Medical therapy (dissolution therapy)

2017 ◽  
Author(s):  
Ben Turney ◽  
John Reynard
Keyword(s):  
Uric Acid ◽  
Medical Therapy ◽  
Percutaneous Nephrolithotomy ◽  
Oral Treatment ◽  
Stone Disease ◽  
Stone Composition ◽  
Large Stone ◽  
Oral Agents ◽  
Long Time ◽  
Cystine Stones

Medical therapy of stone disease aims to prevent stones or dissolve existing stones. Dissolution therapy aims to dissolve stones through administration of oral agents to by direct chemolysis through renal irrigation. Since dissolution therapy may take weeks to achieve an effect, it is usually used as an adjunct to endourological treatment. Urate stones are most amenable to dissolution therapy. Stones containing any calcium have a lower chance of successful dissolution. Providing stone composition is known, irrigating chemolysis is an option for patients with large stone burdens who are unsuitable for percutaneous nephrolithotomy (PCNL). Both uric acid and cystine stones can be treated with irrigating solutions of trihydroxymethyl-aminomethan with pH 8.5–9.0, though it takes a long time to dissolve stones and oral treatment is preferred.

MO120STONE COMPOSITION AND CARDIOVASCULAR DISEASE  IN PATIENTS WIITH NEPHROLITHIASIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ana Lucía Valencia ◽  
Armando Coca ◽  
Arturo Lorenzo ◽  
Veronica Fidalgo ◽  
Vicente Perez ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Logistic Regression ◽  
Uric Acid ◽  
Regression Analysis ◽  
Kidney Disease ◽  
Kidney Stone ◽  
Stone Disease ◽  
Stone Composition ◽  
Adjusted Logistic Regression

Abstract Background and Aims Kidney stone disease is widely prevalent in the general population and has been associated with multiple comorbidities including hypertension, diabetes, chronic kidney disease and cardiovascular disease. We aimed to describe the possible link between stone composition and cardiovascular disease and its differential effect among women and men. Method Retrospective review of patients with known stone composition seen in a nephrolithiasis unit in the last five years. Anthropometric and clinical data were gathered from the hospital records. Stone composition was defined as such if ≥50% of the stone was made from a single component. Cardiovascular disease included coronary artery disease, stroke and peripheral vascular disease. Unadjusted and adjusted logistic regression analysis were applied to describe the potential relationship between stone composition and cardiovascular disease. Results 337 patients were included in the study sample. Median age was 57 (IQR 47-67), 61.1% males. 58.2% suffered from recurrent stone disease and 28.5% from family history of stone formation. 32.9% of patients had hypertension, 22,4% diabetes and 13,1% chronic kidney disease. The most common kidney stone component was calcium oxalate (38.6%) followed by calcium phosphate (21.3%), uric acid (14.2%), struvite (8%) and brushite (0.9%). Only uric acid as main stone component was associated with cardiovascular disease among men but not women in our sample in univariate analysis. That relationship was lost in adjusted logistic regression analysis. Conclusion Calcium oxalate and phosphate were the most common components of kidney stones. No relationship was found between stone composition and cardiovascular disease in the study sample.

scholarly journals Stone composition of renal stone formers from different global regions

2021 ◽  
Vol 93 (3) ◽  
pp. 307-312
Author(s):  
Adam Hali´nski ◽  
Kamran Hassan Bhatti ◽  
Luca Boeri ◽  
Jonathan Cloutier ◽  
Kaloyan Davidoff ◽  
...  
Keyword(s):  
Uric Acid ◽  
Calcium Phosphate ◽  
Calcium Oxalate ◽  
Urinary Stones ◽  
Ureteral Stones ◽  
Stone Analysis ◽  
Stone Composition ◽  
Stone Formers ◽  
Cystine Stones ◽  
Struvite Stones

Objective: To study urinary stone composition patterns in different populations around the world. Materials and methods: Data were collected by reviewing charts of 1204 adult patients of 10 countries with renal or ureteral stones (> 18 years) in whom a stone analysis was done and available. Any method of stone analysis was accepted, but the methodology had to be registered. Results: In total, we observed 710 (59%) patients with calcium oxalate, 31 (1%) with calcium phosphate, 161 (13%) with mixed calcium oxalate/calcium phosphate, 15 (1%) with carbapatite, 110 (9%) with uric acid, 7 (< 1%) with urate (ammonium or sodium), 100 (9%) with mixed with uric acid/ calcium oxalate, 56 (5%) with struvite and 14 (1%) with cystine stones. Calciumcontaining stones were the most common in all countries ranging from 43 to 91%. Oxalate stones were more common than phosphate or mixed phosphate/oxalate stones in most countries except Egypt and India. The rate of uric acid containing stones ranged from 4 to 34%, being higher in Egypt, India, Pakistan, Iraq, Poland and Bulgaria. Struvite stones occurred in less than 5% in all countries except India (23%) and Pakistan (16%). Cystine stones occurred in 1% of cases. Conclusions: The frequency of different types of urinary stones varies from country to country. Calcium-containing stones are prevalent in all countries. The frequency of uric acid containing stones seems to depend mainly on climatic factors, being higher in countries with desert or tropical climates. Dietary patterns can also lead to an increase in the frequency of uric acid containing stones in association with high obesity rates. Struvite stones are decreasing in most countries due to improved health conditions.

scholarly journals Kidney Stone Composition in Various Country Around the World

2021 ◽  
Author(s):  
Adam Halinski ◽  
Elenko Popov ◽  
Kamran Hassan Bhattikam ◽  
Luca Boeri ◽  
Jonathan Cloutier ◽  
...  
Keyword(s):  
Uric Acid ◽  
Calcium Phosphate ◽  
Calcium Oxalate ◽  
Urinary Stones ◽  
Stone Composition ◽  
Calcium Stones ◽  
Uric Acid Stones ◽  
The World ◽  
Cystine Stones ◽  
Struvite Stones

Abstract To compare urinary stone composition patterns in different populations around the world in relation to the structure of their population, dietary habits, and climate. 1204 adult patients with urolithiasis and stone analysis was included . International websites were searched to obtain data. We observed 710(59%) patients with calcium oxalate, 31(1%) calcium phosphate, 161(13%) mixed calcium oxalate/calcium phosphate, 15(1%) carbapatite, 110(9%) uric acid, 7(<1%) urate, 100(9%) mixed uric acid/ calcium oxalate, 56(5%) struvite and 14(1%) cystine stones. Calcium stones were the most common in all countries (up to 91%) with the highest rates in Canada and China. Oxalate stones were more common than phosphate or mixed phosphate/oxalate stones except Egypt and India. The rate of uric acid stones, being higher in Egypt, India, Pakistan, Iraq, Poland, and Bulgaria. Struvite stones occurred in less than 5% except India (23%) and Pakistan (16%). Cystine stones occurred in 1%. The frequency of different types of urinary stones varies from country to country. Calcium stones are prevalent in all countries. Uric acid stones seems to depend mainly on climatic factors, being higher in countries with desert or tropical climates. Dietary patterns can also lead to an increase it. Struvite stones are decreasing in most countries.

Simultaneous Treatment of Calcium Oxalate and Uric Acid Stone Disease in Saudi Arabia

1994 ◽  
pp. 581-586 ◽  
Author(s):  
W. G. Robertson ◽  
H. Hughes ◽  
I. Husain ◽  
S. Al-Faqih ◽  
A. Arafat ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Uric Acid ◽  
Calcium Oxalate ◽  
Stone Disease ◽  
Uric Acid Stone ◽  
Simultaneous Treatment

Preventing the formation of urinary stones

1972 ◽  
Vol 10 (2) ◽  
pp. 5-7
Keyword(s):  
Uric Acid ◽  
Crystal Growth ◽  
Urinary Calculi ◽  
Urinary Stones ◽  
Supersaturated Solution ◽  
Water Diuresis ◽  
Urinary Lithiasis ◽  
Poorly Soluble ◽  
Hot Weather ◽  
Cystine Stones

Urinary calculi form when poorly soluble substances, such as calcium oxalate, cystine or uric acid, crystallise out from a supersaturated solution in urine. It should therefore be possible to prevent the formation of stones by lowering the concentration of the solute, by increasing the solubility of the solute, or by inhibiting crystal growth. The simplest way of reducing the concentration of any of the solutes is by producing a water diuresis and thus increasing the volume of solvent. Clear evidence that this is effective has been obtained only for cystine stones1 and ‘hot weather’ stones,2 but it is worth trying in all forms of urinary lithiasis. Because most other methods of preventing calculi are specific, it is important to identify the type of stone and diagnose its aetiology before starting therapy.

Disorders of renal calcium handling, urinary stones, and nephrocalcinosis

2020 ◽  
pp. 5093-5103
Author(s):  
Christopher Pugh ◽  
Elaine M. Worcester ◽  
Andrew P. Evan ◽  
Fredric L. Coe
Keyword(s):  
Uric Acid ◽  
Urinary Tract ◽  
Calcium Phosphate ◽  
Calcium Oxalate ◽  
Renal Colic ◽  
Ammonium Phosphate ◽  
Renal Stones ◽  
Magnesium Ammonium ◽  
Cystine Stones ◽  
Stone Passage

Renal stones are common, with a prevalence of 5 to 10% worldwide. Acute stone passage almost always produces the severe pain of renal colic, but stones are often asymptomatic and discovered incidentally on imaging. Prevalence of both symptomatic and asymptomatic disease appears to be rising, although the relative contributions of increasing use of more sensitive imaging modalities and real changes relating to diet and lifestyle are debated. The initial evaluation of patients with renal colic optimally includes noncontrast CT to accurately visualize the size and location of stones in the urinary tract. Initial management of stones less than 5 mm in diameter in patients without anatomical abnormalities of the urinary tract is to provide adequate analgesia coupled with α‎-blockade, followed by watchful waiting to allow time for stone passage. The presence of urinary tract infection, inability to take oral fluids, or obstruction of a single functioning kidney requires hospitalization and active management. Once the acute episode of stone passage or removal is over, thought should be given to diagnosis of the underlying causes and steps taken towards prevention. Since stone analysis is the cornerstone of diagnosis, the patient should be encouraged to collect any stones passed and retain them for analysis. Most stones (66–76%) are formed of calcium oxalate: other types include calcium phosphate (12–17%), uric acid (7–11%), struvite (magnesium ammonium phosphate, 2–3%), and cystine (1–2%). They form because urine becomes supersaturated with respect to the solute, and treatment to lower its concentration can prevent recurrence. This chapter describes the aetiology, pathogenesis, diagnosis and treatment of calcium oxalate stones, calcium phosphate stones, uric acid stones, struvite stones, cystine stones, and nephrocalcinosis.

scholarly journals The Clinical Impact of Accurate Cystine Calculi Characterization Using Dual-Energy Computed Tomography

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
William E. Haley ◽  
El-Sayed H. Ibrahim ◽  
Mingliang Qu ◽  
Joseph G. Cernigliaro ◽  
David S. Goldfarb ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Imaging Modality ◽  
Dual Energy ◽  
Clinical Impact ◽  
Clinical Implications ◽  
Stone Composition ◽  
Dual Energy Computed Tomography ◽  
Uric Acid Stones ◽  
Cystine Stones ◽  
Composition Standard

Dual-energy computed tomography (DECT) has recently been suggested as the imaging modality of choice for kidney stones due to its ability to provide information on stone composition. Standard postprocessing of the dual-energy images accurately identifies uric acid stones, but not other types. Cystine stones can be identified from DECT images when analyzed with advanced postprocessing. This case report describes clinical implications of accurate diagnosis of cystine stones using DECT.

scholarly journals Lumbar plexopathy as a complication of percutaneous nephrolithotomy in a horseshoe kidney

2015 ◽  
Vol 9 (1-2) ◽  
pp. 78 ◽  
Author(s):  
Andrea Gail Lantz ◽  
R. John D'A Honey
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Psoas Muscle ◽  
Horseshoe Kidney ◽  
Vascular Supply ◽  
Stone Disease ◽  
Laparoscopic Pyelolithotomy ◽  
Staghorn Calculus ◽  
Leg Weakness ◽  
Independent Ambulation ◽  
Collecting System

Treatment of nephrolithiasis in horseshoe kidneys can be challenging due to anomalies in renal position, collecting system anatomy and vascular supply. We report on a patient who was referred after a failed percutaneous nephrolithotomy for a left moiety staghorn calculus in a horseshoe kidney. Two punctures had been performed involving upper and middle posterior calyces. Both were very medially placed and inadvertently traversed the psoas muscle, resulting in lumbar plexopathy with permanent deficit. This complication presented postoperatively with left leg weakness, paresthesia, and pain which impaired independent ambulation. The patient went on to be successfully treated for her stone disease with robotic-assisted laparoscopic pyelolithotomy.

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