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PubMed1984

[Nephrolithiasis--correlation of calculus type and pathogen spectrum. Calculus analysis and microbiologic diagnosis in 173 surgically treated patients].

The microbiological findings from intraoperative swabs were correlated with the consistency of the calculi in 173 patients, who had been operated on due to nephrolithiasis. The following parameters were taken into consideration: age and sex of the patients, consistency of calculi and germ spectrum of intraoperative swabs from the upper urinary tract. Three main groups were formed corresponding to the consistency of the calculi (carriers of infection calculi, of calciumoxalate calculi and of uric acid calculi) and these were compared to one another regarding the above mentioned parameters.

Bacteriological Techniques↗
PubMed1978

[Normocalcemic nephrolithiasis and primary hyperparathyroidism].

In normocalciuric and in hypercalciuric renal stone formers tubular calcium reabsorption (TRCa) was studied before and during an intravenous calcium infusion. In addition two patients with proven primary hyperparathyroidism (pHPT) were studied. TRCa was decreased in hypercalciuric stone formers whereas an increase was noted both in pHPT and in normocalciuric subjects. It is concluded that normocalciuric nephrolithiasis may be a manifestation of mild and/or early pHPT.

Absorption↗
PubMed1982

Experimental calcium oxalate nephrolithiasis in the rat. Role of the renal papilla.

Calcium oxalate nephrolithiasis in rats, induced by single intraperitoneal injection of sodium oxalate, is associated with pathologic changes in the renal papillary tip. Calcium oxalate crystals appear in the tubular lumens, in the intercellular spaces between epithelial cells, and attached to the tubular epithelial basal lamina. Unusual paracrystalline structures also develop in the distal tubule associated with the basal lamina. Speculations are made about the role of these structures. The epithelial changes are primarily necrotic and are similar to those described in experimental papillary necrosis. Complete morphologic recovery occurs in 1-2 weeks.

Animals↗
PubMed1982

Urate nephrolithiasis in ranch mink.

Urate nephrolithiasis with epistaxis and bleeding around foot pads was diagnosed in ranch mink. Investigation of affected, unaffected-related, and unaffected-unrelated mink did not disclose the cause of these problems but did eliminate inherited bleeding disorders as a cause of the bleeding. All affected mink were males, had been sired by related sires, and were affected in the 1st year of life. Elimination of affected mink and their parents from the breeding stock eliminated the condition from the herd. The findings were consistent with an inherited defect in uric acid metabolism or excretion.

Animals↗
PubMed1982

[Incidence of hyperoxaluria in idiopathic calcium nephrolithiasis].

Urinary excretion rate of oxalate was measured in 79 patients with idiopathic calcium (Ca) nephrolithiasis and the results were compared with those obtained in 28 healthy volunteers. The group of stone formers consisted of 20 patients with idiopathic hypercalciuria (IHC) of the absorptive type, 23 patients with IHC of the renal type, 11 patients with hypercalciuria secondary to dietary factors, 1 patient with hyperuricosuria (as an isolated finding) and 24 patients without hypercalciuria nor hyperuricosuria. Classification was based upon the urinary excretion rate of uric acid, as well as that of calcium measured under 3 different dietary conditions (i.e. free diet, free diet supplemented with 3 g Ca/day for 3 days, and diet free of dairy products for 5 days). On a free diet, normal values of oxaluria ranged from 125 to 435 mumol/24 h; an elevated value was observed in 11 (14%) patients, 5 of whom belonged to the subgroup without hypercalciuria nor hyperuricosuria. On a low Ca diet, mild hyperoxaluria occurred in 3 controls and in 19 patients, the tendency to develop hyperoxaluria being particularly marked in the subgroup with absorptive-IHC. Moreover, there was a positive correlation between oxaluria on a low Ca diet and the estimated degree of intestinal absorption of Ca. This study confirms the finding that on a free diet, the incidence of mild hyperoxaluria amongst idiopathic stone formers is rather low. It shows, however, that a significant percentage of patients classically referred to as "without metabolic disorder" have in fact slight hyperoxaluria, an observation with a potential therapeutic impact. Finally, it shows that on a low Ca diet, patients with absorptive-IHC are particularly prone to develop hyperoxaluria: the latter observation renders questionable the relevance of a low Ca diet for patients with absorptive IHC, unless their intake of oxalate is simultaneously reduced.

Adolescent↗
PubMed1981

Metabolic evaluation of nephrolithiasis in patients with medullary sponge kidney.

Seventeen patients with documented medullary sponge kidney and nephrolithiasis underwent metabolic evaluation. These patients constituted 3.6% of our stone-forming population. Fifteen (88%) of 17 were hypercalciuric. The most common abnormality was absorptive hypercalciuria, occurring in 59%. Only three patients (18%) had renal hypercalciuria. None of the patients had primary hyperparathyroidism. Hyperuricosuria occurred together with hypercalciuria in five patients. In two patients, the precise cause of hypercalciuria could not be determined, and in another two patients, no metabolic abnormality could be detected. Thus, the patients with medullary sponge kidney and renal stones had the same spectrum of metabolic abnormalities as the overall population of stone formers. While these patients may theoretically have a greater anatomic propensity to form stones because of their anatomic abnormality, they should be evaluated and treated appropriately for any metabolic defect.

Adult↗
PubMed1980

[Distal form of renal tubular acidosis and nephrolithiasis].

The distal form of the renal tubular acidosis is a causal factor of the formation of phosphate calculi which is not tao be neglected. Pathophysiology, diagnostics and therapy of the renal tubular acidosis are described under the point of view of the metaphylaxis of urinary calculi. The paraclinical findings of 7 patients with distal renal tubular acidosis and nephrolithiasis and nephrocalcinosis, respectively, are discussed.

Acidosis↗
PubMed1981

A cautious use of sodium cellulose phosphate in the management of calcium nephrolithiasis.

Oral sodium cellulose phosphate, an inhibitor of intestinal calcium absorption, may reduce urinary magnesium, increase urinary oxalate, and have a limited hypocalciuric action or cause negative calcium balance in the absence of increased calcium absorption or in the presence of renal calcium "leak". To overcome these potential complications, we have taken the following precautions: oral magnesium supplements were given, a moderate oxalate restriction was imposed, a modest dose of sodium cellulose phosphate was used (usually 10 g per day), and only patients with documented absorptive hypercalciuria were treated. During a cumulative treatment period of 42.8 years, 18 patients with recurrent calcium nephrolithiasis showed a sustained reduction in urinary calcium, without developing consistent or substantial reduction in urinary magnesium, hyperoxaluria, hyperparathyroidism, or reduced bone density, Urinary saturation (relative saturation ratio) of calcium oxalate and brushite typically decreased. Remission of stone disease was found in 78 per cent of patients. We conclude that sodium cellulose phosphate is a useful drug for absorptive hypercalciuria when used appropriately.

Calcium↗
PubMed1980

[Drug induced nephrolithiasis: observation of an oxalate and hydroxylated triamterene stone (author's transl)].

A 54-year old man who had been taking triamterene (150 mg daily) over a period of 8 months, passed a 3 mm stone partly coated with mustard-colored substance. Metabolic evaluation showed only mild-hyperoxaluria. Through IR spectrography after microdissection, thin-layer chromatography, UV light examination, and mass spectrometry, the stone if found to consist of 70% whewellite, 5% protein, 5% carbapatite and 20% triamterene and hydroxylated triamterene, and perhaps also the sulfate conjugate of this metabolite. In spite of the few number of observations (two cases have been reported previously), triamterene seems likely to induce stone formation, both alone and associated with urate or oxalate, and triamterene should be used cautiously in patients with a predisposition for nephrolithiasis.

Humans↗
PubMed1980

[Diagnostic radiology in nephrolithiasis and nephrocalcinosis (author's transl)].

In summary it can be stated that clinically and radiologically, nephrolithiasis und nephrocalcinosis are not uncommonly encountered together. It is the aim of x-ray diagnostic to detect stones and parenchymal calcification, to assess localisation, size and numer or extent, to recognise secondary changes in the renal parenchyma and urinary-tract resulting from stones and to aid the search for the primary disease. In addition there are readiographic methods valuable for the initiation of treatment, e. g. percutaneous antegrade pyelography and nephrostomy.

Adolescent↗
PubMed1980

Hyperparathyroidism in nephrolithiasis.

We found primary hyperparathyroidism in 56 of 1,132 consecutive patients with nephrolithiasis. We describe 48 of these patients who have undergone curative parathyroidectomy. Thirty of the 48 patients had extremely mild hypercalcemia (serum calcium level, 10.15 to 10.95 mg/dL), often accompanied by very substantial hypercalciuria. Stone disease was of equal severity in these 30 patients and in the 18 with more pronounced hypercalcemia (serum calcium level above 11 mg/dL). In all 48 patients, recurrent stone formation was virtually abolished by parathyroidectomy.

Female↗
PubMed1995

[Prevalence of medullary sponge kidney in patients with and without nephrolithiasis].

Reports on the prevalence of medullary sponge kidneys have given conflicting results. The present work is aimed at defining the prevalence of this abnormality in renal stone formers compared with a non-stone-forming control population by strict radiological criteria. Three separate studies have been carried out: the retrospective analysis of 191 intravenous urographies, which had been performed in 1988; the respective prospective analysis of 104 consecutive intravenous urographies and of 149 consecutive urographies, which had been performed at the end of intravenous digitalized subtraction renal angiographies. The 444 patients were classified according to presence or absence of nephrolithiasis. After exclusion of 70 patients (16%) of which the X-ray didn't fulfill the quality criteria, urographies were classified as 'medullary sponge kidneys', 'papillary blush' or 'negative' according to the radiological aspect of the papillae. Diagnosis of medullary sponge kidneys was based on presence of at least three linear or round papillary opacities seen in at least on papilla even of one kidney on late films (at least ten minutes after injection of contrast medium), taken without ureteral obstruction or abdominal compression. Overall results reveal that prevalence of a medullary sponge kidney in renal stone formers (8.5%) is significantly (p < 0.01) higher than in the control population (1.5%) and higher than what has been generally reported. Results of the retrospective and of both prospective analysis did not significantly differ. The best diagnostic tool to unmask medullary sponge kidneys remains urography.

Angiography, Digital Subtraction↗
PubMed1994

Etiology of experimental calcium oxalate monohydrate nephrolithiasis in rats.

In a rat-model system, tubular crystal retention as a possible mechanism for the etiology of nephrolithiasis in man, was studied by conventional transmission electron microscopy. The animals were supplied for nine days with a crystal-inducing diet, with ethylene glycol plus NH4Cl in their drinking-water. After this induction period, a two day regime with fresh drinking-water was included, to allow crystals to be removed by spontaneous crystalluria. After aldehyde fixation of the rat kidneys, large crystals were seen inside the tubular lumen. The crystals were attached to cell surfaces and covered by neighboring epithelial cells. Some crystals were overgrown by several epithelial cells and underwent a process of so-called exotubulosis, resulting in free or cell-surrounded crystals in the interstitium, and possibly in crystals in Giant cells. To investigate the fate of the retained crystals, some animals were additionally exposed to a low-oxalate challenge from drinking water containing 0.1 volume per cent of ethylene glycol for 12 or 30 days, respectively. It was assumed that this would interfere with the retained intratubular or interstitial crystals, and allow the crystals to grow into mini-stones. This was not observed. After the oxalate challenge, no crystals were found to be retained in the tubules (free or covered by cells). Interstitial crystals were observed, but it remains to be demonstrated whether such crystals actually grow into mini-stones or that they are removed by the sterile inflammation process observed.

Ammonium Chloride↗
PubMed1994

Uric acid nephrolithiasis.

Uric acid is the end-product of purine nucleotide metabolism in man. The renal handling of urate is a complicated process, resulting in a fractional clearance of 8.2-10.3%. The anhydrous form is thermodynamically the most stable uric acid crystal. Uric acid is a weak acid that ionizes with a Pka at pH 5.75. At the normal acidic region, uric acid solubility is strongly increased by urinary pH. The prevalence of uric acid stones varies between countries, reflecting climatic, dietary, and ethnical differences, ranging from 2.1% (in Texas) to 37.7% (in Iran). The risk for uric acid stone formation correlates with the degree of uric acid supersaturation in the urine, depending on uric acid concentration and urinary pH. Hyperuricosuria is the major risk factor, the most common cause being increased purine intake in the diet. Acquired and hereditary diseases accompanied by hyperuricosuria and stone disease include: gout, in strong correlation with the amount of uric acid excreted, myelo- and lymphoproliferative disorders, multiple myeloma, secondary polycythemia, pernicious anemia and hemolytic disorders, hemoglobinopathies and thalassemia, the complete or partial deficiency of HGPRT, superactivity of PRPP synthetase, and hereditary renal hypouricemia. A common denominator in patients with idiopathic and gouty stone formers is a low urinary pH. Uric acid nephrolithiasis is indicated in the presence of a radiolucent stone, a persistent undue urine acidity and uric acid crystals in fresh urine samples. A radiolucent stone in combination with normal or acidic pH should raise the possibility of urate stones.(ABSTRACT TRUNCATED AT 250 WORDS)

Allopurinol↗
PubMedDate not supplied

[The correction of hyperuricemia in patients with different forms of nephrolithiasis using allopurinol and Allomaron].

Metabolic status was assessed in 48 patients with nephrolithiasis followed-up for 4 years. Allopurinol and allomaron-treated patients were examined biochemically by 17 parameters of the blood and urine. The effects of the drugs were compared. It is concluded that in hyperuricemia up to 0.37 +/- 0.02 mmol/l allomaron is more effective (1--2 pills a day). In higher hyperuricemia allopurinol is preferable (4 pills a day). Allomaron can be also used (1--2 pills a day) under the control of urinalysis.

Adult↗
PubMedDate not supplied

[Ultrasonographic and x-ray diagnosis of nephrolithiasis].

Neither the ultrasonic, not the x-ray method alone cannot provide the correct diagnosis in nephrolithiasis. Ultrasonic scanning of the kidneys is indicated at the first stage of the diagnosis. In case of a concrement detection without dilatation of the pelvic calyceal system and the presence of a typical pattern of a calcified papilla or coral-like concrement on the picture the diagnosis can be considered made. If ultrasonic scanning detects, besides the concrement shade, a dilatation of the pelvic calyceal system, excretory urography and x-ray television pyeloscopy are necessary to specify the urodynamic state, that is important to predict the concrement of its fragments elimination under the effect of conservative therapy or long-distance lithotripsy.

Adult↗
PubMedDate not supplied

An unusual association: fibroepithelial polyp and contralateral nephrolithiasis in a child.

A 12-year-old boy presented with fever and flank pain bilaterally. Intravenous pyelogram revealed multiple stones and hydronephrosis in the right kidney and an obstructive filling defect at the left upper ureter. Exploration of the left ureter revealed a fibroepithelial polyp. The presented case was an example of the unreported association between fibroepithelial polyp and contralateral nephrolithiasis.

Child↗