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PubMed1982

Results of surgical and conservative therapy on patients with nephrolithiasis and chronic renal insufficiency.

In a series of 264 inpatients with nephrolithiasis and chronic renal insufficiency, 159 received follow-up care between 1 and 14 years (4.3 years on the average) after primary hospitalization. 59 of these 159 patients had to undergo nephrectomy in the course of calculus disease. Follow-up examinations showed no deterioration in 60 patients and a further 64 showed clear symptoms of improved renal function. In 23 patients renal function deteriorated and 11 of them had to be accepted in chronic dialysis. Special emphasis is placed on the relevance of thorough metaprophylaxis after calculus removal. Stone analyses of patients with renal insufficiency showed a high share of infectious stones (struvite and carbonic apatite) as well as of uric acid calculi. For that reason especially these patients require an intensive follow-up treatment.

Adolescent↗
PubMed1995

Clinical and biochemical features of uric acid nephrolithiasis.

A clinical investigation was carried out on patients with uric acid stones in order to study the frequency and pathogenesis of uric acid nephrolithiasis. Of 652 patients with stones in the upper urinary tract in whom the stone composition could be examined, 36 patients and uric acid stones (5.5%). The male to female ratio was 11:1. The average age of the 33 male subjects was 49 +/- 11 years (mean +/- SD), and the 3 females were 22, 37 and 42 years old, respectively. Two of the females showed hypouricemia. With regard to stone composition, pure uric acid stones were present in 26 cases (72%), a mixed uric acid and calcium oxalate stones were found in 6 cases (17%), both pure uric acid and mixed uric acid and calcium oxalate stones were observed in 3 cases (8%), and a mixed uric acid and sodium acid urate stone in 1 (3%). Biochemical studies on male patients showed that the blood uric acid level was higher in the uric acid stone group and the pure uric acid stone group compared to the calcium stone group. The blood uric acid levels of the former 2 groups did not differ from the control group. With respect to urine chemistry, the excretion of calcium in the uric acid stone group was significantly lower than that in the control group. In the uric acid stone group and the pure uric acid stone group the excretion of calcium tended to be lower than that in the calcium stone group. The amounts of oxalic acid excreted in the uric acid stone group and in the pure uric acid stone group were low compared to the calcium stone group. Oxalic acid elimination in these 2 groups did not differ from the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1981

A lack of unique pathophysiologic background for nephrolithiasis of primary hyperparathyroidism.

The metabolic picture of 32 patients with surgically proven primary hyperparathyroidism presenting with renal stones was compared with that of 37 patients without stones. Between stone-forming and nonstone-forming groups, there was no significant difference in serum 1,25-dihydroxyvitamin D [6.82 +/- 2.62 vs. 6.22 +/- 2.33 ng/dl (mean +/- SD); P greater than 0.05], fractional (intestinal) calcium absorption (0.726 +/- 0.141 vs. 0.690 +/- 0.120), urinary calcium (299 +/- 139 vs. 284 +/- 144 mg/day), serum calcium, phosphorus, and parathyroid hormone, or bone density. Similarly, no differences were found between 29 patients presenting with stones alone and 9 presenting with bone disease alone with respect to the above measures. Moreover, urinary environment was typically supersaturated with respect to stone-forming salts regardless of the presence of stones. The results indicate that there is no unique pathophysiological background for the nephrolithiasis of primary hyperparathyroidism.

Blood Chemical Analysis↗
PubMed1982

Hypocitraturia in calcium nephrolithiasis.

Several investigators have reported that hypocitraturia is frequent in patients with idiopathic kidney stones. In these studies, however, glomerular filtration rate, urinary tract infection, sex, diet, time of day, and medications, all potentially influential variables, were uncontrolled. Fifteen men, aged 30-52 yr, with recurrent idiopathic calcium oxalate stones and 15 normal age-matched men were studied. Patients with hyperparathyroidism, renal tubular acidosis, reduced creatinine clearance (less than 80 ml . min/1.73 M2), or urinary infection were excluded. Medications were stopped 2 weeks before the study began. A standard constant diet, furnishing 800 mg calcium and free of citrate, was fed for 20 days. During the last 10 days, 4.5 g sodium citrate were given orally. Eight-hour collections of urine were analyzed for calcium and citrate. Filtered load and net tubular reabsorption of citrate were also calculated. The 24-h urinary excretion of calcium was elevated in eight stone formers, and citrate excretion was depressed in seven. Five patients were both hypercalciuric anc hypocitraturic. The hypocitraturia resulted from excessive net tubular reabsorption of a normal filtered load of citrate. Urinary citrate was highest between 0800-1600 h, whereas calcium was highest between 1600-2400 h; both components were lowest between 2400-0800 h. The diurnal profiles of urinary calcium and citrate were similar in the stone formers and in the normal men. Oral sodium citrate did not influence urinary citrate in either group. These data suggest that in adult men, hypocitraturia may be a common predisposing factor for calcific nephrolithiasis.

Adult↗
PubMed2000

Medical dissolution of struvite nephrolithiasis using amino acid preparation in dogs.

A new chemolytic therapy with amino acid preparation was tried for use on struvite renal stones in two dogs, which were admitted to Azabu University Veterinary Teaching Hospital. No other special diet, for the purpose of dissolving the stones, was fed during the treatment. Dissolution of the stones began at week 1, and no stone was detected on radiography at week 4 in both cases. The amino acid preparation thereafter has been administered every 2-3 days to prevent formation of the stones. After 6 months from treatment, complete dissolution was confirmed, and no relapse has been observed. Therefore, it is concluded that chemolytic therapy with amino acid preparation might be useful for the treatment of nephrolithiasis with struvite renal stones in dogs.

Animals↗
PubMed2006

Dietary therapy in idiopathic nephrolithiasis.

Like other diseases striking predominantly the affluent societies, idiopathic nephrolithiasis is increasing in rich countries and appears to be closely related to dietary habits. In this review we summarize the latest evidence about the efficacy of dietary treatment for idiopathic calcium and uric acid stones, dealing especially with its effect on the urinary stone risk factors, stone recurrences, and clinical limitations. After a short introduction on epidemiology and pathogenesis, we review the role of the most important foods and nutrients in stone formation and protection: water and other fluids, proteins, carbohydrates, fats, salt, milk and dairy products, fruits and vegetables, and vitamins. The final part of the paper will provide practical guidelines for pursuing an anti-lithogenic diet in idiopathic calcium and uric acid stones.

Calcium Oxalate↗
PubMed1995

Nephrobronchial fistula and lung abscess resulting from nephrolithiasis and pyelonephritis.

There are multiple etiologies reported as causes of lung abscess; however, this differential rarely includes intra-abdominal abnormalities other than extension of a hepatic process. We describe a patient who was found to have a lung abscess and empyema resulting from the development of a nephrobronchial fistula secondary to nephrolithiasis and pyelonephritis. The patient had no urinary symptoms or known abdominopelvic infection and the etiology of lung abscess was only incidentally discovered after chest CT revealed extension of pleural fluid below the diaphragm.

Bronchial Fistula↗
PubMed1990

Pulmonary alveolar microlithiasis with pleural calcification and nephrolithiasis.

A case of pulmonary alveolar microlithiasis (PAM) with pleural calcification and nephrolithiasis is reported. The significance of peripheral white lines, a rarely reported observation on chest roentgenogram in PAM, is discussed. Extrapulmonary calcification in multiple sites raises the possibility of PAM being a systemic disorder.

Adult↗
PubMed2004

Response to an oral calcium load in nephrolithiasis patients with fluctuating parathyroid hormone and ionized calcium levels.

The response to an oral calcium load test was assessed in 17 hypercalciuric nephrolithiasis patients who presented elevated parathyroid hormone (PTH) irrespective of the ionized calcium (sCa2+) levels. Blood samples were collected at baseline (0 min) and at 60 and 180 min after 1 g calcium load for serum PTH, total calcium, sCa2+, and 1.25(OH)2D3 determinations. According to the sCa2+ level at baseline, patients were classified as normocalcemic (N = 9) or hypercalcemic (N = 8). Six healthy subjects were also evaluated as controls. Bone mineral density was reduced in 14/17 patients. In the normocalcemic group, mean PTH levels at 0, 60 and 180 min (95 +/- 76, 56 +/- 40, 57 +/- 45 pg/ml, respectively) did not differ from the hypercalcemic group (130 +/- 75, 68 +/- 35, 80 +/- 33 pg/ml) but were significantly higher compared to healthy subjects despite a similar elevation in sCa2+ after 60 and 180 min vs baseline in all 3 groups. Mean total calcium and 1.25(OH)2D3 were similar in the 3 groups. Additionally, we observed that 5 of 9 normocalcemic patients presented a significantly higher concentration-time curve for serum PTH (AUC0',60',180') than the other 4 patients and the healthy subjects, suggesting a primary parathyroid dysfunction. These data suggest that the individual response to an oral calcium load test may be a valuable dynamic tool to disclose a subtle primary hyperparathyroidism in patients with high PTH and fluctuating sCa2+ levels, avoiding repeated measurements of both parameters.

Adult↗
PubMed1994

Diagnosis and treatment of nephrolithiasis: current perspectives.

Urinary stones are a frequent cause of morbidity in persons in affluent industrialized societies. The surgical management of symptomatic stones in the upper urinary tract has changed dramatically in the past generation, largely because of the introduction of progressively less invasive treatment techniques. The concurrent revolution in radiologic imaging and interventional techniques has mirrored the surgical experience. This article reviews the current diagnosis and therapy of nephrolithiasis. An evaluation of the complex metabolic abnormalities present in the population of patients with urolithiasis is beyond the scope of this article, but several good reviews of this subject have been published recently [1-4]. Because primary urolithiasis involving the bladder or urethra is less common and is a separate medical entity, this article is focused on renal and ureteral calculi.

Humans↗
PubMed1986

Idiopathic hypocitraturic calcium-oxalate nephrolithiasis successfully treated with potassium citrate.

The effects of long-term treatment with potassium citrate, 30 to 80 meq/d over 2.13 +/- 0.76 (SD) years, were examined in 37 patients with "idiopathic" hypocitraturic calcium-oxalate nephrolithiasis, in whom the main causes of hypocitraturia (renal tubular acidosis, chronic diarrhea, urinary tract infection, or hypokalemia) were excluded or considered unlikely. Potassium citrate treatment produced a sustained increase in urinary citrate excretion from initially low values (223 to 253 mg/d) to within normal limits (470 to 620 mg/d). Urinary pH rose significantly and was maintained at 6.5 to 7.0. Along with these changes, urinary saturation of calcium oxalate declined significantly to normal limits. Further stone formation ceased in 89.2% of patients during treatment, and the stone formation rate declined from 2.11 +/- 5.68 to 0.28 +/- 1.30 stones/patient-year (p less than 0.01).

Adult↗
PubMed1979

Urinary saturation measurements in calcium nephrolithiasis.

Urinary saturation with respect to calcium oxalate monohydrate was measured in 111 consecutive patients with calcium nephrolithiasis. Each patient also was evaluated by a detailed conventional metabolic protocol. Patients with idiopathic hypercalciuria produced abnormally oversaturated urine more frequently than normal subjects and normocalciuric patients, but normocalciuric patients had unexpectedly high levels of urine saturation. Measuring levels of calcium concentration, oxalate concentration, or the chemical concentration product of calcium and oxalate in urine did not predict oversaturation. During thiazide treatment, saturation level tended to fall if it was initially elevated, whether the patient was hypercalciuric or not. Patients whose urine was not remarkably oversaturated showed no tendency to elaborate even less saturated urine during thiazide treatment; instead, the average calcium oxalate saturation level remained constant. Direct urine saturation measurements can detect a small but significant number of normocalciuric patients who have marked oversaturation with respect to calcium oxalate and appear to benefit from treatment.

Calcium↗
PubMed1998

[Nephrolithiasis in "disk-variant" cross-over renal dystopia. Report of a case].

Renal dystopia is a frequent urogenital anomality. Renal dystopia encloses pelvic kidney or malascending kidney, but also rare anomalities like renal duplication or crossed renal dystopia. These allotopias are often diagnosed on routine examination of the urogenital system. We report a case with fused crossed renal dystopia on the left with atypical symptoms of nephrolithiasis and give a summery of the embryological origin.

Diagnosis, Differential↗
PubMed1978

Reduced red blood cell carbonic anhydrase activity in a patient with nephrolithiasis.

Low levels of red blood cell (RBC) carbonic anhydrase (CA) activity in hemoglobin-free hemolyzate (HFH) were found in 2 children with nephrolithiasis when compared to age-matched controls. The lowest levels were consistently found over a two year period in a 6 1/2 year old boy (U.P.) whose renal calculi contained uric acid, ammonia, calcium carbonate and oxalate. His RBC CA values ranged from 1.4-2.7 U/g Hb compared with levels of 3.9-5.3 U/g Hb in control subjects. Statistical comparisons of the mean values for U.P., 2.06 U/g Hb, and his age-matched control subjects, 4.46 U/g Hb, revealed a significant difference (P = less than 0.001). Similar reductions in RBC CA activity were found in his father--2.0 and 2.1 U/g Hb compared with 3.3 and 3.9 U/g Hb in adult controls. HFH CA activity was not decreased in the mother or sister. Polyacrylamide gel electrophoresis of HFH from 4 of the children and the father of U.P. was abnormal. However, this abnormal electrophoretic pattern could only be demonstrated when the gel was run for 120 minutes and not when it was run for 80 or 160 minutes. We have identified a patient and his father with low levels of RBC CA activity.

Adolescent↗
PubMed1999

Nephrolithiasis.

Genetic factors are important determinants for kidney stone formation. Cystinuria, primary hyperoxaluria, and X-linked nephrolithiasis (Dent's disease) are monogenic kidney stone diseases for which responsible genes have been identified. Familial stone disease with hyperuricosuria or renal tubular acidosis has been described in several clinical settings. Idiopathic hypercalciuria is the most common stone risk factor, and evidence in humans and in a rat model indicates that hypercalciuria is a complex, polygenic trait. Some candidate genes for idiopathic hypercalciuria are suggested by the known physiology, including those encoding the vitamin D receptor, the 1 alpha-hydroxylase of vitamin D, the calcium-sensing receptor, the renal sodium-dependent phosphate transporter, and chloride channels, but others remain to be identified. The multifaceted physiology of hypercalciuria may reflect the combined effects of polymorphisms in several genes.

Animals↗
PubMed1999

Specific modulatory effect of arachidonic acid on human red blood cell oxalate transport: clinical implications in calcium oxalate nephrolithiasis.

Greater arachidonic acid (AA) contents, which were correlated with erythrocyte transmembrane oxalate (Ox) transport, were observed in plasma and erythrocyte membrane phospholipids of patients with idiopathic calcium renal stones, suggesting a link between membrane phospholipid fatty acid composition and cellular Ox transport. To confirm this hypothesis, the effects of exogenous red blood cell incorporation of three different fatty acids (i.e., oleic acid, AA, and eicosapentaenoic acid) on Ox transport and the phosphorylation status of band 3 protein, which has been shown to mediate red blood cell Ox flux, were investigated. Preincubation of erythrocytes with AA induced a dose-dependent increase in the phosphorylation level of band 3 protein and an increase in transmembrane Ox self-exchange. In contrast, inhibitory effects on both parameters were observed after the incorporation of oleic and eicosapentaenoic acids. These data, together with previous observations of dietary effects on erythrocyte Ox transport and urinary Ox excretion, indicate that genetic and/or nutritional changes in membrane phospholipid fatty acid composition play a crucial role in modulating cellular Ox transport in idiopathic calcium Ox nephrolithiasis.

Adult↗
PubMed1999

Molecular detection of heparan sulfate proteoglycan mRNA in rat kidney during calcium oxalate nephrolithiasis.

The present study used reverse transcription (RT)-PCR to examine heparan sulfate proteoglycan (HSPG) mRNA expression in rat kidneys. Total mRNA in kidney was isolated and converted to cDNA. To confirm the exact expression level of HSPG mRNA, quantitative competitive (QC)-PCR was performed for each sample. PCR products were resolved by electrophoresis on 1.5% agarose gel and visualized with ethidium bromide. Fragment intensity and area were measured using an image analyzer. In QC-PCR, target DNA and competitive DNA were expressed, using gene-specific primer for HSPG mRNA, as 506- and 345-bp bands, respectively. The level of HSPG mRNA expression apparently increased in the nephrolithic rat kidney. Immunohistochemical study revealed that increased production of heparan sulfate was detected in both distal and proximal tubules during nephrolithiasis. These findings suggest that increased expression of HSPG may play a significant role during calcium oxalate stone formation.

Animals↗