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PubMed2004

[Urolithiasis and pregnancy. Presentation of results and management norm at the National Institute of Perinatology].

AIMS: Urolithiasis associated to pregnancy has an incidence of 1:1,500. It is more frequent in multiparity patients and is a risk factor for preterm labor in more than 40%. OBJECTIVES: To know the incidence of urolithiasis associated to pregnancy at the National Institute of Perinatology; to determine the prevalence of: symptoms and signs, hydronephrosis, urinary tract infections, uropathogens, use of catheters and perinatals results. METHODS: A cohort study was made from January 1998 to October 2003, to identify pregnant patients with urolithiasis. The clinical files were reviewed; Fisher's exact test was used for statistical analysis. RESULTS: Twenty-one patients were diagnosed with urolithiasis; 71% had lumbar pain; 57.1% hematuria; 47.6% bilateral urolithiasis; and 33% bilateral hydronephrosis. All the patients who had lumbar pain, hematuria or were catheterized developed urinary tract infection, even with antibiotics prophylaxis. The 52.4% had at least one urinary tract infection episode. The average gestational age at birth was 38.5 weeks (+/- 5.6 weeks). The 84.22% were preterm births. CONCLUSION: Our incidence is similar to the one reported in the literature. The 71.26% has at least one of the symptoms from the classic triad of urolithiasis. The prevalence of urinary tract infection in these patients is very high therefore; antibiotics prophylaxis and urine cultures are required. A lower prevalence of preterm births was obtained. A flow chart for diagnosis and follow-up was presented in order to decrease and to face the possible complications of this pathologic entity.

Adult↗

PubMedDate not supplied

[Poisonous chemicals and urolithiasis].

For the last 30 years urolithiasis incidence in Kirghizia has been growing. Its prevalence is the highest in Chu and Osh rural areas (89%) where farmers widely use toxic insecticides. Urban population develop the disease more often (63%), especially employees (57.7%) versus workers (27.7%). Urolithiasis occurs in workers 8 times more frequently than in farmers. Food products contain insecticides in quantities much higher than MAC. The contamination concerns fruit and vegetables in a lesser and meat, milk products in greater degrees. In renal tissue, blood, urine of urolithiasis patients concentrations of the chemicals were increased 4 times against the control samples. In renal tissue and fat of urolithiasis animals nephrotoxic insecticides levels surpassed those in the controls 2-3 times. Uroliths contain chemicals in great concentrations also. Basing on the conformity of geography of insecticides us a ge with urolithiasis epidemiological data, high concentrations of the chemicals in food and biological objects, frequent occurrence of recurrent urolithiasis in patients known to acquire high chemicals levels in renal tissue and urine, it is inferred that toxic chemicals are involved in nephrolithiasis genesis by tubular impairment.

Agrochemicals↗

PubMed1994

[Clinical and epidemiological studies on urolithiasis in Ilan].

Clinical and epidemiological studies were performed on 1,184 cases of urolithiasis treated in the Department of Urology, Poh Ai Hospital. The incidence of urolithiasis was 147/100,000 population in 1991. The highest incidence was found in patients in their 50s. The male to female ratio was 2.9:1. There were 895 cases with single stones, and 289 cases with multiple stones. The ratio of upper to lower urinary tract stones was 13.6:1. Among the hospitalized patients, 673 cases (56.8%) underwent surgical treatment and 511 cases (43.2%) received conservative treatment with spontaneous stone passage. Among 1071 cases of upper urinary tract calculi, 567 cases (52.9%) underwent surgical treatment: 236 cases (41.6%) were treated by endoscopic surgery, 176 cases (31.0%) were treated by open-surgery and 131 cases (23.1%) by extracorporeal shock wave lithotripsy. Among 79 cases of lower urinary tract calculi, 75 cases (94.9%) were treated surgically: 68 cases (90.7%) by transurethral endoscopic surgery and 7 cases (9.3%) by cystolithotomy. According to analysis of 365 stones, the most frequent type was calcium-containing stones (92.3%). Pyuria was noted in 250 out of 1,086 (23.0%) cases. Bacteriuria was noted in 202 out of 914 (22.1%) cases. Concerning organisms isolated from the urine, Staphylococcus epidermidis was found most frequently (55/202). Stone patients increased in number during the summer season (July and August). Systematic questionnaires completed by the patients with urolithiasis, lead us to the following conclusions: 1) 50.7% (216/438) of patients gave a past history of urolithiasis, and 2) family histories showed that males whose siblings had urolithiasis were at the highest risk of uolithiasis, followed by those whose fathers had a history of urolithiasis.

Adult↗

PubMed2004

Bone mineral density and urolithiasis interaction in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a systemic inflammatory disease with extraarticular manifestations involving many organs. Both urinary stone formation and bone mineral density (BMD) can be affected by calcium (Ca) metabolism changes in RA. We aimed, in our study, to investigate the incidence of urolithiasis in adult RA patients and to identify the BMD characteristics of stone-forming RA patients. Seventy-nine RA patients and 35 control subjects participated in our study. None had a known renal disease, except for urolithiasis. Complete blood count (CBC), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and C-reactive protein (CRP) were recorded. Twenty-four-hour urinalysis, as well as plain X-ray, ultrasound imaging, and BMD measurements with dual-energy X-ray absorptiometry (DEXA) were performed. T scores more than 1 SD below the mean value were accepted as low BMD. There was no statistically significant difference between urinary stone incidence in RA patients and controls. There was a significant difference between BMD values in RA patients with and without urinary stone disease. The low T scores of stone-forming RA patients may be explained by the additive effect of two coexisting diseases, both shown to be related to low bone mass. From another point of view, both BMD loss and urolithiasis can be consequences of altered Ca metabolism in RA. So we suggest that RA patients with urolithiasis should be evaluated for BMD, and that RA patients with low BMD be evaluated for urolithiasis.

Absorptiometry, Photon↗

PubMed1989

Urinary volume in children with urolithiasis.

Urinary volume in 24-hour urine collections was examined in 50 children with hypercalciuria and urolithiasis or hematuria, 12 with idiopathic calcium oxalate urolithiasis and 36 healthy children. Urinary volume was 22.2 +/- 2.0 ml. per kg. per day in healthy children and 25.4 +/- 2.0 ml. per kg. per day in children with hypercalciuria, and it was similar in children with absorptive and renal hypercalciuria, and significantly lower in children with idiopathic calcium oxalate urolithiasis (12.2 +/- 1.4 ml. per kg. per day, p less than 0.001 from controls and children with hypercalciuria). Volume was not statistically different in hypercalciuric children with and without urolithiasis. Urinary sodium excretion in children with idiopathic calculi was not statistically different from controls. Urine osmolality was similar among the groups. Urinary volume represents a risk factor in children with idiopathic calcium oxalate urolithiasis, and increased fluid intake should be emphasized in such patients.

Calcium↗

PubMed1980

Pediatric urolithiasis in the 1970s.

We studied retrospectively 38 children who presented with urolithiasis between 1970 and 1977. The sex ratio was 1:1 and the mean age was 9.4 years. A positive family history was found in 36 per cent. Urinary tract abnormalities predisposing to infective urolithiasis was found in 7 children (18 per cent) but required voiding cystography for detection in 5. Hypercalcemia was found in 3 of 32 (8 per cent), while 28 of the 38 patients (74 per cent) had idiopathic urolithiasis. Idiopathic hypercalciuria was found in 5 of 13 patients (38 per cent) with idiopathic urolithiasis. Investigation of urolithiasis in children should include voiding cystography and measurement of urine calcium, as well as oxalate and uric acid, under home diet conditions.

Adolescent↗

PubMed1993

Urolithiasis in pediatric patients.

Urolithiasis in pediatric patients has been perceived as uncommon, and the appropriate evaluation and management have been controversial. To determine the clinical characteristics, types of stone problems, and outcomes of pediatric patients with urolithiasis encountered in a referral center, we retrospectively assessed 221 patients (113 girls and 108 boys) with urolithiasis examined at the Mayo Clinic between 1965 and 1987. The median age at onset of symptoms was 11 6/12 years among the female patients and 10 6/12 years among the male patients. Analysis of stone constituents in 122 patients showed the proportion of calcium oxalate (44.7%), calcium phosphate (23.6%), and cystine (8.1%) stones to be similar in all age-groups. Overall, struvite stones were found in 17.1% and uric acid stones in 1.6% of patients. Conditions that predisposed to metabolic urolithiasis were identified in 115 patients (52%). Hypercalciuria was confirmed in 49 of 145 patients (33.8%) and hyperoxaluria in 25 of 124 (20.2%). Eight of 96 patients had hyperuricosuria, and 5 of 54 had hypocitraturia. Forty-one patients (18.6%) had infection-related stones. Of 66 patients with structural anomalies of the genitourinary tract, 24 (36%) had metabolic abnormalities and 26 (39%) had chronic infection. Among patients with chronic infection, 29% had metabolic abnormalities. Of the 221 patients, 148 (67%) had two or more stones during a mean follow-up of 59 months. Among 140 patients with 12 months or more of follow-up, metabolic activity was present in 31 (22.1%) at the time of most recent examination. Overall, 166 of 221 children (75.1%) were found to have factors that predisposed to urolithiasis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Determination of urine saturation with computer program EQUIL 2 as a method for estimation of the risk of urolithiasis.

To investigate the risk for the development of urolithiasis in 30 children with urolithiasis, 36 children with isolated hematuria, and 15 healthy control children, 24-h urinary excretion of calcium, sodium, oxalate, citrate, sulfate, phosphate, magnesium, urate, chloride, ammonium, and glycosaminoglycans was determined and urine saturation for calcium oxalate was calculated with the computer program EQUIL 2. Compared with controls, children with urolithiasis had significantly increased calcium excretion, oxalate excretion, and urine saturation, whereas children with isolated hematuria had significantly increased calcium excretion only. The best estimation of the relative risk of urolithiasis can be made after urine saturation, using logistic regression. The percentage of patients correctly classified after urine saturation is 85.41% in comparison with 80.95% and 73.81% when the estimation was done by calcium excretion and oxalate excretion, respectively. Using the breakpoint value of 4.29 for urine saturation, it was possible to separate children with increased risk of urolithiasis development from the group of children with isolated hematuria.

Calcium↗

PubMed1999

Urolithiasis associated with protease inhibitors.

OBJECTIVE: We evaluated the radiographic characteristics as well as the clinical management of urolithiasis induced by systemic therapy with indinavir sulfate, a protease inhibitor utilized in the treatment of HIV infection. PATIENTS AND METHODS: Fifteen consecutive HIV-positive male patients (average age 41.3 years) who presented with urolithiasis while being treated with indinavir sulfate (average time 11.1 months) were studied. RESULTS: All patients presented with flank pain, and eight had gross hematuria. All but one patient had microscopic hematuria. The location of the stones was the kidney in three, the proximal ureter in four, and the distal ureter in nine. One patient had both a renal and a proximal ureteral stone. The stones were radiolucent on CT imaging in five patients and could not be seen in five. In the five cases in which a stone was not definitely identified, a diagnosis of urolithiasis was established on the basis of ureteral obstruction and periureteral/renal streaking noted on CT. Treatment included observation with hydration in eight patients, ureteral stent placement in two patients, ureteroscopy in three patients, and extracorporeal shockwave lithotripsy in two patients. Stones were analyzed in five patients and proved to be 100% indinavir in three and a mixture of indinavir, calcium oxalate monohydrate, and calcium oxalate dihydrate in two. CONCLUSIONS: Urolithiasis is a recognized complication of treatment with indinavir sulfate. Pure indinavir stones cannot be seen on CT unless intravenous contrast medium is utilized. Mixed calcium and indinavir stones can occur and may be radiopaque. The majority of HIV-positive patients with symptomatic urolithiasis can be treated conservatively with hydration. Metabolic evaluation of these patients with identification and correction of factors predisposing to stone formation may minimize future recurrences. Administration of this effective medication thus can continue uninterrupted.

Adult↗

PubMed1999

Hyperoxaluria and urolithiasis in young children: an atypical presentation.

Urolithiasis is uncommon in adolescence and rare in early childhood. In pediatric populations, congenital urinary tract anomalies associated with stasis and infection, idiopathic urolithiasis (adolescents), and nephrocalcinosis (premature infants) account for the majority of urolithiasis patients. Inborn errors of metabolism, such as the primary hyperoxalurias, are rare causes of urolithiasis in childhood. We report six children (mean age at symptom onset 1.3 years; range 0.32-4.1 years) with moderate hyperoxaluria (mean 1.10 +/- 0.58 mmoL/1.73m2 per day; range 0.69-2.19 mmoL/1.73m2 per day). Urolithiasis was present in four. Stones from two children were comprised of calcium oxalate dihydrate. Calcium oxalate crystalluria was seen in two of the patients. Findings included a mean urine calcium concentration of 6.61 +/- 2.28 mg/kg per day, urine citrate of 925.5 +/- 291.29 mg/g of creatinine per day, and mean renal clearance of 99.83 +/- 23.27 mL/min. All children were born full term, none was receiving diuretics, and none had recurrent urinary tract infections. Secondary causes of hyperoxaluria, including dietary oxalate excess, pyridoxine deficiency, and malabsorption, were excluded. Urine glycolate and glycerate were normal in all patients. In one hyperoxaluric member of each sibship, hepatic alanine-glyoxylate aminotransferase and D-glycerate dehydrogenase/glyoxylate reductase activity were normal. The clinical and biochemical features of these children are unlike those in previously recognized hyperoxaluric states. Thus, our description of a separate hyperoxaluric entity, referred to as unclassified hyperoxaluria.

Calcium Oxalate↗

PubMed1987

A possible synergism of dietary phosphate and urine-acidifying salts in preventing silica urolithiasis in a rat model.

Using an animal model involving rats fed tetraethylorthosilicate, the minimal effective dietary concentration of ammonium chloride for reduction of silica urolithiasis was determined to be approximately 0.10 equivalents/kg diet. Ammonium sulfate appeared to be only slightly less effective. The lower incidences of urolithiasis were associated with urinary pH less than 7. A subprophylactic concentration (0.067 equivalents/kg diet) of ammonium chloride was factored with three levels of supplemental phosphorus (0, 0.15 and 0.30%) from Na2HPO4 to determine whether the antiurolithic effects of dietary phosphate and urinary-acidifying salts are synergistic. Phosphate had no effect on urinary pH. A 50% urolith incidence occurred in controls; the incidence was 25% (P = 0.08) with 0.15 and 10% (P less than 0.01) with 0.30% phosphorus. Urinary pH was 7.5 in controls compared with approximately 7.2 in rats given the subprophylactic level of ammonium chloride, but ammonium chloride alone had no effect on urolithiasis. However, complete protection from urolithiasis was provided by each of the two levels of phosphorus in combination with ammonium chloride. It is concluded that supplemental dietary phosphorus is most effective for protection against silica urolithiasis under conditions contributing toward urinary acidification due to a possible synergism between dietary phosphorus and urinary acidifying salts.

Ammonium Chloride↗

PubMed2005

Urologic diseases in America project: urolithiasis.

PURPOSE: We quantified the burden of urolithiasis in the United States by identifying trends in the use of health care resources and estimating the economic impact of the disease. MATERIALS AND METHODS: The analytical methods used to generate these results have been described previously. RESULTS: The rate of national inpatient hospitalizations for a diagnosis of urolithiasis decreased by 15% and hospital length of stay decreased from 2.6 to 2.2 days between 1994 and 2000. Rates of hospitalization were 2.5 to 3-fold higher for Medicare beneficiaries with little change between 1992 and 1998. Almost 2 million outpatient visits for a primary diagnosis of urolithiasis were recorded in 2000. Hospital outpatient visits increased by 40% between 1994 and 2000 and physician office visits increased by 43% between 1992 and 2000. In the Medicare population hospital outpatient and office visits increased by 29% and 41%, respectively, between 1992 and 1998. The distribution of surgical procedures remained relatively stable through the 1990s. Shock wave lithotripsy was the most commonly performed procedure, followed closely by ureteroscopy. Overall the total estimated annual expenditure for individuals with claims for a diagnosis of urolithiasis was almost $2.1 billion in 2000, representing a 50% increase since 1994. CONCLUSIONS: The cost of urolithiasis is estimated at almost $2 billion annually and it appears to be increasing with time despite a shift in inpatient to outpatient treatment and the emergence of minimally invasive treatment modalities, perhaps because the prevalence of stone disease is increasing.

Adolescent↗

PubMed2005

Urolithiasis and obesity: metabolic and technical considerations.

PURPOSE OF REVIEW: The increasing prevalence of obesity poses a challenge to urologists in the diagnosis and treatment of urolithiasis. This review summarizes the new evidence linking obesity and urolithiasis, and the technical considerations and modifications necessary in the diagnosis and treatment of stone disease in obese patients. RECENT FINDINGS: Recent studies have confirmed the epidemiological link between obesity and urolithiasis, and have provided some possible explanations for its underlying cause. New clinical series have demonstrated that flexible ureterorenoscopy and adapted percutaneous nephrolithotomy techniques can result in similar stone clearance rates and morbidity to the non-obese patient. New data, however, suggest that obesity may be an independent predictor of extracorporeal shock wave lithotripsy treatment failure for ureteric stones. Evidence of the efficacy of dietary modification and medical treatment of metabolic abnormalities has been reported in obese stone formers. SUMMARY: Urolithiasis can be safely and effectively managed in obese patients with minor modifications to the established surgical techniques. Increased understanding of the underlying metabolic abnormalities in obese patients with urolithiasis may improve prevention strategies in the future.

Diet↗

PubMed1979

Incidence of urolithiasis leading to hospitalization in Finland.

The study population consists of 2304 urolithiasis patients discharged from all hospitals in 21 central hospital districts in 1970. The incidence rate was 50 per 100 000 inhabitants per year, 74 for men and 27 for women. The age distribution resembles the Gaussian curve, with a peak between 45 and 49 years for men and between 50 and 54 years for women. The male/female ratio was 2.7 in the entire material, about 1 in the age group 0--24 years, about 3 in the age group 25--74 years and about 1.5 in patients 75 years or older. The standardized incidence was highest in Southeastern Finland and in the archipelago of Aland, and lowest in the coastal area of Southwestern Finland. In the area with high incidence, the age distribution of urolithiasis patients differed from that in the rest of the country: in the age groups over 40 the incidence of urolithiasis did not appear to decrease. This difference was attributed to some lifelong environmental exposure. The standardized incidence of urolithiasis leading to hospitalization was higher among urban than rural residents. Seasonal variation in the hospital admissions for urolithiasis was not evident, temporal patterns of admissions were, however, dissimilar in urban and rural areas, and might reflect differences in the physical activities of urban and rural populations.

Adolescent↗

PubMed1992

Urinary Tamm-Horsfall glycoprotein concentrations in normal and urolithiasis-affected male cats determined by an ELISA.

A precise and reproducible enzyme-linked immunosorbent assay (ELISA) which measures urinary cat Tamm-Horsfall glycoprotein (cTHP) was developed in order to investigate the possible role of cTHP in the pathogenesis of feline urolithiasis. Reproducible quantification required that the cTHP be disaggregated with 2M urea and 0.05% Tween 20. It was necessary to standardize rigidly the handling of the samples prior to analysis, since the apparent cTHP concentration varied depending on the preanalysis protocols. Using the sample handling protocol of freezing urine at -70 degrees C before dialysis, urinary cTHP was quantified in male cats with no history of urolithiasis ("normal" cats) and in male cats with a history of urolith formation ("urolithiasis" cats). The mean cTHP concentration in adult, male "normal" cats of 49.2 +/- 35.5 micrograms/ml (N = 23) was significantly lower than the mean cTHP concentration of 95.4 +/- 34.1 micrograms/ml (N = 9) in "urolithiasis" cats (p < 0.01, Students' T-test). These findings indicate a correlation between urolithiasis and high urine cTHP concentrations in male cats which warrants further investigation.

Analysis of Variance↗

PubMed2004

Mode of presentation and first line of management of non-recurrent urolithiasis in Kuwait.

AIMS: To determine the incidence, mode of presentation, first line of management and composition of non-recurrent urolithiasis in Kuwait. METHODS: Consecutive patients admitted between January 1999 and December 2002 with non-recurrent urolithiasis were prospectively analyzed. RESULTS: The average annual incidence of hospital admission for non-recurrent urolithiasis in Kuwait was 43.44 per 100,000 population, representing men and women (ratio, 9:1) with a median age of 41.91 years. Of the hospital admissions for non-recurrent urolithiasis, 57.2% of cases were acute. Overall, the most predominant symptom was flank pain, while the least common symptom was acute urinary retention. Ureteroscopic stone manipulation was the most common initial treatment modality in the present series, as it was utilized in 43.3% and 37.09% for patients admitted on elective and emergency basis, respectively. Of the calculi available for chemical analysis, 91% contained calcium, 73% contained calcium oxalate, 17% contained mixed calcium and 1% contained calcium phosphate. The composition of the rest of the stones were urate in 7%, struvite in 1% and cystine in 1%. CONCLUSIONS: Urolithiasis is a common disease in the Kuwait region that mainly presents with flank pain. Ureteroscopic calculus removal is the most common modality of treatment. The majority of the calculi seen in Kuwait contained calcium.

Acute Disease↗

PubMedDate not supplied

Caprine obstructive urolithiasis: requirement for 2nd surgical intervention and mortality after percutaneous tube cystostomy, surgical tube cystostomy, or urinary bladder marsupialization.

OBJECTIVES: To determine the requirement for 2nd surgical interventions and mortality after 3 different surgical techniques (percutaneous tube cystostomy [10 goats], surgical tube cystostomy [25 goats], urinary bladder marsupialization [10 goats]) for caprine obstructive urolithiasis, and to determine whether pre- or 24-hour postoperative physical examination findings or serum chemistry results could be used as predictors of mortality. STUDY DESIGN: Retrospective study. ANIMALS: Male goats (45) with obstructive urolithiasis. METHODS: Medical records for all male goats admitted and operated for obstructive urolithiasis between 1993 and 2003 were reviewed. Data retrieved included signalment, pre- and 24-hour postoperative values for temperature, pulse, respiratory rate, packed cell volume, serum K(+), serum creatinine, and blood urea nitrogen [BUN]. The type of initial surgical procedure, time to 2nd surgical intervention, time to death, and duration and cost of hospitalization were also obtained. RESULTS: Percutaneous tube cystostomy was associated with a significantly increased requirement for (5.6-fold increased hazard) and decreased time to a 2nd intervention (P=.002). There were no differences between the 3 procedures for time to mortality. Increased BUN and respiratory rate at admission were associated with increased mortality (hazards ratio of 4.8 and 5.0, respectively). Urinary bladder marsupialization was associated with significantly decreased hospitalization time (P=.02) and cost (P=.04) compared with surgical tube cystostomy and percutaneous tube cystostomy. CONCLUSION: Surgical tube cystostomy and bladder marsupialization are both acceptable surgical methods for treatment of caprine obstructive urolithiasis. Each procedure has inherent complications that should be discussed with the owner before choosing the surgical treatment. CLINICAL RELEVANCE: There are acceptable options for treatment of caprine obstructive urolithiasis; however, percutaneous tube cystostomy should be avoided.

Animals↗

PubMed1998

Purine metabolism of uric acid urolithiasis induced in newborn piglets.

To clarify the relationship between uric acid urolithiasis and purine catabolites in newborn piglets, the incidence of uric acid urolithiasis and the plasma concentrations of xanthine, hypoxanthine, uric acid and allantoin were examined in 32 piglets. The newborn piglets were divided into two groups: normal (over 1.2 kg, n = 18, group N) and low body weight (below 0.9 kg, n = 14, group L). The animals in both groups were given water (non-nutrition, n = 11, treatment W), artificial milk (normal nutrition, n = 12, treatment M), or a combination of water and allopurinol (prophylactic treatment for the urolithiasis, n = 9, treatment A), during the first 60-hr of birth. At necropsy, the incidence of urolithiasis was higher in the piglets that received treatment W than those in the treatment M or A in both the N and L groups. In group L, the plasma xanthine, hypoxanthine and uric acid concentrations were markedly increased in the piglets that underwent treatment W compared with the treatment M. In both the N and L groups, the plasma allantoin concentration was higher in the treatment W piglets as compared with the treatment M piglets. These results suggested that the occurrence of uric acid urolithiasis in the newborn piglets is attributable to increased purine catabolites due to a starvational condition after birth.

Aging↗