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Milk of calcium renal stone and renal pelvic cancer associated with hydronephrosis.

A 56-year-old male was admitted to a hospital because of gastric ulcer in 1967, and by chance he was diagnosed right milk of calcium renal stone associated with hydronephrotic kidney by plain abdominal X-ray film. In 1979, he was admitted to our hospital complaining of hematuria, and died from renal pelvic cancer on the 49th hospital day. Milk of calcium renal stone associated with hydronephrotic kidney is rare, with only 13 cases were reported previously. This is the first report, a case of milk of calcium renal stone associated with hydronephrosis died from renal pelvic cancer.

Calcium Carbonate

Distal renal tubular acidosis in recurrent renal stone formers.

Renal acidification ability was examined in 90 recurrent renal stone formers, using fasting morning urinary pH levels followed by a short ammonium chloride loading test in subjects with pH levels above 6.0. Fifteen patients (16.6%) revealed a distal renal tubular acidification defect: one patient (1.1%) had complete distal renal tubular acidosis and 14 (15.5%) incomplete distal renal tubular acidosis. Our results confirm that distal renal tubular acidification defects are associated with a more severe form of stone disease and make distal renal tubular acidosis one of the most frequent metabolic disturbances in renal stone formers. Distal renal tubular acidosis (dRTA) was relatively more common in female stone formers and most often found in patients with bilateral stone disease (36%). Since prophylactic treatment in renal stone formers with renal acidification defects is available, this has important therapeutic implications. The pathological sequence in renal stone formers with dRTA is discussed.

Acidosis, Renal Tubular

[Influences of renal stone surgeries on renal function--evaluation of renal function with 99mTc-DMSA renal scintigraphy].

From 1984 to 1990, 99mTc-DMSA renal scintigraphy was performed before and after nephrolithotomy (15 cases), pyelolithotomy (15 cases), percutaneous nephrolithotripsy (PNL: 15 cases) and extracorporeal shock wave lithotripsy (ESWL: 16 cases, 17 kidneys) in order to evaluate of influences of renal stone surgeries on split renal function. DMSA renal uptake change ratio of treated kidneys of nephrolithotomy (-24.94 +/- 5.60%) was significantly lower than that of PNL (-0.06 +/- 3.92%), pyelolithotomy (-4.08 +/- 4.79%) (p less than 0.01) and ESWL (-7.72 +/- 3.87%) (p less than 0.05). The average change ratios of contralateral kidneys were as follows: PNL 4.80 +/- 4.21% nephrolithotomy 4.67 +/- 4.73%, pyelolithotomy -1.46 +/- 5.39% and ESWL -2.02 +/- 4.44%. One to 3 weeks after PNL, the cold area on the renal image was found in 10 (66.7%) of 15 cases. In cases of ESWL, DMSA renal uptake decreased even 4-10 weeks (mean 7 weeks) after treatment. In conclusion, possivility of deterioration of renal function after ESWL was suggested.

Adult

Influence of percutaneous renal stone extraction on renal function.

The total and separate renal function was studied in 10 patients by means of 51Cr-EDTA-clearance and gamma camera renography with 99mTc-DTPA before and 2 weeks to 5 months after percutaneous renal stone extraction. There was no major complication related to the operations. There was no significant change of function as measured as the glomerular filtration rate. The stone extraction procedure was well tolerated by the kidneys.

Chromium Radioisotopes

Screening renal stone formers for distal renal tubular acidosis.

A group of 110 consecutive renal stone formers were screened for distal renal tubular acidosis (RTA) using morning fasting urinary pH (mfUpH) levels followed by a short ammonium chloride loading test in patients with levels above 6.0. In 14 patients (12.7%) a renal acidification defect was noted; 13 had incomplete and 1 had complete distal RTA. Distal RTA was found particularly in recurrent stone formers (17%), and especially in those with bilateral stone disease, where a distal renal tubular acidification defect was found in 50%. We have been unable to differentiate primary from secondary RTA in renal stone formers. Regardless of whether the acidification defect is primary or secondary to stone formation, however, all renal stone formers with distal RTA can expect to benefit from prophylactic alkaline therapy and it is recommended that the screening procedure, which is easy to use in daily clinical practice, is applied to all stone formers and not restricted to patients with recurrent stone disease.

Acidosis, Renal Tubular

Sucrose and idiopathic renal stone.

Idiopathic renal stone comprises more than 80 per cent of kidney stone disease. Whilst the incidence rate in the Western World is high, that in Africa south of the Sahara is very low. Epidemiological studies point to a dietary aetiology as the basis for stone formation in the kidney. A number of dietary constituents increase the urinary risk factors for stone formation and one of these is sucrose. The sucrose effect is exaggerated when it is consumed in certain forms. There is also the evidence that a third of a normal population responds in an exaggerated manner in respect of an increased excretion of urinary risk factors when sucrose is consumed and this phenomenon has been noted in over 70 per cent of idiopathic stone formers. In studying the mechanism of this, insulin was found to influence distal renal tubular function to increased calcium excretion. Stone formers with an exaggerated urinary risk factor response to sucrose were found to have abnormally high and sustained blood levels of insulin following a standard glucose test meal. Where sucrose or sucrose products are in abundance, quite apart from its effect in increasing urinary risk factors in the population in general, there is particular vulnerability of a significant sub group within the population with this type of insulin response. Sucrose furthermore is known to induce nephrocalcinosis in the kidney of the rodent and similar calcific lesions have been found in the kidney substance of man and these have been observed to begin to appear within the first decade of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcium

[A case report of crossed renal ectopia with renal stone].

Crossed renal ectopia is a relatively rare renal anomaly. A 49-year-old man with macrohematuria and right flank pain was admitted to our hospital. Various urological examinations were carried out, and a diagnosis of left crossed renal ectopia with renal stone was made. Pyelolithotomy was performed and stone analysis revealed a calcium oxalate. In Japan, 166 cases of crossed renal ectopia have been reported and 15 of them including our case were associated with urinary tract stones.

Calcium Oxalate

Schistosomiasis affection of the kidney as a possible cause of renal stone formation.

Nowadays, renal stone is one of the medical complaints. Many theories have been suggested to account for its formation. The present work aimed to find out a correlation between schistosomiasis affection of the kidney and the formation of renal stones. Three groups of patients with renal stones were selected. They had Schistosoma mansoni infection (1st group), with Schistosoma haematobuim infection (2nd group) and Schistosoma free (3rd group or control). The results showed pathological changes in the kidney biopsied materials, particularly the glomerulus, ranging from periglomerular fibrosis to complete atrophy and lymphoid follicles in the interstitium. Sometimes, distal-tubular atrophy was seen. The serum and tissue immunoglobulins, particularly the IgA, in schistosomiasis patients were above normal as compared to control ones. It is concluded that the schistosomiasis affection of the kidney, and the resulting immunopathological changes were factors predisposing, in one way or another, to the formation of renal stones.

Adult

Impact of percutaneous renal stone removal on renal function: assessment by urinary lysozyme activity.

Lysozyme in the urine in concentrations greater than 3 micrograms per milligram of creatinine reflects renal tubular disease or dysfunction in patients without bowel disease or leukemia. We therefore used urine lysozyme assays to assess renal response to percutaneous nephrostomy and stone removal in 42 patients. Eight patients had striking increases (4.2-21.1 [mean 7.58] micrograms/mg creatinine) immediately after nephrostomy puncture in urine obtained directly from the punctured kidney. Lysozyme declined sharply thereafter and was within normal limits in all cases by postoperative day 3. This increase appeared to result from bleeding into the urine from the tract. Five other patients had lysozymuria on admission, only 1 of whom had a sharp increase after nephrostomy puncture. In the remaining patients, the lysozyme levels remained within normal limits throughout the hospital course. These data are further evidence of the absence of significant deleterious effects of nephrostomy puncture on the kidney.

Acute Kidney Injury

The relation between urinary tract infections and stone composition in renal stone formers.

During a seven-year period (1975-1981) a total of 1325 patients hospitalized for stone disease were studied as to the occurrence of positive urine cultures. Urinary stones from 535 surgically treated patients were analyzed with infrared spectrophotometry and the relationships between stone composition, level of surgery and bacteriological strains were studied. Positive urinary cultures were found in 34% of the surgically treated patients and in 21% of those not operated upon. Among the surgically treated patients with urinary tract infection (UTI) E. coli was the most frequent microorganism (35%), followed by Proteus (28%). Patients with Proteus infection had the highest frequency of UTI episodes, most of which occurred before hospitalization. There was a higher frequency of magnesium ammonium phosphate (MAP) calculi among patients with Proteus infection than among those with non-Proteus infection, in whom no difference in stone composition was found. Patients infected with E. coli had more phosphate-containing stones (CaP+MAP) than non-infected patients. The highest frequency of oxalate calculi (CaOx+CaOx/CaP) was found among patients without infection. No E. coli infections were seen in male patients with CaP and MAP calculi. MAP stones were most often found in the kidney and oxalate stones in the ureter.

Calcium Oxalate

Outcome of conservative management of small renal stones in prepubertal children.

INTRODUCTION: Renal stones are relatively uncommon in the pediatric population. This study aimed to evaluate the utility of conservative management of small renal stones in prepubertal children. PATIENTS AND METHODS: A retrospective chart review was conducted for children (&#x2264;12 years old) with small renal stones (3-10 mm) from 2016 to 2023 who underwent conservative management. Management included periodic renal ultrasonography, every 6 months, in addition to good hydration. Stones were confirmed by two consecutive ultrasounds. We recorded the patient's demographics and ultrasound findings (stone side, size, laterality, location, number, and associated hydronephrosis). Surgical intervention was indicated if recurrent loin pain, recurrent UTI, or worsening hydronephrosis (obstructing stone). Nephrolithiasis was considered resolved if stones were not visualized on 2 consecutive ultrasounds. Moreover, we evaluated conservative management outcomes for those presented during infancy (<12 months) versus later. RESULTS: We included 52 patients (65renal units) who presented at a median age of 46.1months (5.3-155.1). Seventy-five percent of patients had incidental renal stones. The median stone size was 4 mm (3-10). Forty-six percent of stones were in the lower calyx. The majority (70.8 %) had no hydronephrosis at presentation. During a median follow-up of 39months, 15patients with 17units (26.2 %) were documented stone-free. Ten patients (19.2 %) had symptomatic stone events, all measured &#x2265;4 mm. Of them, 6 patients (6 units) underwent surgical interventions, and 4 patients (4 units) experienced complications. A ROC curve analysis identified a stone size cutoff of 4 mm (sensitivity 100 % and 29 % specificity) that could be associated with symptomatic stone events. Using a multivariate Cox regression model, stone size was the only significantly associated factor with subsequent surgical intervention (p = 0.007). 19 % (10patients,12units) presented during infancy. Notably, the incidence of stone-free rate was significantly higher during infancy compared to older children (58.3 % vs 18.9 %,respectively). DISCUSSION: During a 39-month follow-up, 4 patients developed complications (2recurrent pain and 2 experienced UTI), supporting the safety of conservative management of small renal stones. This study is limited due to its retrospective design and the reliance on ultrasound as the main imaging method. To minimize that, all ultrasound images were carefully reviewed by two pediatric urologists. Moreover, renal stones were confirmed using strict criteria, which required detection in two consecutive ultrasounds. CONCLUSION: Although 26.2 % of units had spontaneously resolved nephrolithiasis, surgical intervention was only required in 11.5%of patients, all of whom had renal stones&#x2265;4 mm. Infants had higher spontaneous resolutions without complications, suggesting that conservative management may be especially effective in this subgroup.

Humans

Intrasinusal pyelocalicotomy with lower pole nephrotomy for removal of renal stones.

A small renal sinus often limits exposure of the intrarenal pelvis and restrains the sinus approach for removal of renal stones. For 14 such cases, we used a lower pole nephrotomy combined with extended pyelolithotomy. Incision of the renal parenchyma through the intersegmental avascular plane greatly facilitated exposure of the intrarenal collecting system and enabled stone removal through the longitudinal incision of the collecting system. The indication for operative technique and results of the procedure are described.

Humans

Ceftazidime as prophylactic treatment in renal stone surgery. Clinical evaluation and pharmacokinetics in renal tissue.

The effect of ceftazidime in surgery of renal stones associated with urinary tract infection was investigated and its pharmacokinetics in serum and renal tissue was compared in 14 patients (15 kidneys) operated on for renal calculi associated with multiple urinary tract infection. Two to four days preoperatively ureteric catheterization was performed to localize the level of the infection and 2 g of ceftazidime was given intravenously twice daily for 10 days. Renal biopsy, serum samples and in one patient renal lymphatic fluid were taken simultaneously for antibiotic assay. Urine cultures were performed at regular intervals pre- and postoperatively. Ten patients had bacterial growth in the stone-carrying renal pelvis. The same strain was found in the bladder as in the pelvis. Nine patients had sterile urine after 3-5 days of treatment. One patient with bilateral stones did not get sterile urine until after seven days of treatment. Bacterial growth was found in two out of six cultured stones obtained from patients with bacterial growth in the pelvis. The decreases in concentration of ceftazidime in serum and renal tissue seemed to be parallel. Slight reversible elevation of liver transaminases was noted in 5/14 patients. It is concluded that the concentration of ceftazidime in serum parallels that in renal tissue. Ceftazidime seems to be an effective prophylactic in renal stone surgery and the preoperative dose should be given close to the operation.

Adult

Possible role of hyaluronate in experimental renal stone formation in rabbits.

We produced renal stones in rabbits by modifying Itatani's method, ligation of the right ureter followed by ureteroneocystostomy 1 week later. Renal stones formed in all animals within 2 weeks after ureteroneocystostomy. We measured the components of glycosaminoglycan in the stone matrix, renal tissue and urine by 2-dimensional electrophoresis. Glycosaminoglycan of the stone matrix consisted solely of hyaluronate. Glycosaminoglycan of the control normal urine consisted of only chondroitin sulfate, although hyaluronate was contained in urine in the hydronephrotic and stone forming period. Glycosaminoglycan of the control normal kidney consisted mainly of hyaluronate and chondroitin sulfate, while hyaluronate was the main component of glycosaminoglycan in the stone forming kidney. From these results, it is clear that hyaluronate is the most important component of glycosaminoglycan in the early stone forming period.

Animals

The urinary excretion and serum concentration of calcium, magnesium, sodium and phosphate in male patients with recurring renal stone formation.

Only about 20% of renal stone cases have an unquestionable cause such as hyperparathyroidism, renal tubular acidosis etc. explaining their stone formation. About 20-40% are believed to result from idiopathic hypercalciuria. The purpose of the present investigation was to study the renal excretion of calcium, magnesium, sodium and phosphate in 47 consecutive men with recurring renal stone formation without a demonstrable underlining metabolic disease and, for comparison, 43 normal men. The results are related to previous hypotheses on renal stone formation. No difference in urinary calcium (either concentration or excretion) per day is found between the two groups. Consequently the concept of idiopathic hypercalciuria is questioned. The Mg/Ca ratio in urine is found lower in the stone patients than in the controls, suggesting that the Mg/Ca ratio might be of importance in stone formation.

Adult