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At least 973 records · Page 54Linked to original sources
PubMed2001

Proportional reduction of urine supersaturation during nephrolithiasis treatment.

PURPOSE: During metabolic stone therapy, urine supersaturation decreases in proportion to pretreatment levels. We gauge the quantitative contribution of regression to the mean for reducing urine supersaturation from high pretreatment to lower values during therapy. MATERIALS AND METHODS: The 24-hour urine supersaturations for calcium oxalate, calcium phosphate and uric acid were measured on 2 pretreatment and at least 1 treatment 24-hour collection for each of the 2,667 patients in 2 networks and at a university based specialty clinic. Changes in supersaturation between the first and second pretreatment collections were an estimate of random change and compared to therapeutic changes. RESULTS: Supersaturations decreased between the first and second pretreatment collections, proportional to the supersaturation in the first collection. However, the magnitude of this effect was minor compared to therapeutic changes. Also, mean change between pretreatment collections was 0, whereas mean change with therapy was greater than 0 for all 3 supersaturations. CONCLUSIONS: Although regression to the mean can be detected, it cannot be responsible for the decrease in urine supersaturation with therapy or the fact that the decrease is proportional to pretreatment mean supersaturation. The mechanisms responsible for proportional reduction remain to be clarified.

Calcium Oxalate↗
PubMed2001

Urethrolithiasis and nephrolithiasis in a horse.

A 9-year-old, quarter horse gelding with obstructive urethrolithiasis was treated with a perineal urethrostomy. The horse's condition deteriorated and abdominocentesis confirmed septic uroperitonitis. The horse was euthanized and postmortem examination revealed peritonitis, a tear in the lateral wall of the bladder, and a nephrolith within the left renal pelvis.

Animals↗
PubMed2002

A single 24-hour urine collection is inadequate for the medical evaluation of nephrolithiasis.

PURPOSE: We determined the adequacy of a single 24-hour urine sample for evaluating patients for medical renal stone prevention. MATERIALS AND METHODS: A total of 459 patients from a private urology practice specializing in the treatment of urolithiasis and 683 from a university stone research clinic provided 2 and 3, 24-hour urine samples, respectively. We used samples 1 and 2 from private practice patients, and 1 and 3 from university clinic patients for analysis, and compared each to the others by correlation coefficients and calculation of the mean difference plus or minus standard deviation (SD) of the difference. Urine risk factors were measured by standard methods. RESULTS: Although the correlation of urine values 1 and 2 was excellent for all stone risk factors, SD values for the differences were large enough that within 1 SD on either side of 0, which included 68.8% of cases, by chance urine 1 would depart from urine 2 by clinically important amounts. These departures would be more than sufficient to misdiagnose common metabolic disorders. CONCLUSIONS: A single 24-hour sample is not sufficient for evaluating patients before metabolic treatment for stone prevention because misdiagnosis is common, leading to inappropriate treatment.

Female↗
PubMed2002

Primary hyperoxaluria: a rare but important cause of nephrolithiasis.

We report on a middle-aged man with end-stage renal failure apparently secondary to recurrent renal stones. He developed systemic oxalosis soon after commencing dialysis. The diagnosis of primary hyperoxaluria type 1 was supported by the finding of high dialysate glycolate excretion. The patient subsequently received an isolated cadaveric renal transplant, but the outcome was a rapid recurrence of oxalosis and early graft failure. Although isolated liver or renal transplantation in addition to various adjuvant measures may be considered in the early stage, combined liver-kidney transplantation remains the only definitive therapy for a patient with end-stage renal failure and systemic oxalosis due to hyperoxaluria type 1. This case illustrates the possible late presentation of primary hyperoxaluria type 1 and the poor outcome with isolated renal transplantation after the development of systemic oxalosis. One should thus have a high index of suspicion in patients with recurrent renal stones of this rare, but nevertheless important, entity.

Humans↗
PubMed2004

Advances in the surgical management of nephrolithiasis.

The surgical management of urinary calculus disease has undergone a dramatic evolution over the past 2 decades. Twenty years ago, open surgical procedures for urinary calculi were some of the most frequently performed urologic procedures. Since then, however, stone management has been at the forefront of "minimally invasive" intervention. Specifically, the initiation and refinement of percutaneous and ureteroscopic access to the upper tracts, along with the rapid and nearly simultaneous development of both extracorporeal and intracorporeal lithotripsy techniques, has limited the role of open surgery to less than 1% of patients undergoing intervention for their stone disease. This manuscript will review the current indications for the surgical management of urinary calculi, the basic physics of the most frequently utilized vehicles for both extracorporeal and intracorporeal lithotripsy, and the respective roles of extracorporeal and intracorporeal lithotripsy with percutaneous or ureteroscopic access and open surgery. In addition, the results and complications associated with each of these forms of intervention will be reviewed. Finally, a discussion of specific clinical challenges to the urologist will be presented.

Decision Trees↗
PubMed2004

[Future perspective on the prevention of nephrolithiasis].

Renal stone formation has been explained by the physicochemical theory; i.e., nucleation, growth and aggregation of crystals in the urine. Current medical prevention is based on this theory and seeks to modulate promoters and inhibitors of stone formation. Recent studies have identified increasing numbers of macromolecular inhibitors such as glycosaminoglycans, bikunin, osteopontin and urinary prothrombin F1. These appear to be more important than low-molecular inhibitors like citrate. On the other hand, many investigators have focused on the role of tubular epithelial cells in stone formation. While crystal retention in the nephron has been considered necessary for stone formation, we and others have found that calcium oxalate crystals can bind to renal epithelial cells. Moreover, available evidence suggests that oxalate and/or calcium oxalate crystals can damage renal epithelial cells and enhance crystal binding. Concurrently, oxalate exposure induces genes coding macromolecular inhibitors, which are supposed to be a protective mechanism against stone formation. Thus, understanding of the mechanisms involved in kidney stone formation could lead to new therapeutic approaches to preventing stone recurrence. However, clinical application of the prophylactic approaches proposed here awaits further progress in basic research using rapidly growing new technologies. Application of the DNA microarray technique to the rat stone model may provide a clue to understanding stone forming process at the genetic level. In addition, case-control association analysis using single nucleotide polymorphism as a marker may be useful for detecting susceptibility genes in patients with calcium stone disease.

Allopurinol↗