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PubMed2003

[Urinary calcium oxalate supersaturation beyond nephrolithiasis. Relationship with tubulointerstitial damage].

A number of studies have demonstrated that the urinary ion activity product (IAP) of calcium oxalate (CaOx), as an index of urinary CaOx supersaturation (SS), is higher in renal stone formers than in normal subjects. Besides, the relation between CaOx SS and lithogenesis, crystal CaOx exposition can produce tubular cell as well as renal interstitial lesions. The aim of our study was to evaluate the possible relationship between CaOx SS and tubulointerstitial (TI) damage in an animal model of hyperoxaluria. During four weeks, male Sprague-Dawley rats received: G1 (n = 8) control regular water, and G2 (n = 8) 1% ethylene glycol (ETG) (precursor for oxalates) in drinking water. In order to evaluate urinary CaOx SS, IAP assessed by Tisselius formula was performed. At the end of the study, renal lesions were evaluated by light microscopy and immunohistochemistry. Animals from G2 (ETG) presented higher (p < 0.01) values of: a) urinary oxalate excretion; b) urinary CaOx SS; c) crystalluria score; d) proteinuria; and lower (p < 0.01) creatinine clearance, with respect to the control group (G1). Moreover, pathology studies showed that rats from G2 (ETG), presented significant TI lesions characterized by a higher (p < 0.01) score of: a) tubular atrophy; inflammatory infiltrates (monocyte/macrophage); c) crystal deposits; d) intersticial fibrosis; e) interstitial alpha-smooth muscle actin; f) collagen type III; g) TI TGF beta 1 compared with G1 (control). Rats from G2 (ETG) presented a high correlation between urinary CaOx SS and most of the TI damage parameters evaluated, in especial with interstitial fibrosis. Both, inflammatory infiltrates and urinary CaOx SS were the most significant variables related to interstitial fibrosis. Finally, since hyperoxaluric animals showed higher urinary CaOx SS associated with higher renal TI damage, the results from this study suggest the presence of a tight link between urinary CaOx SS and renal TI damage. Considering these findings we think that urinary CaOx SS control rises in importance beyond nephrolithiasis.

Animals↗
PubMed1992

Hyperparathyroidism: cause or consequence of recurrent calcium nephrolithiasis?

Primary hyperparathyroidism (PHP) might be characterized by either prevailing bone or renal stone patterns with different metabolic features. To explore the possibility of different hormonal patterns we studied 129 patients with PHP: 95 stone formers (SF) and 34 nonstone formers (NSF). Females prevailed over males in both groups. Severe and specific bone lesions were more evident in NSF than SF. Parathyroid gland histology displayed a prevalence of adenoma in NSF, whereas isolated hyperplasia prevailed in SF. SF had lower levels of serum Ca, urinary Ca, ALP and serum PTH than NSF. As expected serum 1,25-dihydroxyvitamin D [1,25(OH)2 D] levels were greater in both groups of patients than in controls but we found no difference between the two groups. 25-Hydroxyvitamin D was neither increased with respect to controls nor different between groups. We conclude that patients with PHP may represent well separated metabolic and clinical entities, but we cannot confirm that serum 1,25(OH)2D levels play a key role in discriminating the different clinical features. In addition, the findings of predominant parathyroid hyperplasia in SF and the clinical evidence of recurrent hyperparathyroidism only in these patients suggest the possibility that the endocrine disorder might be the consequence over time rather than the cause of nephrolithiasis.

Adult↗
PubMedDate not supplied

[Nephrolithotomy in the treatment of severe nephrolithiasis].

Nephrolithotomy results are available for 63 patients with coral and multiple nephroliths operated in 1990-2002. These patients underwent 64 operations (one patient with bilateral nephrolithiasis had 2 consecutive nephrolithotomies within a month). The sites preferable for transverse nephrolithotomy are described and validated. Ligation of the renal artery with pharmacological antiischemic protection of the kidney with lasix and verapamil was performed in 40 cases.

Adolescent↗
PubMedDate not supplied

[Use of "Serebrianyĭ Kliuch" mineral water in the postoperative treatment of patients with nephrolithiasis after extracorporeal shock-wave lithotripsy].

27 patients with nephrolithiasis were exposed to extracorporeal shock-wave lithotripsy (ESWL). They were divided into two groups: group 1 of 10 patients who were exposed to ESWL and drank tap water and group 2 of 17 patients who were exposed to ESWL and drank silver-containing mineral water Serebryany klyuch. In group 2 there was a marked diuretic effect manifesting with intensive excretion of electrolytes (K, Na), phosphorus and uric acid. This led to improvement and normalization of renal function, promoted faster elimination of concrement fragments and more frequent (by 52.3%) complete elimination of the concrements.

Drinking↗
PubMedDate not supplied

[The selection of the treatment method in stenosis of the pelviureteral segment in nephrolithiasis].

Ureteropelvic stenoses in nephrolithiasis are suggested to be considered reversible and irreversible depending on the lesions of the upper urinary tracts and the adjacent fat. To ascertain reversibility of the stenosis, use was made of the progesterone test in view of progesterone ability to dilate the ureter. No retention changes in the upper urinary tract in the reversible stenosis can serve an indication to impulse lithotripsy. Large stones and all cases of irreversible stenosis indicate validity of open surgery the scope of which is decided intraoperatively after isolation of the ureteropelvic segment from the periureteral fat and upon the indigo carmine test. In the absence of dysfunctional zone in the segment the patients may be subjected to ureterolysis and pyelolithotomy. If such zone is detected it is possible to make pelvic and proximal ureteral resection, pyeloureterostomy. The technique of the latter surgery in the intrarenal pelvis is detailed.

Constriction, Pathologic↗
PubMedDate not supplied

[Prolit in the treatment and prophylaxis of nephrolithiasis].

In the course of prolit treatment there was a spontaneous evacuation of small concrements from renal calyces and ureters in 11 (27.5%) patients, dilution of the concrements and reduction in size of the latter were observed in prolit combination with blemaren (2 patients--5% and 7 patients--17.5%, respectively). Overall response was 50% while that to cyston--16.7%. Diuretic, anti-inflammatory and plastic actions of prolit manifested in 100% patients with disappearance of salts from urinary sediment, abatement of microhematuria and mild leukocyturia. Thus, prolit is a highly effective food additive in the treatment of nephrolithiasis and opens new perspectives in the treatment of urolithiasis.

Adult↗
PubMedDate not supplied

[Extracorporeal shock-wave lithotripsy in the treatment of patients with coral-like nephrolithiasis].

An analysis was performed of results of treatment with extracorporeal shock-wave lithotripsy (ESWL) of 57 patients with coral-like nephrolithiasis (CLN), a total of 151 sessions. The policy of dealing with the patients has been worked out in conducting ESWL as related to the stage of formation, mineral composition of the coral-like calculus, functional condition of the kidneys, phase of the inflammatory process, condition of the urinary tracts, as well as to the indications for draining. Efficiency is shown of ESWL depending on the stage of formation of the coral-like calculus. An analysis of ESWL-related complications in CLN patients is submitted together with ways for their prevention and cure.

Humans↗
PubMed2005

Magnesium therapy for nephrolithiasis.

PURPOSE: Critically evaluate the experimental evidence and clinical trial outcomes as the basis for use of magnesium (Mg) supplements as therapy for calcium oxalate nephrolithiasis. MATERIALS AND METHODS: Literature search of MedLine and Web of Science through January 2005; articles cited in papers found by searches. RESULTS: Magnesium inhibits calcium oxalate crystallization in human urine and model systems. Magnesium also inhibits absorption of dietary oxalate from the gut lumen. Three early trials of Mg oxide (MgO) and Mg hydroxide (Mg(OH)2) reported lower rates of recurrent stone formation. However in a double-blind, randomized, placebo-controlled trial with more carefully selected patients, there was no significant difference between recurrence rates with 650 or 1300 mg MgO daily and the placebo. Another trial reported 391 mg (21 meq) Mg daily as a mixed salt, Mg potassium citrate, reduced calcium stone recurrence by 90%, similar to potassium citrate, but with better gastrointestinal tolerance. The failure of MgO and Mg(OH)2 as sole therapy may be related to poor absorption and low rates of Mg deficiency in the patient populations tested. CONCLUSIONS: Clinical trial evidence does not justify the use of MgO or Mg(OH)2 as a sole therapy for calcium oxalate kidney stones in a general patient population. However, the addition of magnesium to potassium citrate therapy improves outcomes. Clinical trials should focus on patients who are likely to be Mg deficient.

Calcium Oxalate↗
PubMedDate not supplied

[Results of surgical treatment of coral nephrolithiasis].

A total of 98 patients (39 males and 59 females) with coral nephrolithiasis (CN) were divided into 3 groups depending on the variant of surgical treatment. The results were followed up for 5 years. Group 1 and 2 patients have undergone combined low-traumatic open surgery or low-invasive interventions (extracorporeal lithotripsy--ECL or percutaneous nephrometolapaxy--PN), group 3 patients--open surgery (pyelonephrolithotomy or section nephrolithotomy. It was found that the treatment was longest in group 1 and shortest in group 3, complications occurred most frequently in group 3 on section nephrolithotomy, least frequently in group 2. A significant decline of operated on kidney late after the treatment was observed in patients subjected to section nephrolithotomy. Thus, ECL and PN produce positive results in patients with CN (elimination of the stone with a minimal risk of residual concrements) in good long-term function of the operated on kidney.

Adult↗
PubMedDate not supplied

[Quality of life of elderly patients with nephrolithiasis].

Clinical findings have been analysed for 105 presenile and senile patients with nephrolithiasis. A total of 168 operations have been made: open intervention (n=22), percutaneous nephrolitholapaxia (n=12), extracorporeal lithotripsy (n=134). Quality of life was assessed according to the questionnaire survey (an original visual graphic questionnaire on the patient's attitude to his/her disease and the treatment, questionnaire on the doses of analgetics and antibiotics, conventional questionnaire EQ-SD. It was found that elderly patients note a statistically significant fall in frequency of pains (renal colics, lumbar pains, subfebrile condition), in the dose of analgetics and antibacterial drugs 6-12 months after removal of the concrement. Removal of the concrement had a positive influence on quality of life of patients with urolithiasis. Extracorporeal lithotripsy had a weaker emotional effect on the patients than open surgical interventions. It is suggested to remove nephroliths if contraindications are absent.

Aged↗
PubMed1991

[Oxalate as a promoter in calcium oxalate nephrolithiasis].

Oxalate transports on membranes of red blood cell, intestinal epithelium and proximal tubule cell were reviewed, and the new findings about oxalate transport across these membranes are reported. Red blood cell oxalate influx rate in a group of recurrent calcium oxalate stone formers was significantly higher than that of a control group. In the red blood cells of mammals, the band 3 protein transports oxalate. Although abnormal influx rate of red blood cells might be recognized as an expression of somatic cell abnormality of oxalate transport in some recurrent stone formers, the band 3 protein is not related to oxalate transport in both kidney and intestine. The study using brush border membrane vesicles suggested the presence of Na-oxalate co-transport. In humans, sodium intake increased the oxalate/creatinine ratio of urine. This indicated that excessive sodium intake might be a risk factor of stone formation. Further study of oxalate transport of both kidney and intestine will be required to elucidate an etiology of calcium oxalate nephrolithiasis.

Animals↗
PubMed1990

Renal excretion of oxalate in patients with chronic renal failure or nephrolithiasis.

This study was carried out in order to investigate renal oxalate excretion in a group of normal subjects (n = 40), a group of patients with uremia (n = 52) and a group with nephrolithiasis (n = 34). We found that the mean concentrations of oxalate in the 24-hour urine specimens of both patient groups were below the normal range. Although the renal creatinine clearance (CCR) was significantly decreased in some stone patients (n = 14), decreased renal oxalate clearance was noted only in those patients with severe renal failure. Thus, plasma oxalate was found to be elevated only in patients with chronic renal failure (mean +/- SD, 49.7 +/- 12.4 mumol/l), while the normal value was 17.0 +/- 6.7 mumol/l. The mean tubular excretion fraction of oxalate was also found to increase markedly in uremia with a mean of 26.3 +/- 17.3% (in normal subjects, 11.7 +/- 7.5%), but their mean daily urinary excretion of oxalate decreased to 63.2 mumol/day (mean value of 232.6 mumol/day in normal subjects). A positive correlation was observed between oxalate and creatinine, and between oxalate and calcium excretion, which was not found in normal subjects or patients with kidney stones. In nephrolithiasic patients, the daily excretion of oxalate, calcium and phosphate had no discernible increment and the mean excretory ratio of oxalate, calcium or phosphate to creatinine was all within normal limits. But when the CCR of stone patients was below 80 ml/min, their daily excretion of oxalate and calcium decreased significantly (p less than 0.01) and the excretory ratio of phosphate to creatinine markedly increased.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Nephrolithiasis in twins with APRT-deficiency. Stones as a marker of an inborn error of metabolism.

We describe the first case of twins with complete APRT-deficiency, indicating homozygosity, and 2.8-dihydroxyadenine stones in both kidneys. The stones were discovered accidentally during a routine abdominal ultrasound examination, and thus the diagnosis of an inborn error of metabolism, was established. In nephrolithiasis caused by an inborn error of metabolism, early diagnosis and therapy are of great importance for prognosis and quality of life.

Adenine↗
PubMedDate not supplied

[Ultrasonic study of the parathyroid glands in patients with coralliform nephrolithiasis].

Functional activity of the parathyroid glands (PTG) is important for the choice of proper therapeutic policy in patients with dendritic nephrolithiasis. The location of the hyperfunctioning gland (usually adenomatously or hyperplastically changed) is a complicated problem as the dimensions of the gland are extremely small. Ultrasonic investigation of the parathyroid gland area for detection of the enlarged gland is used at the Research Institute of Urology, the RSFSR Ministry of Health. Linear (7.5 mHz) and sector (5 mHz) transducers have been used through the water medium and by the immediate contact with the surface of the patient's neck. A total of 24 subjects were enrolled in the study (13 females and 11 males aged 23-64 years). Enlarged parathyroid glands situated in the lower thyroid lobe (low parathyroid glands) or in the upper medial third of the thyroid lobe (upper parathyroid glands) were recorded in 9 patients and confirmed in the course of surgeries. In one case, the enlarged parathyroid gland was found in the thyroid tissue. Its length varied from 0.6 to 1.5 cm and its thickness, from 0.4 to 0.9 cm. All the glands were echographically evidenced as oval formations with a low-rate echogeneity and clear-cut smooth contours. In 3 cases the site of the gland was confirmed by a selective testing of the neck venous blood for parathyroid hormone. Histological examination of the removed glands revealed that hyperplastic changes were more common than the adenomatous ones.

Adenoma↗
PubMed1990

[Crossed renal ectopia with nephrolithiasis].

Crossed unfused renal ectopia is an uncommon anomaly in which one of the uretes crosses the midline from the kidney to the vesical orifice on the opposite side. We report one case of crossed unfused renal ectopia, nephrolithiasis and pain on the side opposite to the renal mass.

Humans↗
PubMedDate not supplied

[Hypercalciuria and hyperuricosuria causing hematuria in the absence of nephrolithiasis].

A prospective study was made of 38 adult patients (15 male and 23 female, age 30.5 +/- 10.8 years) with isolated hematuria of unknown etiology in which presence of hypercalciuria and/or hyperuricosuria without lithiasis was observed. Eighteen patients also referred episodes of macroscopic hematuria. Twenty-six patients had hypercalciuria (5.1 +/- 1.4 mg/kg/day), 29 hyperuricosuria (1053 +/- 198 mg/day) and 17 presented both alterations. A four months treatment was instituted with thiazides in patients with hypercalciuria and allopurinol in those with hyperuricosuria. From the first months and throughout the whole therapy, urinary excretion of calcium an uric acid became normalized in all cases. In 22 patients (57.8%) (Group I: Respondents) hematuria disappeared coinciding with normalization of calcium and uric acid values in urine and was maintained during the follow-up months. In the remaining 16 patients (Group II: Non-Respondents) the hematuria condition persisted in spite of such normalization, in most cases other causes for hematuria becoming clear later. No differences with regard to age, relationship male/female nor basal calciuria and uricosuria values were seen between both Groups. Group I had a greater incidence of macroscopic hematuria episodes (64% vs 12% in Group II, p less than 0.01) and of family nephrolithiasis (64 vs 25% in Group II, p less than 0.05). We conclude that hypercalciuria and hyperuticosuria are potentially reversible causes of hematuria in adults. Therefore, urinary determination of calcium and uric acid should be included in urinary evaluation of patients with hematuria even though they do not present renal lithiasis.

Allopurinol↗