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Results for “Nephrolithiasis”

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At least 253 records · Page 14Linked to original sources

PubMed1978

Calcium-uric acid nephrolithiasis.

A small fraction of patients with nephrolithiasis form mixed stones containing calcium and uric acid or pass both calcium and uric acid stones; 23 of 539 patients we have studied fall in this category. These mixed stone formers tend to have unusually frequent stone recurrences. Although the patients are often considered to have a variant of uric acid nephrolithiasis, a high proportion harbor calcium as well as uric acid disorders. The usual treatment for uric acid lithiasis may fail to prevent calcium stone recurrence, unless concomitant calcium disorders are simultaneously corrected. Dual treatment may be very effective in preventing continued stone disease.

Adult↗

PubMed1983

[Complications in the postoperative period resulting in recurrent nephrolithiasis].

Under study were the factors influencing the recidivation of nephrolithiasis. An analysis of 1310 operations was made. Organ-preserving operations made up 90,3%. The analysis of repeated operations shows the transparenchymatous pathology for the removal of a kidney stone to be complicated by recurrent stones in 73% of cases. A disturbed outflow of urine not corrected in due time after operation results in purulent injuries of the kidney with or without a recurrent stone in 35,8% of cases. A recidivation of the disease is also related with urine leakage into the retroperitoneal fat. Technical improvement of the operative procedures and prevention of complications can make the operative treatment of nephrolithiasis more effective.

Adult↗

PubMed1983

Renal threshold phosphate concentration in patients with idiopathic nephrolithiasis: correlations with tubular functions, serum parathyroid hormone and 1,25(OH)2D3.

The renal handling of inorganic phosphate was measured in 17 idiopathic nephrolithiasis patients with normal glomerular filtration rate and effective renal plasma flow. TmPO4/GFR was less than 2.5 mg/dl in nine subjects (Group I) and greater than or equal to 2.5 in eight (Group II). The former had serum PO4 of 2.5 +/- 0.13 mg/dl and the latter, 3.5 +/- 0.11 mg/dl (p less than 0.01). Four in Group I and five in Group II were hypercalciuric. There was no significant difference in the serum parathyroid hormone and 1,25(OH)2D3 between the two groups. However, renal tubular functions were abnormal in both groups. The low TmPO4/GFR in 53 per cent of the patients is another manifestation of tubular functional abnormality seen in idiopathic nephrolithiasis.

Adult↗

PubMedDate not supplied

[Therapeutic physical exercise before and after an operation on the kidney in nephrolithiasis patients].

As shown by cardiorespiratory investigations, nephrolithiasis patients have defects in external respiration and central hemodynamics. These can be corrected by specially developed preoperative exercises which are also able to prevent postoperative complications. The above preoperative exercises are promoted as a part of preoperative preparation and postoperative management of nephrolithiasis patients.

Adult↗

PubMedDate not supplied

[Lipid peroxidation in patients with nephrolithiasis and chronic pyelonephritis in the remission stage].

Lipid peroxidation (LPO) was evaluated in 31 patients with nephrolithiasis and chronic pyelonephritis in remission. Chronic inflammation of renal parenchyma is shown to be associated with LPO activation. Urine diene conjugates excretion, plasma and red cell membrane malonic dialdehyde concentrations increase. LPO activation may contribute to maintenance of chronic renal inflammation in nephrolithiasis.

Adult↗

PubMed1994

[Sulfadiazine nephrolithiasis and nephropathy].

Sulfadiazine-nephropathy and -nephrolithiasis were well known complications of high dose sulfadiazine therapy 50 years ago. In the last few years high dose sulfadiazine therapy has been widely used for treatment of toxoplasmic encephalitis in AIDS patients. As a consequence sulfadiazine-nephropathy and -nephrolithiasis have become increasingly common. We describe 2 patients with the typical picture of these complications. Therapy is based on the fact that the solubility of sulfadiazine and its acetylated metabolite are markedly improved at higher urine-pH levels. Urine alkalinization is also effective for prophylaxis during sulfadiazine treatment. We present our guidelines for prophylaxis and treatment of these complications.

AIDS-Related Opportunistic Infections↗

PubMed1994

[Arterial pressure in idiopathic calcium nephrolithiasis].

Hypertension and calcium nephrolithiasis show some common features, such as the high prevalence of hypercalciuria and of elevated urinary sodium excretion. 28 patients with idiopathic calcium stone disease and 17 normals were studied: all the subjects were evaluated for the mean arterial pressure, and for the metabolic risk factors for calcium stone disease. The mean arterial pressure proved to be higher in patients with calcium nephrolithiasis than in normals. In normals the mean arterial pressure showed a direct relationship with the urinary calcium, while in the group of stone patients it had a direct relationship with the urinary sodium excretion. The lack of relationship between the mean arterial pressure and calcium excretion, in patients with calcium stones, suggests an impaired tubular calcium handling in such patients.

Blood Pressure↗

PubMedDate not supplied

[The physicochemical and biochemical signs of nephrolithiasis].

Urolithiasis diagnosis by uroliths presence reflects insufficient knowledge of the disease pathogenesis. 42 patients with oxalocalcium nephrolithiasis and 20 healthy patients were examined for differences in the urine and plasma composition. The authors studied factors involved in regulation of mineral metabolism and urinary elimination of crystal-forming substances. The patients with urinary stones compared to the control are characterized by low total crystal-inhibiting activity, hyperosmia, hypodipsia, decreased surface free energy, high quantities of ionized calcium, low ionized magnesium in the urine, oligo- and uricosuria. Shifts in hormonal regulation in nephrolithiasis result from slight elevation of urinary cyclic adenosine monophosphate, a relative rise in the levels of aldosterone and parathyroid hormone, low blood calcitonin, all the changes being statistically significant.

Chemical Phenomena↗

PubMed1993

[Evaluation of uric acid transport in nephrons of patients with calcium nephrolithiasis and hyperuricosuria].

Renal excretion of uric acid was studied in 48 patients with recurrent calcium nephrolithiasis. Hyperuricosuria was found in 16 patients (33%) and among them 10 patients had increased values of urate clearance and fractional excretion. The tubular transport of urate was evaluated by means of pharmacological tests with pyrazinamide (PZA) and benzbromarone (BB) in these 11 patients with hyperuricosuria of renal origin. PZA suppression test was normal in 10 patients while in one case uric acid excretion was not suppressed sufficiently by PZA. Maximal uricorusirc response to BB was increased in two patients, normal in one patient and impaired in eight patients. PZA and BB tests revealed isolated defect of uric acid postsecretory reabsorption in seven patients, impaired reabsorption at both pre- and postsecretory site in one case and enhanced tubular secretion of uric acid in two patients. This study indicates that different defects of uric acid transport in nephron are the frequent cause of hyperuricosuria in patients with recurrent calcium nephrolithiasis.

Absorption↗

PubMed1995

Etiology of calcium oxalate nephrolithiasis in rats. II. The role of the papilla in stone formation.

In kidneys of healthy rats submitted to a crystal-inducing diet (CID) with ethylene glycol (EG) and NH4Cl, the fate of retained crystals in the papillar region is studied during a recovery period of one, five or ten days, as model system for human nephrolithiasis. Scanning electron microscopy (SEM) shows, at papillary tips bulging into the calycine space, crystal masses covered either by the epithelium or a thin fibrous veil, or by unidentified mobile cuboidal cells. After CID plus one or five days recovery, small sub-epithelial swellings are seen of large sub-epithelial crystals at or around the papillary tip. After CID plus ten days, massive sub-surface crystal-containing micrometer-sized stones are seen in which the presence of calcium is confirmed by X-ray microanalysis. The papillary tip of rats after a re-challenge with an oxalate load from 0.1 vol% EG for twelve or forty-two days shows minor lesions. But a re-challenge with 0.3 vol% EG for thirty-seven days induces large sub-epithelial papillary millimeter-sized stones. The Von Kossa section staining converts the crystals into a black precipitate, but large peri-tubular or peri-vascular calcium deposits are absent. A new hypothesis about the etiology of an inductive calcium oxalate monohydrate nephrolithiasis is formulated which differs from the one proposed by Randall based on his deductive human kidney studies.

Ammonium Chloride↗

PubMed1996

Dietary manipulation with lemonade to treat hypocitraturic calcium nephrolithiasis.

PURPOSE: Pharmacological treatment of hypocitraturic calcium nephrolithiasis requires as many as 12 tablets, or numerous crystal packages or liquid supplements taken throughout the day. In addition to added cost, this cumbersome regimen decreases patient compliance, which may increase stone recurrence rates. We evaluated the urinary biochemical effects of dietary citrate supplementation in hypocitraturic calcium stone formers in an attempt to decrease or eliminate the need for pharmacological therapy. MATERIALS AND METHODS: A total of 12 patients who were either noncompliant with or intolerant of pharmacological citrate therapy supplemented their routine diet with citrate in the form of lemonade, consisting of 4 ounces of reconstituted lemon juice (5.9 gm. citric acid) mixed with tap water to a total volume of 2 l. and consumed at uniform intervals throughout the day. Urine specimens (24-hour) were obtained for biochemical analysis after 6 days of lemonade therapy and compared to pre-lemonade baseline values. RESULTS: Of the 12 patients 11 had increased urinary citrate levels during lemonade therapy (average 204 mg. per day). Average levels increased from 142 mg. daily (range less than 10 to 293) at baseline to 346 mg. daily (range 89 to 814) after treatment (p < 0.001). Daily total urinary volumes were similar (2.7 versus 2.9 l.). Seven of 12 patients became normocitraturic while consuming lemonade. Urinary calcium excretion decreased an average of 39 mg. daily, while oxalate excretion was unchanged. The lemonade mixture was well tolerated. Two patients complained of mild indigestion that did not require cessation of therapy. CONCLUSIONS: Citrate supplementation with lemonade increased urinary citrate levels more than 2-fold without changing total urinary volume. Lemon juice, which contains nearly 5 times the concentration of citric acid compared to orange juice, is an inexpensive and well tolerated dietary source of citrate. Lemonade therapy may improve patient compliance, and may be useful as adjunctive treatment for patients with hypocitraturic calcium nephrolithiasis.

Beverages↗

PubMed1997

Chronic renal failure and nephrolithiasis in a solitary kidney: role of intervention.

PURPOSE: We determined the role of intervention and its outcome in patients with a solitary kidney, nephrolithiasis and chronic renal insufficiency, as well as the role of clearance in these patients compared to those with a solitary kidney, nephrolithiasis and normal renal function. MATERIALS AND METHODS: A total of 36 records was evaluable, including 16 from patients with normal (group 1) and 20 from those with abnormal (group 2) renal function. Group 2 was further subdivided into those with mild to moderate (group 2A) and advanced (group 2B) renal failure. Patients with acute renal failure were excluded from the study. Glomerular filtration rate was calculated by the Cockcroft and Gault formula. The reciprocal of serum creatinine was used to determine outcome. RESULTS: Groups 1 and 2 were comparable demographically except for serum creatinine, stone bulk and hospital stay. Of 36 patients 8 with normal renal function and 15 with chronic renal failure underwent percutaneous nephrolitholapaxy, 6 underwent extracorporeal shock wave lithotripsy and 7 underwent open surgery. Total clearance was achieved in 25 of 36 patients (72%). Glomerular filtration rate improved in 24 patients, remained stable in 8 and deteriorated in 4. However, 3 patients had less than 20% deterioration and 1 had significant deterioration in function after intervention. Improvement in glomerular filtration rate after intervention was significantly greater in cases of advanced renal failure. Patients with residual stones did worse than those without residual calculi. Mean hospital stay, deterioration in glomerular filtration rate and major morbidity rate were significantly greater in patients with residual calculi than in those with total clearance. CONCLUSIONS: Intervention should be contemplated in patients with a solitary kidney, stone disease and renal failure as in any other patient with stone disease, with the aim being total clearance. Stone eradication delays deterioration, and decreases the requirement for dialysis and renal replacement.

Adult↗

PubMed1998

[Magnesium hydroxide in idiopathic calcium nephrolithiasis].

BACKGROUND: While in vitro the protective effect of magnesium on calcium oxalate crystallization is well known, its clinical relevance in calcium nephrolithiasis is still debated. Therefore, the clinical and metabolic effects of magnesium hydroxide therapy were evaluated in calcium stone formers. METHODS: Nine patients (7 M, 2 F), selected for a low urinary magnesium excretion (uMg 56 +/- 12 mg/day), were given Mg hydroxide (500 mg/day), with clinical and metabolic controls at 3, 12 and 18 months. RESULTS: Urinary Mg/uCreat increased throughout the study; uOx/uCreat decreased significantly; uCa/uCreat increased but not significantly. The stone recurrence rate decreased from 0.75 to 0.11 stones/year/patient, throughout the study period. The decrease of uOx is considered a more important risk factor in calcium stone patients than a similar uCa change; it may be due to a reduced intestinal Ox absorption, for the formation of insoluble and not absorbed Mg oxalate. CONCLUSION: In conclusion, Mg hydroxide therapy was encouraging in patients with calcium nephrolithiasis and low uMg; nevertheless a longer period of treatment is needed to confirm these data.

Calcium↗

PubMedDate not supplied

[Ways of prevention of kidney lesions during nephrolithotomy or extracorporeal lithotripsy in nephrolithiasis].

Outcomes of nephrolithiasis treatment depend not only on renal dysfunction resultant from abnormal urine passage and concomitant infection but also on intraoperative mechanical trauma and ischemia. To compare renal damage induced by nephrolithotomy with that of shock-wave lithotripsy and effects of chemotherapy, 54 patients with nephrolithiasis were divided into 2 groups and 2 subgroups. Patients of group 1 underwent nephrolithotomy, those of group 2--extracorporeal shock-wave lithotripsy (ESWL). Subgroups "a" in both groups received no chemotherapy, subgroups "b" were treated with alpha-tocopherol, pentoxifylline, indomethacin. ESWL was found less traumatic. Postoperative drug prophylaxis promoted more pronounced inhibition of lipid peroxidation products and urinary enzymes activity, contributing to lessening of the operative trauma. Anti-ischemic protection of the kidneys also improved renal function.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2026

Physiologic age modifies the association between visceral fat predominance and urinary calcium excretion in adults with nephrolithiasis.

Although adiposity is associated with kidney stone disease, the relationship between abdominal fat distribution and urinary calcium excretion remains unclear. We investigated whether the CT-derived visceral-to-subcutaneous fat ratio (VSR) was associated with 24-hour urinary calcium excretion and whether physiologic age modified this association. This retrospective cross-sectional study included 308 adults with nephrolithiasis who underwent preoperative CT, stone removal, and postoperative metabolic evaluation. Participants were stratified into prespecified younger (men aged < 50 years and premenopausal women) and older (men aged ≥ 50 years and postmenopausal women) physiologic-age groups. Multivariable linear regression assessed the association between VSR and urinary calcium excretion and its modification by physiologic age. Results showed that VSR was not associated with urinary calcium excretion in the overall cohort, but its association differed significantly by physiologic age (P for interaction < 0.001). Among younger participants, each 1-unit higher VSR was associated with 2.07 mmol/day greater urinary calcium excretion (95% CI, 1.23-2.90), whereas no significant association was observed in the older group. These findings suggest that the metabolic relevance of visceral fat predominance differs by physiologic age, with a significant association observed only in younger adults. Prospective studies are needed to confirm these findings and determine their clinical implications.

Humans↗

PubMed2006

Uric acid nephrolithiasis: proton titration of an essential molecule?

PURPOSE OF REVIEW: The majority of uric acid nephrolithiasis in humans occurs in the absence of frank hyperuricosuria and is primarily a disease of excessively low urinary pH. Uric acid is substantially less soluble than urate salts so in low urine pH urate is protonated, thus favoring precipitation even under what is considered physiologic concentrations of total urinary uric acid/urate. This commentary examines the rationales behind the existence of uric acid in urine and body fluids in vertebrate evolution. RECENT FINDINGS: The purpose of uric acid in arthropod, avian and reptilian species is to enable nitrogen excretion in solid state without loss of water. The re-emergence of uric acid in higher primates as an end product of metabolism is intriguing since urea functions perfectly well as a nitrogenous waste. Uric acid must purvey important physiologic functions in primate biology. Numerous roles of uric acid as an antioxidant, immune signaling molecule, and a defender of circulatory integrity have recently been proposed. SUMMARY: There is little doubt that uric acid serves multiple important functions in higher primates. It is also conceivable, however, that this important molecule when present in the wrong concentration or context can lead to undesirable phenotypes.

Animals↗

PubMed1992

Physicochemical action of potassium-magnesium citrate in nephrolithiasis.

Effect of potassium-magnesium citrate on urinary biochemistry and crystallization of stone-forming salts was compared with that of potassium citrate at same dose of potassium in five normal subjects and five patients with calcium nephrolithiasis. Compared to the placebo phase, urinary pH rose significantly from 6.06 +/- 0.27 to 6.48 +/- 0.36 (mean +/- SD, p less than 0.0167) during treatment with potassium citrate (50 mEq/day for 7 days) and to 6.68 +/- 0.31 during therapy with potassium-magnesium citrate (containing 49 mEq K, 24.5 mEq Mg, and 73.5 mEq citrate per day). Urinary pH was significantly higher during potassium-magnesium citrate than during potassium citrate therapy. Thus, the amount of undissociated uric acid declined from 118 +/- 61 mg/day during the placebo phase to 68 +/- 54 mg/day during potassium citrate treatment and, more prominently, to 41 +/- 46 mg/day during potassium-magnesium citrate therapy. Urinary magnesium rose significantly from 102 +/- 25 to 146 +/- 37 mg/day during potassium-magnesium citrate therapy but not during potassium citrate therapy. Urinary citrate rose more prominently during potassium-magnesium citrate therapy (to 1027 +/- 478 mg/day from 638 +/- 252 mg/day) than during potassium citrate treatment (to 932 +/- 297 mg/day). Consequently, urinary saturation (activity product) of calcium oxalate declined significantly (from 1.49 x 10(-8) to 1.03 x 10(-8) M2) during potassium-magnesium citrate therapy and marginally (to 1.14 x 10(-8) M2) during potassium citrate therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1986

Metabolic fate and solubility of triamterene--not an explanation for triamterene nephrolithiasis.

In an attempt to explain the triamterene stone diathesis, we studied the excretion and solubility of triamterene, 1, and its metabolite, the sulfate ester of the hydroxy derivative of triamterene, 3. The urinary excretion pattern and metabolism in stone formers was the same as in other chronic users of triamterene or healthy volunteers. The solubility of triamterene in urine was approximately one-half of its solubility in buffer solution, whereas the sulfate ester, 3, was nearly twice as soluble in urine as in the buffer solution. In the majority of the subjects studied, we found concentrations of 3 which approached or exceeded apparent solubility limits in urine. This was not true for triamterene where most measured urine concentrations were less than the apparent solubility as determined by equilibration. Alteration in the metabolism of triamterene is probably not a causative factor for triamterene nephrolithiasis. The saturation of urine with triamterene and especially with the sulfate ester, 3, may be related to stone formation, but other physical factors play a role in determining the relative amounts of drug found in calculus material.

Adult↗