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Chronic renal failure associated with nephrolithiasis, ureterolithiasis, and renal dysplasia in a 2-year-old quarter horse gelding.

A 2-year-old quarter horse gelding presented for evaluation of polyuria and polydipsia. Azotemia was detected on serum chemistry profile. Small, misshapen, hyperechoic kidneys with decreased corticomedullary demarcation, hydronephrosis, and a right nephrolith were noted ultrasonographically. The diagnosis of end-stage kidney disease and dysplasia was made histopathologically using ultrasound-guided biopsy. Two ureteroliths were found in the right ureter via cystoscopy, and a nephrolith was seen in the right kidney at necropsy. Clinical, ultrasonographic, and pathologic features of equine urolithiasis and renal dysplasia are discussed.

Animals↗

Should dietary calcium and protein be restricted in patients with nephrolithiasis?

Renal stone disease is a painful condition that affects 1-20% of the general population. Therapy aimed at decreasing the incidence of recurrent stones includes dietary advice. Dietary considerations include intake of both calcium and protein. Calcium restriction in stone formers is not recommended because it can have adverse effects on bone and the incidence of stones. Although a high-protein diet can elevate urinary calcium, uric acid, and sulfate and decrease urinary citrate, which may alter the propensity to form stones, restriction of protein to less than the current RDA for the management of stone disease can not be recommended at this time.

Calcium↗

Hypercalciuria relative to total solutes in nephrolithiasis.

Urines obtained from normal controls, from patients with calcium-containing renal stones, and from acutely ill patients suffering from various other renal or electrolyte disorders were analysed for Na, K, NH(4), Ca, Mg, inorganic phosphate and sulphate, pH, and osmolality.The stone-formers' urines were found to be characterized by hypercalciuria relative to Na, K, Mg, SO(4), osmolality, and ionic strength. Hypercalciuria relative to osmolality was a more consistent finding than hypercalciuria relative to Na.These findings are in keeping with the supposition that calcium-containing renal stones occur in urine saturated with calcium salts.

Calcium↗

ACP Best Practice No 181: Chemical pathology clinical investigation and management of nephrolithiasis.

Renal stones have afflicted humans for millennia but there is still no solution to this problem. This review discusses the laboratory and metabolic aspects of the clinical management of patients with renal stones, both primary and secondary in origin. First, non-pharmacological interventions such as increased fluid intake, decreased protein consumption, dietary changes in sodium, calcium, oxalate, potassium, purine, vitamins, and essential fatty acids are considered. Then specific pharmacological treatment to modify urine calcium, oxalate, urate, citrate, and acidity are considered. Finally, more unusual types of stone are examined.

Acidosis, Renal Tubular↗

Enterococcal endocarditis after extracorporeal shock wave lithotripsy for nephrolithiasis.

We report a case of enterococcal endocarditis following extracorporeal shock wave lithotripsy (ESWL) for ureteral stone. Although endocarditis following ESWL is very rare, transient bacteraemia occurs during ESWL. This case is a reminder that enterococcal endocarditis may follow innovative genitourinary procedures without appropriate prophylaxis.

Endocarditis, Bacterial↗

Management of nephrolithiasis: new approaches to "surgical" kidney stones.

The majority of kidney stones that come to clinical attention are large enough to cause symptoms but small enough to pass spontaneously. Recent technological developments have revolutionized the approach to kidney stones that heretofore required surgery. Percutaneous removal of stones through a nephrostomy tract, with or without ultrasonic or electrohydraulic lithotripsy, and extracorporeal shock wave lithotripsy (ESWL) have all but eliminated indications for open surgical procedures. These new techniques have their own advantages and are complementary. Despite these advances, any change in accepted indications for stone removal should await further evidence of the long-term safety of percutaneous techniques and ESWL.

Fluid Therapy↗

A nontraumatic para-aortic lymphocele complicating nephrolithiasis.

Many cases of traumatic para-aortic lymphocele have been reported. Recently, a case of nontraumatic para-aortic lymphocele was investigated. The etiologic consideration for this lymphocele formation is either a localized inflammatory process, or fibrosis induced by prior passage of calculi.

Cysts↗

Effect of etidronate treatment on bone mass of male nephrolithiasis patients with idiopathic hypercalciuria and osteopenia.

Osteopenia is frequently found among calcium stone forming (CSF) patients with hypercalciuria. We investigated the effect of a 2-year therapeutic course of etidronate, a bone-sparing agent, in 7 young male CSF patients. The treatment consisted of a cyclic intermittent administration of phosphate followed by sodium etidronate and calcium supplementation every 74 days. Bone mineral density (BMD) measured at 12-month intervals and bone biopsies performed at baseline and after 2 years were the primary efficacy parameters. Mean lumbar spine BMD increased significantly after the 1st year by 2.6 +/- 1.0% (mean +/- SE, p < 0.05) and nonsignificantly after the 2nd year by 5.6 +/- 2.6%. Nonsignificant changes were observed for femoral neck mean BMD after either the 1st or the 2nd year (decrease of 2.0 +/- 1.0% and 2.0 +/- 3.0%, respectively). Mean histomorphometric parameters showed that bone volume, osteoid volume, and eroded surfaces did not differ from baseline (13.9 +/- 2.2 vs. 12.2 +/- 1.1%, 1.2 +/- 0.7 vs. 2.6 +/- 0.7%, and 20.7 +/- 6.2 vs. 13. 7 +/- 1.3%, respectively). Osteoid surface was significantly lower than baseline values (9.5 +/- 5.2 vs. 18.8 +/- 5.3%, p < 0.05). These data suggest that etidronate given to young male CSF patients presenting with hypercalciuria and osteopenia led to a significant amelioration of BMD, evident only in the lumbar spine after 1 year of treatment. There was no histological evidence of long-term improvement in bone remodeling.

Adult↗

Nephrolithiasis at the turn of the 18th to 19th centuries: biochemical disturbances. A genuine cascade giving rise to clinical chemistry.

This report will discuss the relationship between urinary calculi, urine composition and urinary sediment and the link to chemistry unveiled during the years 1775-1840. It was by this interconnection that physicians, who were also chemists, introduced some basic sciences into medicine particularly in studying normal and diseased metabolism. The chemistry of urinary stones definitely influenced the progress of medicine in the post-Enlightment period. "We would probably still not have chemistry, botany, or anatomy had not physicians studied and taught them." G. Cuvier Report on Natural Sciences, Paris 1980.

Chemistry, Clinical↗

Outcome and safety of extracorporeal shock wave lithotripsy as first-line therapy of lower pole nephrolithiasis.

INTRODUCTION: The aim of this study is to assess the efficiency of extracorporeal shock wave lithotripsy (ESWL) as initial therapy for isolated lower pole kidney stones smaller than 20 mm. PATIENTS AND METHODS: During a 24-month period 116 patients with previously untreated single stones under 20 mm in diameter were treated with a Dornier lithotripter S. They were analyzed with regard to stone site and size, number of ESWL sessions, auxiliary measures, retreatment rates, complications and the time taken for stone clearance. RESULTS: 76 patients (65.5%) became stone free, 50 of them (43.1%) within 3 months after ESWL. Depending on stone size the stone-free rates were 67.1% for patients with a stone diameter of <10 mm (59 of 88 patients), and 60.7% for stone diameters between 10 and 20 mm (17 of 28 patients). Complications during and after treatment were rare, i.e. the necessity of ureteral stent insertion due to colic (n = 10), endoscopic stone removal (n = 2), acute pyelonephritis (n = 1), stonestreet (n = 1) and 1 case of hematoma not requiring intervention. The recurrence rate during follow-up (13.2-36.9, mean 25.0 months) was low: 16 patients (13.8%) had recurrent or persistent stones, and 74 patients (63.8%) had no evidence of urolithiasis. CONCLUSIONS: ESWL is a safe and efficient first-line therapy for treatment of isolated small lower pole kidney stones with acceptable stone-free rates, low morbidity, few complications and a low stone recurrence rate.

Adult↗