persistent microscopic or gross hematuria. Later, proteinuria is seen and its presence portends disease progression. Other findings may include sensorineural hearing loss and ocular abnormalities. There are various inherited tubulopathies, including Bartter syndrome, a group of renal tubular disorders that consist of two phenotypes with four genotypes. Patients usually present early in life with salt wasting, hypokalemia and metabolic alkalosis. Other features, depending on genotype, may include polyhydramnios and premature birth. Gitelman syndrome is also a salt-losing tubulopathy characterized by hypokalemic alkalosis. The majority of patients with Gitelman syndrome present during adolescence or early adulthood.
10.2174/157339631002140513101755
A Simple Modification for the Usage of Flexible Cystoscope in Modified Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction with Renal Calculi: A Flexible Guiding Tube.
Hong Peng,Li Ziao,Zhu Dongdong,Zhuang Liyan,Yang Kunlin,Hao Han,Li Xuesong,Zhou Liqun
Urologia internationalis
OBJECTIVE:To present our technique of laparoscopic pyeloplasty (LP) with concomitant pyelolithotomy in ureteropelvic junction obstruction (UPJO) complicated by renal calculi and compare outcome with a group of UPJO patients undergoing modified LP without coexistent calculi. MATERIALS AND METHODS:We retrospectively reviewed the charts of 51 UPJO patients undergoing modified LP from January 2013 to November 2016 at our institution. Sixteen patients were diagnosed as UPJO with coexistent ipsilateral renal calculi and underwent pyelolithotomy using our modified technique at the time of modified LP. The outcome data of this group were compared with those of 16 matched patients undergoing modified LP without calculi. RESULTS:No conversion to open surgery occurred. The mean operative time for modified LP and pyelolithotomy was 151.6 min, while the mean operative time for modified LP was 137.6 min (p = 0.21). Additionally, no differences in estimated blood loss (p = 0.96) or postoperative complications (p = 1.00) were observed between the 2 groups. The stone-free rate was 100%. During a mean follow-up of 27.1 months, there were no recurrent calculi or secondary UPJO. CONCLUSIONS:The combination of our novel flexible guiding tube and modified suture technique provides a practical and economic approach with satisfying outcome in the treating of UPJO with concomitant renal calculi.
10.1159/000495569
Complications and long-term outcome of primary obstructive megaureter in childhood.
Gimpel Charlotte,Masioniene Liuda,Djakovic Nenad,Schenk Jens-Peter,Haberkorn Uwe,Tönshoff Burkhard,Schaefer Franz
Pediatric nephrology (Berlin, Germany)
We assessed the clinical outcome of 49 children with 56 primary obstructive megaureters (POM) treated with the primarily conservative approach recommended by the 2001 German consensus guidelines. POM occurred more often in boys (71%) and on the left side (67%). Forty-three POM (77%) were treated conservatively. Four kidneys underwent immediate surgery and nine of 52 kidneys managed primarily conservatively worsened subsequently, requiring surgery. Urinary tract infections (UTI) were the most common complication (mean 1.3 per patient), with frequent hospital admission (45%). During the first year of life, the incidence of UTIs was 55% less during prophylactic antibiotic treatment (0.94 vs.0.42 UTIs per year, p < 0.05). Spontaneous regression occurred in 80% of POMs with dilated non-obstructive renogram, but in <20% with intermediate or relevant obstruction. All megaureters with <8.5 mm sonographic diameter regressed, but none over 15 mm. Eight patients had a poor outcome (partial kidney function <40% (n = 6), renal atrophy (n = 3)), but in seven of the patients, these findings were already present postnatally. In summary, the long-term outcome of POM appears favorable with mainly conservative treatment. UTI as the most common complication was 55% lower with antibiotic prophylaxis in infants. Adverse outcome was more closely related to congenital kidney hypoplasia than to degree of obstruction.
10.1007/s00467-010-1523-0
Primary obstructive megaureter with a giant lower ureteral stone synchronous with ipsilateral staghorn kidney.
Moslemi Mohammad Kazem
International journal of surgery case reports
INTRODUCTION:Primary obstructive megaureter (POM) is uncommon in adults. Urolithiasis formation may uncover the underlying congenital abnormally of these patients. PRESENTATION OF CASE:Herein, we present a 20-year-old man who was admitted with synchronous left renal staghorn and a lower giant ureteral stone. Radiologic evaluations revealed that POM is the underlying cause of the uncommon occurrence of synchronous left reno-ureteral stone formation. DISCUSSION:Urinary tract stones are not uncommon in the POM. Although synchronous renal-ureteral unit stones are less common but staghorn-ureteral stones complex are very rare. In such conditions full radiologic work-up is recommended. Based on our literature review, this is the first reported case of staghorn-ureteral stones complex in the setting of adult POM. CONCLUSION:In every case with dilated ureter concomitant with ureteral stone or renal stone, the POM should be included in the differential diagnosis.
10.1016/j.ijscr.2012.07.006
Magnetic resonance urography and X-ray urography findings of congenital megaureter.
Li Tian-Ran,Du Xiang-Ke,Huo Tian-Long
Chinese medical sciences journal = Chung-kuo i hsueh k'o hsueh tsa chih
OBJECTIVE:To observe the imaging findings of congenital megaureter in order to enhance the understanding of this disease. METHODS:Image data of 5 patients with congenital megaureter and 2 misdiagnosed patients were analyzed, and image findings of congenital megaureter were summarized.Elscint Prestig 2.0T superconductive magnetic resonance urography (MRU) with conventional sequence (spin-echo, T1WI560 ms/16 ms; fast spin-echo, T2WI 9600 ms/96 ms ) was performed. Raw data were acquired with fastspin-echo sequence from heavy T2-weighted image (9600 ms/120 ms). Post-processing method of MRU was the maximum intensity projection with three-dimensional reconstruction in the workstation. Intravenous pyelography (IVP) was conducted, in which X-rayfilms were taken 7 minutes, 15 minutes, and 30 minutes after injecting contrast agent, exceptthat in 2 patients the films were taken delayed at 60 and 90 minutes .X-ray retrograde pyelography was performed on 2 patients, successful in one butfailed in the other. RESULTS:The dilated ureter showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images in conventional MRI. The mass wall was intact, uniform in thickness, and showing hypointensity on T1-weighted and T2-weighted images. The MRU images showed a retroperitoneal mass appearing as an elongated tubular cystic structure spreading from kidney to bladder. MRU also revealed dilated calices and renal pelvis, pelviureteric obstruction, and renal duplication. The main signs of congenital megaureter in X-urography was significant dilatation of ureter, or normal renal pelvis with ureter dilatation, hydronephrosis, deformity, and displacement. CONCLUSIONS:MRU with X-urography could visualizethe characteristics of congenital megaureter, including the dilation of renal pelvis and ureter, calculi, urinary tract duplication, and stenosis location. The two techniques can complement each other in disease diagnosis and provide more detailed information for preoperative treatment.
10.1016/s1001-9294(11)60028-x
Congenital Segmental Megaureter in an Ectopic Kidney.
Khanna Ashish,Mavuduru Ravimohan Suryanarayana,Bora Girdhar S,Devana Sudheer K,Mandal Arup K
Urology
We describe the imaging findings of a 19-year-old female patient who presented with recurrent urinary tract infections and pain abdomen which was diagnosed to be due to a left-sided focal segmental megaureter with a calculus. The highlights of the case are functioning moiety with no other associated anomalies like vesicoureteral reflux, Duplex system, and so on.
10.1016/j.urology.2017.11.032
Urolithiasis in the horseshoe kidney: a single-centre experience.
Symons Stephanie J,Ramachandran Anil,Kurien Abraham,Baiysha Ramen,Desai Mahesh R
BJU international
OBJECTIVE:To report the operative management and subsequent stone-free rates of patients with urolithiasis in a horseshoe kidney and treated at one centre. PATIENTS AND METHODS:We retrospectively reviewed all patients presenting to our centre with a horseshoe kidney and urolithiasis over a 15-year period. The stone burden, surgical management, complications and stone clearance rates were recorded. RESULTS:In all, 55 patients with urolithiasis in horseshoe kidney were treated. Percutaneous nephrolithotomy (PCNL) was used in 60 renal units in 47 patients. Five patients had extracorporeal shock wave lithotripsy (ESWL), two had flexible ureteroscopy and one had a laparoscopic pyelolithotomy for a stone extending into the isthmus. PCNL was used for large stones (mean digitized surface area = 614.32 mm(2)) and required one to four stages to achieve an overall stone clearance rate of 88%. Stones were cleared at one sitting in 77% of PCNL procedures, completely cleared in two-thirds of patients treated by ESWL, and in both who had flexible ureteroscopy and the one treated with laparoscopic pyelolithotomy. Complications were minimal, with 15% minor and 3% major complications in the PCNL group only. CONCLUSION:Appropriate management of urolithiasis within the horseshoe kidney depends not only on stone burden, but also on stone location, calyceal configuration and malrotation. Stones can be cleared successfully in almost all patients providing that all techniques are available to the operating surgeon.
10.1111/j.1464-410X.2008.07987.x
Incidence and characteristics of kidney stones in patients with horseshoe kidney: A systematic review and meta-analysis.
Pawar Aditya S,Thongprayoon Charat,Cheungpasitporn Wisit,Sakhuja Ankit,Mao Michael A,Erickson Stephen B
Urology annals
INTRODUCTION:The horseshoe kidney (HSK) is the most common type of renal fusion anomaly. The incidence and characteristics of kidney stones in patients with HSK are not well studied. The aim of this meta-analysis was to evaluate the incidence and types of kidney stones in patients with HSK. METHODS:A systematic literature search was performed using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from the databases' inception through November 2016. Studies assessing the incidence and types of kidney stones in patients with HSK were included. We applied a random-effects model to estimate the incidence of kidney stones. The study protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42016052037). RESULTS:A total of 14 observational studies with 943 patients (522 adults and 421 pediatric) with HSK were enrolled. The estimated pooled incidence of kidney stones was 36% (95% confidence interval [CI], 15%-59%) in adults with the HSK. Kidney stones were less common in pediatric patients with HSK with an estimated pooled incidence of 3% (95% CI, 2%-5%). The mean age of adult stone formers with HSK was 44.9 ± 6.2 years, and 75% were males. Within reported studies, 89.2% of kidney stones were calcium-based stones (64.2% calcium oxalate [CaOx], 18.8% calcium phosphate [CaP], and 6.2% mixed CaOx/CaP), followed by struvite stones (4.2%), uric acid stones (3.8%), and others (2.8%). CONCLUSIONS:Kidney stones are very common in adult patients with HSK with an estimated incidence of 36%. Calcium-based stones are the most prevalent kidney stones in adults with HSKs. These findings may impact the prevention and clinical management of kidney stones in patients with HSK.
10.4103/UA.UA_76_17
[Horseshoe kidney, stone disease and prostate cancer: a case presentation].
Hermida Pérez J A,Bermejo Hernández A,Hernández Guerra J S,Sobenes Gutierrez R J
Semergen
The horseshoe kidney is the most common congenital renal fusion anomalies. It occurs in 0.25% of the population, or 1 in every 400 people. It is more frequent in males (ratio 2:1). The most observed complication of horseshoe kidney is stone disease, although there may be others such as, abdominal pain, urinary infections, haematuria, hydronephrosis, trauma and tumours (most commonly associated with hypernephroma and Wilms tumour). We describe a case of a male patient with horseshoe kidney, stone disease and adenocarcinoma of the prostate. One carrier of this condition who suffered a transitional cell carcinoma of the prostate was found in a review of the literature.
10.1016/j.semerg.2012.07.007
Combined laparoscopic pyelolithotomy with retrograde intrarenal surgery in a patient with horseshoe kidney anomaly and kidney stone: a case report.
Journal of surgical case reports
Horseshoe kidney is the most prevalent congenital kidney fusion anomaly, affecting 0.25% of the general population and occurring in 1 in 400-1600 births. Approximately 40 percent of patients develop kidney stones due to anomalies. In our case, we aimed to perform combined laparoscopic pyelolithotomy with retrograde intrarenal surgery (RIRS) instead of percutaneous nephrolithotomy (PNL) in a patient with a horseshoe anomaly. This procedure enabled us to detect the location of the mobile stone with RIRS and then successfully extract it with laparoscopic pyelolithotomy. Laparoscopic pyelolithotomy combined with RIRS is a reasonable additional treatment option for complicated stone surgery due to horseshoe kidney anomalies.
10.1093/jscr/rjad617
Lithiasis in a horseshoe kidney.
Pineda-Murillo Javier,Arellano-Cuadros José Rodrigo,Torres-Aguilar Jesús,Viveros-Contreras Carlos,Sánchez-Bermeo Alfredo Fernando,Pineda-Murillo Elba Gabriela,Hernández-León Omar
Archivos espanoles de urologia
Ureteropelvic junction obstruction and coexisting renal calculi in children: role of metabolic abnormalities.
Tekin A,Tekgul S,Atsu N,Ergen A,Kendi S
Urology
OBJECTIVES:To identify the role of metabolic risk factors in the development of renal calculi associated with ureteropelvic junction obstruction (UPJO) in children. METHODS:A metabolic evaluation, including serum biochemistry and measurement of daily urinary calcium, creatinine, oxalate, citrate, magnesium, urate, and inorganic phosphorus, was carried out in three different populations as follows: UPJO group, 12 children with UPJO and coexisting nephrolithiasis (median age 6 years); calcium stone formation (CSF) group, 90 children with normal urologic anatomy and calcium urolithiasis (median age 7 years); control group, 24 healthy children (median age 7.3 years). The investigation data of the three groups were compared. RESULTS:The stone composition was calcium oxalate in 9 of the 12 children with UPJO. The investigation data of the UPJO group and CSF group were not significantly different. Both groups differed from the control group in a similar manner. The UPJO and CSF groups excreted more oxalate (P = 0.067 and 0.014, respectively) and less citrate (P = 0.020 and 0.010, respectively) than did the control subjects. CONCLUSIONS:Abnormal urinary biochemistry seems to have an additional role in the high incidence of nephrolithiasis in children with upper tract anatomic anomalies, and the urinary biochemistry should be screened in such children.
10.1016/s0090-4295(00)01030-x
[Advance in re-do pyeloplasty for the management of recurrent ureteropelvic junction obstruction after surgery].
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences
Ureteropelvic junction obstruction (UPJO) is characterized by decreased flow of urine down the ureter and increased fluid pressure inside the kidney. Open pyeloplasty had been regarded as the standard management of UPJO for a long time. Laparoscopic pyeloplasty reports high success rates, for both retroperitoneal and transperitoneal approaches, which are comparable to those of open pyeloplasty. However, open and laparoscopic pyeloplasty have yielded disappointing failure rates of 2.5%-10%. The main causes for recurrent UPJO are severe peripelvic and periureteric fibrosis due to urinary extravasation, ureteral ischemia, and inadequate hemostasis. In addition, failing to diagnose lower pole crossing vessels before or during the primary procedure is also responsible for recurrent UPJO. In addition, poor preoperative split renal function, hydronephrosis, presence of renal stones, patient age, diabetes, prior endopyelotomy history, and retrograde pyelography history were considered as predictors of pyeloplasty failure. The failure is usually defined by persistent pain, persistent radiographic obstruction (infection or stones), continued decline in split renal function, or a combination of the above. And the failure of pye-loplasty often occurs in the first 2 years after the surgery. The available options for managing recurrent UPJO with a salvageable renal unit include endopyelotomy, re-do pyeloplasty, stent implantation, percutaneous nephrostomy, ureterocalicostomy, and nephrectomy. Re-do pyeloplasty has such merits as high successful rates and rare complications, compared with endopyelotomy or ureterocalicostomy. And some investigators think that re-do pyeloplasty should be regarded as the gold standard for secondary therapy if feasible. Open pyeloplasty can enlarge the operating field, facilitate the exposure of the ureteropelvic junction, reduce the difficulty of operation, and thus reduce the occurrence of complications. There are no significant differences among the success rates of re-do pyeloplasty under open approach, traditional laparoscopy and robot-assisted laparoscopy, according to previous reports. However, traditional laparoscopic and robot-assisted pyeloplasty give advantages of cosmetology, small trauma, less postoperative pain, speedy recovery and shorter hospitalization, fewer complications and lower recurrent rates. If the primary pyeloplasty is an open operation in retroperitoneal approach, the traditional laparoscopic and robotic operation with retroperitoneal approach should be considered for secondary repair. The cause of recurrent UPJO should be evaluated before surgery and identified intraoperatively to minimize the possibility of recurrence.
Simultaneous treatment of ureteropelvic junction obstruction complicated by renal calculi with robotic laparoscopic surgery and flexible cystoscope.
Yang Cheng,Zhou Jun,Lu Zhao Xiang,Hao Zongyao,Wang Jianzhong,Zhang Li,Liang Chaozhao
World journal of urology
OBJECTIVE:To present our experience of combining transperitoneal robot-assisted laparoscopic pyeloplasty (RALP) and concomitant flexible cystoscope lithotomy for ureteropelvic junction obstruction (UPJO) complicated by renal caliceal stones in the same session. PATIENTS AND METHODS:Between October 2014 and November 2017, RALP combined with flexible cystoscope lithotomy was performed in 16 patients with UPJO and ipsilateral renal caliceal stones. Stone location and size were preoperatively assessed. After pyelotomy with appropriate length (about 8-15 mm), a 16F flexible cystoscope through the assistant trocar or robotic trocar was introduced directly into the renal pelvis under laparoscopic vision. Holmium laser lithotripsy and pressure irrigation via a pump were used for caliceal stone removal. Subsequently, robot-assisted laparoscopic pyeloplasty was undergone in a standard fashion. RESULTS:The calculi sizes ranged from 5 to 34 mm (mean 18.6 mm) and an average of 3.4 stones per patient was removed (range 1-8 stones). Complete stone clearance confirmed by postoperative imaging was achieved in all patients. Mean operative time was 204.6 min and estimated blood loss was 55.6 mL. Mean hospital stay was 6.7 days (3-17). The stent was removed after 8 weeks. No major intraoperative or postoperative complications were noted during a mean follow-up of 10.4 months (range 6-27 months). CONCLUSIONS:RALP combined with flexible cystoscope lithotomy is safe and effective alternatives for the simultaneous management of UPJO complicated by renal caliceal stones.
10.1007/s00345-018-2608-9
Ureteropelvic junction obstruction and renal calculi: Simultaneous treatment by robot-assisted laparoscopic pyeloplasty and transcutaneous retrograde flexible ureteroscopy. Technique description and early outcomes.
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie
BACKGROUND:Ureteropelvic junction obstruction (UPJO) and renal calculi are associated in 20 to 30% of cases and treatment is mandatory. The simultaneous surgical management is a therapeutic challenge that is still a source of controversy. We describe our technique combining robot-assisted laparoscopic pyeloplasty and transcutaneous retrograde flexible ureteroscopy (fURS), assessing the feasibility of simultaneous treatment through an original technique. METHODS:This single centre series reports our initial experience with 12 patients. From January 2014 to September 2018, 12 patients underwent robot-assisted laparoscopic pyeloplasty with simultaneous fURS for UPJO and renal calculi. Mean age was 46 years (24-68). 92% had multiple renal stones and the mean cumulative stone diameter was 31,3mm. Robot-assisted pyeloplasty was performed with peroperative transcutaneous retrograde fURS through a ureteral access sheath introduced in an incision on the bassinet through a subcostal trocar. Stone extraction was performed using a basket. RESULTS:All patients underwent surgery successfully, achieving UPJ repair and complete stone extraction. Mean operating time was 92,5min (85-110). All reported Clavien-Dindo complications were grade 1. Non-contrast enhanced abdominal CT performed 1 month after surgery confirmed the absence of residual stones in all patients. Mean follow-up time was 10 months with no recurrence of UPJO. CONCLUSION:This small series confirms the feasibility with good surgical results of concomitant robot-assisted laparoscopic pyeloplasty and transcutaneous retrograde fURS stone extraction. No major complications were observed. This technique is easily reproducible but requires 2 experienced urologists to be achieved in a contained operative time.
10.1016/j.purol.2023.01.006
Ureteropelvic obstruction and renal stones: etiology and treatment.
Urolithiasis
The simultaneous surgical management of ureteropelvic junction obstruction (UPJO) with concomitant renal stones has evolved the last 20 years; hence, the ideal minimally invasive technique is still controversial. Laparoscopic and robot-assisted laparoscopic operations allow precise surgical maneuvers and were thought to simplify the reconstruction steps of the procedure, especially in the treatment of complex cases with large stones. The aim of this study was to summarize the available perioperative and functional outcomes of minimally invasive available techniques. A non-systematic review of the literature was performed using a free-text protocol in the MEDLINE database. The terms used were "ureteropelvic junction obstruction," "renal calculi" and "renal stones." Furthermore, other significant relevant studies cited in the reference lists of the selected papers were also evaluated in the structure of this review. Currently, available evidence suggests that both laparoscopic and robotic-assisted techniques offer excellent surgical solutions in the field of UPJO reconstruction and renal stones removal. In the hands of experienced surgeons, laparoscopic and robotic pyeloplasty with concomitant stone removal is a safe procedure with high stone-free rates and UPJ patency. Minimally invasive pyeloplasty should constitute the first choice of treatment for concomitant renal stones and ureteropelvic junction obstruction.
10.1007/s00240-014-0736-2
[Urinary lithiasis in children: a study of 20 cases].
Sow Y,Coulibaly M,Fall B,Sarr A,Fall P A,NDoye A K,Ba M,Diagne B A
Le Mali medical
PURPOSE:To report the cases of urolithiasis in children and to assess epidemiological, clinical and therapeutically aspects. PATIENTS AND METHODS:We study retrospectively the cases of urolithiasis in children of 0 to 15 years old between 2003 and 2008. The parameters of study were: age, sex, clinical and therapeutically aspects. RESULTS:We report 20 cases. The mean age was 5.4 years. The sex-ratio was 9/1. Dysuria was the most common symptom. Abdominal plain radiography associate with ultrasonography permitted the diagnostic in most cases. Stone location was in the bladder mainly (n = 12). Posterior Urethra valves were the common etiology found. The surgical treatment was performed in all cases and consisted of cystolithotomy in the majority. CONCLUSION:Children urinary stones are less common than in adults. The etiologies are different but the treatment is coming to be alike.
Unusual giant prostatic urethral calculus.
Bello A,Maitama H Y,Mbibu N H,Kalayi G D,Ahmed A
Journal of surgical technique and case report
Giant vesico-prostatic urethral calculus is uncommon. Urethral stones rarely form primarily in the urethra, and they are usually associated with urethral strictures, posterior urethral valve or diverticula. We report a case of a 32-year-old man with giant vesico-prostatic (collar-stud) urethral stone presenting with sepsis and bladder outlet obstruction. The clinical presentation, management, and outcome of the giant prostatic urethral calculus are reviewed.
10.4103/2006-8808.63721
Posterior urethral valves and vesicolithiasis in children.
Neulander E,Kaneti J
International urology and nephrology
Although posterior urethral valves is a well known and important entity in paediatric urology, its association with bladder calculi is not well documented and this condition is not discussed commonly in the literature. Association between posterior urethral valves and vesicolithiasis is presented in three children.
Posterior urethral valves with vesical calculus: A rare association.
Acharya Himanshu,Dhende N P,Mane S B,Obaidah Abu
Journal of Indian Association of Pediatric Surgeons
Posterior urethral valve and vesical calculus are individually among the most common causes of obstructive lower urinary complaints in children. There are very few reports of association between posterior urethral valves and bladder calculus. We report three such cases. This association of the vesical calculi with posterior urethral valves may lead to a delay in the diagnosis of the posterior urethral valves. The diagnosis of posterior urethral valves should be suspected in all children with vesical or urethral calculi who have persistence of symptoms even after removal of the calculi.
10.4103/0971-9261.57705
Urethroscopy in small neonates with posterior urethral valves and ureteroscopy in children with ureteral calculi.
Smith D P,Jerkins G R,Noe H N
Urology
OBJECTIVES:To describe our recent experience using a 6.9F cytoscope in the fulguration of posterior urethral valves (PUVs) in premature neonates and distal ureteroscopy with stone extraction in children. METHODS:Fulguration of PUVs was performed in 3 premature neonates born at 34 to 36 weeks' gestation with weights of 2480 to 2900 g. The PUVs were fulgurated during a single endoscopic procedure using a 6.9F cystoscope and a 3F bugbie electrode. In addition, 11 children (8 girls, 3 boys; mean age, 11.1 years; range 5 to 16) with symptomatic calculi underwent 15 distal ureteroscopic procedures using the 6.9F cystoscope. RESULTS:In the neonates with fulguration of PUVs, vesicostomy, the only reasonable alternative, was avoided, and each infant now voids with an excellent stream 3 to 16 months later, without evidence of stricture or residual valves. In the children with distal ureteroscopy, the ureteral calculi were retrieved using a 3F four-wire stone basket. With one exception, distal ureteroscopy was performed without dilation of the ureteral orifice. Extracorporeal shock-wave lithotripsy (ESWL) was not recommended because of stone position and difficult radiographic visualization. Nine children were rendered stone free with one procedure. Two procedures were required in 1 child and three in another. In both cases, ureteral edema was present, and the stone was embedded in the ureteral wall. One child underwent separate procedures for bilateral calculi. In all cases general anesthesia was used, with a mean duration of 63 minutes (range 28 to 96). Temporary ureteral stenting was performed in 10 (93%) patients, and 9 (81%) were discharged home on the same day or the next morning. A mean follow-up period of 8.5 months (range, 0.5 to 22) has failed to show any problems related to ureteral stricture or injury. CONCLUSIONS:Endoscopic fulguration of PUVs is now possible in small neonates and is minimally invasive compared with vesicostomy. Distal ureteroscopy with stone retrieval should be considered in children, especially those with calculi that are not suitable for ESWL.
10.1016/s0090-4295(96)00069-6
Bladder stone in a three-year-old Nigerian child with posterior urethral valve: a case report.
Adedoyin O T,Adesiyun O O,Mark F,Anigilaje E A,Adeniyi A,Abdulkadir A Y,Popoola A A
West African journal of medicine
BACKGROUND:Stone in the bladder is an uncommon presentation in the tropics, especially in children. Its rarity makes the index of suspicion to be low. Patients presenting with it may be mistaken for urinary tract infection (UTI) because of the presence of frequency and dysuria. OBJECTIVE:To present a rare cause of urinary bladder stone in a child in the tropics. METHODS:The patient, a three-year-old boy, presented with recurrent episodes of dysuria and stragury for a duration of about one year. Work up included clinical evaluation and laboratory assessments, results of which informed surgical intervention. RESULTS:The child had been treated repeatedly for urinary tract infection. He was acutely ill with suprapubic tenderness dysuria and poor urinary stream. He was hypertensive. Micturating cystourethrography showed posterior urethral valves and a bladder stone. He had vesicolithotomy and valvotomy with improvement of his blood pressure. CONCLUSION:The coexistence of bladder stone with PUV coupled with delayed diagnosis may be a predisposing factor to hypertension in children. Conventional surgical treatment gives good results.
[Urinary stones and urinary tract abnormalities. Is the stone composition independent of the anatomical abnormality?].
Daudon Michel,Cohen-Solal Fabrice,Lacour Bernard,Jungers Paul
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie
INTRODUCTION:More than ten per cent of stones are associated with a urinary tract abnormality. To verify whether the malformation influences stone composition, we studied the composition of stones observed in fifteen urological abnormalities. MATERIAL AND METHOD:This study is based on 1,461 stones associated with a clearly defined malformation analysed by infrared spectroscopy plus 402 bladder stones in men with benign prostatic hyperplasia. RESULTS:In this series of 1,863 abnormalities, 732 (39.3%) involved the kidney, 561 (30.1%) involved the ureter and 570 (30.6%) involved the lower tract. Whewellite stones were predominant in all renal abnormalities with the exception of cysts, which were mainly associated with uric acid. The main differences concerned the second constituent: weddellite in horseshoe kidneys, carbapatite in Cacchi-Ricci disease and caliceal abnormalities. Struvite was uncommon (<10%). Whewellite was the main component in ureteric abnormalities except for megaureter and reflux in which carbapatite was predominant. Struvite was present in 10% to 30% of stones. Vesicourethral abnormalities were accompanied by calcium and magnesium phosphate stones (90% of cases), and struvite was present in 58% to 90% of cases. The exception to this general rule was bladder stones associated with benign prostatic hyperplasia, in which the main component was uric acid. CONCLUSION:Significant differences in stone composition were observed as a function of anatomical abnormalities reflecting the fact that some abnormalities add infectious or metabolic risk factors to anatomical factors.
Complicated urinary tract infections.
Conrad S,Busch R,Huland H
European urology
Complicated urinary tract infections (UTIs) are defined as those infections causing severe complications, such as urosepsis, renal scarring, and end-stage renal disease. Major complicating factors are infection stones, infected atrophic kidney, renal papillary necrosis, indwelling catheters, and other causes of bacterial persistence, as well as vesicoureteral reflux and urinary tract obstruction in recurrent UTI. Operative therapy is mandatory in all types of persistent UTI besides chronic bacterial prostatitis, as well as in UTI associated with urinary tract obstruction. Recurrent UTI complicated by vesicoureteral reflux, on the other hand, should be managed conservatively.
Urinary lithiasis and urinary tract malformations in children: a retrospective study of 34 cases.
Chahed Jamila,Jouini Riadh,Krichene Imed,Maazoun Kaies,Brahim Mohamed Ben,Nouri Abdellatif
African journal of paediatric surgery : AJPS
BACKGROUND:Although the association of urinary lithiasis and urinary tract malformation is not rare, their management poses challenges. The aim of this study was to evaluate the relationship between urolithiasis and malformations of the urinary system. There were 34 patients (19 males and 15 females) with a mean age of 4.8 years (range, 2 months to 14 years). All patients had urinary lithiasis with a urinary tract malformation. Abdominal pain was the most frequent clinical symptom (38%). Urinary infection was found in 7 patients (21%) and macroscopic haematuria was present in 10 patients (29%). The most frequent urinary tract malformations were megaureter (8 cases), uretero-pelvic junction obstruction (7 cases) and vesico-ureteric reflux (8 cases), but its malformative origin could not be confirmed. Treatment consisted of lithiasis extraction in 32 cases associated with specific treatment of the uropathy in 27 cases. Postoperative outcome was uneventful in all cases. In fact, urinary lithiasis and urinary tract malformation association is not rare. Indeed, 9-34% of urinary lithiasis are noted to be associated with urinary tract malformation. Positive diagnosis relies specifically on kidney ultrasound, intravenous urography, and urethrocystography. Treatment depends on the type of urinary tract malformation, localisation and size of the urinary lithiasis. CONCLUSION:In conclusion, urinary lithiasis and urinary tract malformation association is a frequent eventuality. Surgical intervention is the usual mode of treatment.
10.4103/0189-6725.86055
Vesicoureteral reflux in the adult. II. Nephropathy, hypertension and stones.
Torres V E,Malek R S,Svensson J P
The Journal of urology
The level of renal function, presence of hypertension or characteristics of nephrolithiasis were analyzed in relation to the severity of renal scarring and other clinical parameters in 67 patients with primary bilateral vesicoureteral reflux. A significant positive correlation was observed between impairment of renal function and severity of renal scarring. Renal insufficiency occurred only in patients with bilateral scarring. Significant proteinuria was found more often in patients with depressed renal function. Hypertension was observed in 34 per cent of the patients, mostly in those with bilateral scarring or depressed renal function. Radiopaque calculi were noted in 18 per cent of the patients. In all but 1 case these calculi occurred in scarred kidneys.
10.1016/s0022-5347(17)50943-x
Vesicoureteral reflux diagnosed in adulthood. Incidence of urinary tract infections, hypertension, proteinuria, back pain and renal calculi.
Köhler J,Tencer J,Thysell H,Forsberg L
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
STUDY PURPOSE:To determine the incidence of urinary tract infections, hypertension, back pain, and renal calculi in adult patients with vesicoureteral reflux and reflux nephropathy. METHODS:A group of 115 patients (16-60 years of age, median 28 years) with vesicoureteral reflux, combined with reflux nephropathy in 101 patients, first detected between 1967 and 1984, was studied retrospectively. The group comprised 99 women and 16 men. RESULTS:Symptoms and findings associated with the urinary tract preceded the diagnosis of vesicoureteral reflux by median 14 years (1-60 years). Intravenous pyelography preceded investigation with micturating cystography in 99 patients. Fifteen patients had no urinary tract infections, 17 patients had only lower urinary tract infections, and 83 patients had upper with or without lower urinary tract infections. Females had 12 times more lower and seven times more upper urinary tract infections than males, whereas males had impairment of renal function and proteinuria more often than females. Hypertension was present in 39 patients (34%) and five times more frequent in patients with bilateral than in those with unilateral reflux nephropathy. The median age at the first recording of hypertension was 33 years (16-60 years). Malignant hypertension was uncommon and occurred in two patients. An older group (> 45 years of age at presentation) of 19 patients showed a 90% incidence of hypertension compared with 23% in 96 patients in the younger group (< or = 45 years of age at presentation). Back pain of varying type and severity was present in 48 patients (42%). A total of 38 renal calculi was found in 21 (18%) patients, of whom 14 were completely asymptomatic. CONCLUSIONS:The natural history of vesicoureteral reflux first detected in adulthood has shown a strikingly high incidence of urinary tract infections, arterial hypertension, back pain, and renal calculi.
10.1093/ndt/12.12.2580
Renal infection and vesico-ureteric reflux.
Rossleigh Monica A
Seminars in nuclear medicine
Urinary tract infection (UTI) is a common disease of childhood. The investigation of UTI in children has been the subject of debate and controversy for many years. Most workers agree that the first imaging modality to be used should be an ultrasound examination to exclude obstruction, structural abnormalities, and renal calculi. The role of (99m)Tc dimercaptosuccinic acid scintigraphy (DMSA) in the diagnosis of acute pyelonephritis is becoming increasingly important. Many argue that if the DMSA study is normal at the time of acute UTI, no further investigation is required because the kidneys have not been involved and thus there will be no late sequelae. Others use the acute DMSA study to determine the intensity of antibiotic therapy. The importance of the role of vesico-ureteric reflux (VUR) is being debated. Some workers will only proceed to cystography to detect VUR if the DMSA study is abnormal, whereas others advocate a more aggressive approach. VUR can be identified by a variety of radiological and scintigraphic techniques. Although the radiological cystogram is the gold standard and is essential in the first UTI in a male patient, to exclude the presence of posterior urethral valves, radionuclide cystograms are advantageous in other situations. Suprapubic cystography techniques have been described to overcome the trauma of urethral catheterization but have not been widely accepted.
10.1053/j.semnuclmed.2007.02.006
The vesical calculus.
Schwartz B F,Stoller M L
The Urologic clinics of North America
Bladder calculi account for 5% of urinary calculi and usually occur because of foreign bodies, obstruction, or infection. Males with prostate disease or previous prostate surgery and women who undergo anti-incontinence surgery are at higher risk for developing bladder calculi. Patients with SCI with indwelling Foley catheters are at high risk for developing stones. There appears to be a significant association between bladder calculi and the formation of malignant bladder tumors in these patients. Transplant recipients are not at increased risk for developing vesical calculi in the absence of intravesical suture fragments and other foreign bodies. Patients who undergo bladder-augmentation procedures using a vascularized gastric patch appear to be protected from vesicolithiasis, perhaps by the acidic environment. Ileum and colon tissues, however, are colonized by urease-producing organisms, producing an alkaline pH that promotes stone formation. Children remain at high risk for bladder-stone development in endemic areas. Diet, voiding dysfunction, and uncorrected anatomic abnormalities, such as posterior urethral valves and vesicoureteral reflux, predispose them to bladder-calculus formation. Finally, there are a number of techniques and modalities available to remove bladder stones. Relieving obstruction, eliminating infection, meticulous surgical technique, and accurate diagnosis are essential in their treatment.
10.1016/s0094-0143(05)70262-7
A unique presentation, and management, of acute urinary retention in a young boy with underlying vesicoureteral reflux.
Patel Chirag,Modgil Vaibhav,Luscombe Christopher,Liu Samson
Journal of surgical case reports
Vesicoureteral reflux (VUR) affects ∼1% of children. We present an unusual case of urinary retention secondary to an obstructing urethral stone, underlying reflux, and its management. A 7-year-old boy presenting with acute urinary retention had a palpable penile shaft swelling and patent urethral meatus on examination. Cysto-urethroscopy with a 6.6Fr ureteroscope, due to unavailability of paediatric instruments, revealed an obstructing calculus impacted in the navicular fossa. This was laser fragmented and extracted. Cystoscopy revealed multiple bladder calculi with a patulous right ureteric orifice. Post-operative investigations revealed a small, scarred right kidney (ultrasound), bilateral ureteric reflux (micturating-cystourethrogram), 4 cm by 0.8 cm right ureteric calculus (CT-KUB) and 4% right split renal function (DMSA). Right laparoscopic nephroureterectomy was subsequently performed. Our case highlights the variety with which VUR can present and the effectiveness of a ureteroscope in an emergency setting as an alternative to a paediatric cystoscope to visualize the urethra and the bladder.
10.1093/jscr/rjt047
[Renoureteral malformation and lithiasis. Therapeutic approach].
Fernández Rodríguez A,Arrabal Martín M,Miján Ortiz J L,Palao Yago F,Zuluaga Gómez A
Archivos espanoles de urologia
OBJECTIVE:To analyze our results in the treatment of calculi in renoureteral malformations with extracorporeal shock wave lithotripsy (ESWL) alone and the efficacy of ESWL and adjuvant methods in the resolution of calculi in different types of renoureteral malformations. METHODS:The study comprised 141 cases of renoureteral malformations with urinary calculi; 68 were renal, 69 ureteral and 4 in the Bricker urinary diversion. All patients had been diagnosed by IVP and treated by ESWL. These patients were compared with a control group of 125 patients with calculi and a normal renoureteral system that were treated similarly. RESULTS:The malformations accounted for 2.61% of the 5,400 patients that had been treated in our unit from 1990-1998. The mean number of sessions for the patients with malformations was 1.5 versus 1.2 for the control group. The results of treatment were significantly lower for the group of patients with renal malformations than for the control group (54% vs. 87.2%, respectively). Similar results were obtained for the group of patients with ureteral malformations and the control group (87% vs. 75%). CONCLUSIONS:ESWL can be the first treatment option for calculi in patients with renal malformations, although they should be individually evaluated for status of the excretory system, urinary flow dynamics and size of the calculus in order to select the best treatment option. In patients with ureteral malformations, the same criteria utilized for those with a normal excretory system should be applied.
Evaluation and management of the urologic consequences of neurologic disease.
Kotkin L,Milam D F
Techniques in urology
Neurologic disorders create important functional urinary tract abnormalities. Loss of bladder reflex inhibition and coordination due to neurologic disease or injury to higher centers may lead to morbidity such as recurrent urinary tract infection, hydronephrosis, urinary tract stones and loss of renal function. This paper discusses neurogenic bladder disease using a descriptive urodynamic format. The importance of detrusor hyperreflexia and internal and external sphincter dyssynergia are discussed in detail. Finally, a practical clinical management plan is discussed for patients with urologic dysfunction due to cerebrovascular accident, Parkinson's disease, multiple sclerosis, spinal cord injury, and peripheral neuropathy.
Congenital urological anomalies diagnosed in adulthood - management considerations.
Halachmi Sarel,Pillar Giora
Journal of pediatric urology
OBJECTIVE:Despite worldwide availability of prenatal ultrasound, many patients are diagnosed in adult life with congenital anomalies such as ureteropelvic junction obstruction (UPJO), undescended testicle (UDT), ureterocele, hypospadias, vesicoureteral reflux (VUR) and primary obstructing megaureter (POM). The aim of this review was to describe these clinical conditions and their suggested management based on the available medical literature. REVIEW:Adult UPJO is not a rare condition; symptomatic patients should be treated rather than observed. Treatment options are nephrectomy for non-functioning kidneys and reconstructive surgery for functioning renal units. The adult UDT has low fertility potential and increased cancer risk; hence most of the data in the literature indicate performing an orchiectomy. Adult ureteroceles are usually related to single systems and they are intravesical and less obstructive. For symptomatic patients endoscopic incision showed high efficacy for symptom elimination with minimal side effects. Primary hypospadias correction in the adult patient is feasible, but success rates are low compared to the pediatric age group. Secondary correction, whether primary correction was performed in childhood or adulthood, is a challenging task with a high complication rate. Treatment decisions regarding adult patients with VUR are difficult to make as the available data are inconsistent; there is no strict evidence that reflux in an adult is directly related to renal growth impairment, ascending pyelonephritis, and/or embryo loss in a pregnant woman. In contrast to the pediatric age group, adult POM is usually a symptomatic condition and related to a high complication rate including infections, stone formation and renal failure. Spontaneous resolution is rare and hence active surgical management is advocated. CONCLUSION:Congenital urological anomalies identified in adulthood are not rare and pose a management challenge to the urologist. For most of the reviewed diseases, evidence-based management direction is difficult due to a lack of randomized trials and long-term follow up.
10.1016/j.jpurol.2007.03.001
Methods for diagnosing the risk factors of stone formation.
Robertson William G
Arab journal of urology
OBJECTIVE:To compare various systems for assessing the risk of recurrent stones, based on the composition of urine. METHODS:The relative supersaturation (RSS) of urine, the Tiselius Indices, the Robertson Risk Factor Algorithms (RRFA) and the BONN-Risk Index were compared in terms of the numbers of variables required to be measured, the ease of use of the system and the value of the information obtained. RESULTS:The RSS methods require up to 14 analyses in every urine sample but measure the RSS of all the main constituents of kidney stones. The Tiselius Indices and the RRFA require only seven analyses. The Tiselius Indices yield information on the crystallisation potentials (CP) of calcium oxalate and calcium phosphate; the RRFA also provide information on the CP of uric acid. Both methods provide details on the particular urinary abnormalities that lead to the abnormal CP of that urine. The BONN-Risk Index requires two measurements in each urine sample but only provides information on the CP of calcium oxalate. Additional measurements in urine have to be made to identify the cause of any abnormality. CONCLUSIONS:The methods that are based on measuring RSS are work-intensive and unsuitable for the routine screening of patients. The Tiselius Indices and the RRFA are equally good at predicting the risk of a patient forming further stones. The BONN-Risk Index provides no additional information about the causative factors for any abnormality detected.
10.1016/j.aju.2012.03.006
Characteristics of infant urolithiasis: A single center experience in western Turkey.
Çamlar Seçil Arslansoyu,Soylu Alper,Kavukçu Salih
Journal of pediatric urology
INTRODUCTION:Urolithiasis (UL) in infancy has different incidence, etiology, presentation and course compared to UL in childhood and in adults. We evaluated the clinical, radiological, metabolic factors and course of infant UL in western Turkey. METHODS:Medical records of the infants between 1 and 12 months of age with a diagnosis of UL were reviewed retrospectively for gender, gestational age, age at diagnosis, presenting symptoms, past medical history, parental consanguinity, family history of UL, urinary tract abnormalities, urinary tract infections, localization-size-number of stones, course of stones, treatment modality of UL (medical vs surgical) and follow up duration. Patients were grouped as those who did not require surgical intervention (Group 1) and those who underwent any kind of stone surgery (Group 2). Both groups were compared for the study parameters. RESULTS:There were 80 infants (48 males) with a mean age of 6.0 ± 2.9 months at diagnosis. Mean follow-up duration was 29.7 ± 23.1 months. Two thirds of the patients presented with symptoms/signs not directly related to urinary system. Predisposing factors included metabolic abnormalities in 24 (30%) patients and urinary tract malformations in 9 (11%) patients. Group 1 (n = 58) and Group 2 (n = 22) were not different with respect to the study parameters except for the larger stone size and higher rate of hyperuricosuria in Group 2. Stone size of 4.5 mm has a 72.7% sensitivity and 74.1% specificity for predicting surgical intervention. Infants treated medically and those followed by hydration only did not differ for regression rate of stones and for requirement for surgical intervention. However, metabolic abnormalities were significantly higher in medically treated infants. CONCLUSION:Every infant with urolithiasis should be evaluated for risk factors. Modification of such predisposing factors when possible may mitigate the notably high recurrence rate of UL in children. Increased awareness of infant UL may allow for earlier detection, improved evaluation and follow up, and may thereby decrease the morbidity of the disease.
10.1016/j.jpurol.2020.05.005