scholarly journals The new patterns of nephrolithiasis: What has been changing in the last millennium?

2021 ◽  
Vol 93 (2) ◽  
pp. 195-199
Author(s):  
Elisa Cicerello ◽  
Matteo Ciaccia ◽  
Gian D. Cova ◽  
Mario S. Mangano
Keyword(s):  
Metabolic Syndrome ◽  
Stone Formation ◽  
Strong Association ◽  
Epidemiologic Studies ◽  
Stone Disease ◽  
Normal Weight ◽  
Last Millennium ◽  
Stone Formers ◽  
Stone Former ◽  
Stage Renal Disease

Nephrolithiasis has been increasing over the last millennium. Although early epidemiologic studies have shown that kidney stones were two to three times more frequent in males than in females, recent reports have suggested that this rate is decreasing. In parallel a dramatic increase of nephrolithiasis has also been observed among children and adolescents. Furthermore, epidemiologic studies have shown a strong association between metabolic syndrome (Mets) traits and kidney stone disease. Patients with hypertension have a higher risk of stone formation and stone formers are predisposed to develop hypertension compared to the general population. An incidence of nephrolithiasis greater than 75% has been shown in overweight and obese patients compared to those of normal weight. It has also been reported that a previous diagnosis of diabetes mellitus increases the risk of future nephrolithiasis. Additionally, an association between metabolic syndrome and uric acid stone formation has been clearly recognized. Furthermore, 24-h urinary metabolic abnormalities have been decreasing among patients with nephrolithiasis over the last decades. Finally, nephrolithiasis could cause chronic kidney disease (CKD) and end stage renal disease (ESRD), especially in women and overweight patients. According to these observations, a better understanding of these new features among stone former patients may be required. Hence, the recognition and the correction of metabolic disorders could help not only to reduce the primary disease, but also stone recurrence.

scholarly journals Identifying risk factors for development of nephrolithiasis in end-stage renal disease patients

2019 ◽  
Vol 14 (5) ◽  
Author(s):  
Charles Hesswani ◽  
Sameena Iqbal ◽  
Khashayar Rafat Zand ◽  
Simon Sun ◽  
Bernard Unikowsky ◽  
...  
Keyword(s):  
End Stage Renal Disease ◽  
De Novo ◽  
Stone Formation ◽  
Ionized Calcium ◽  
Lower Serum ◽  
Stone Formers ◽  
Serum Ionized Calcium ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Introduction: We sought to assess the incidence and risk factors for stone development in patients with end-stage renal disease (ESRD) on hemodialysis (HD). Methods: Medical records of patients receiving HD between 2007 and 2017 were retrospectively reviewed. Patients who had been on HD for at least three months and had imaging studies (computed tomography [CT] scans or ultrasound [US]) pre- and post-initiation of HD were included. Exclusion criterion was presence of stones pre-HD. De novo stones were defined as renal stones found on followup imaging. Demographics, laboratory data, comorbidities, and dialysis characteristics were compared between non-stone-formers and stone-formers using propensity score matching. Results: A total of 133 patients met the inclusion criteria. Their median age was 68.5 years, median body mass index 28.7 kg/m2, and median dialysis duration 59.5 months. After HD, 14 (10.5%) patients developed de novo stones and their median dialysis-to-stone duration was 23.5 months. When compared with non-stone-formers, stone-formers had significantly lower incidence of hypertension (48.2% vs. 14.3%; p=0.03), lower serum ionized calcium (1.16 vs. 1.07 mmol/L; p=0.01) and magnesium (0.95 vs. 0.81 mmol/L; p=0.01), and significantly higher serum uric acid (281.5 vs. 319.0 mmol/L; p=0.03). Multivariate analysis demonstrated that lower serum ionized calcium (adjusted odds ratio [OR] 0.00001; 95% confidence interval [CI] 0–0.18) and magnesium (adjusted OR 0.0003; 95% CI 0–0.59) were significantly associated with stone formation. Conclusions: The incidence of de novo nephrolithiasis in ESRD patients on HD was 10.5%. Increased serum uric acid, decreased serum magnesium and ionized calcium, and absence of hypertension were associated with increased stone-formation in ESRD patients on HD.

Urine protein markers distinguish stone-forming from non-stone-forming relatives of calcium stone formers

2006 ◽  
Vol 291 (3) ◽  
pp. F530-F536 ◽  
Author(s):  
Kristin J. Bergsland ◽  
Jennifer K. Kelly ◽  
Brian J. Coe ◽  
Fredric L. Coe
Keyword(s):  
Discriminant Analysis ◽  
Stone Formation ◽  
Stone Disease ◽  
Small Subset ◽  
Protein Markers ◽  
Urine Protein ◽  
Multivariate Discriminant Analysis ◽  
Stone Formers ◽  
Calgranulin B ◽  
Multivariate Discriminant

We have investigated urine protein inhibitors of calcium oxalate crystallization to determine whether variations in these proteins are associated with kidney stone disease and whether protein measurements improve the identification of stone formers compared with conventional risk factors (RF). Using Western blotting, we studied variations in the electrophoretic mobility patterns and relative abundances of crystallization-inhibitory proteins in urine from 50 stone-forming (SF) and 50 non-stone-forming (NS) first-degree relatives of calcium SF patients, matched by gender and age. Standard urine chemistry stone risk measurements were also made. Multivariate discriminant analysis was used to test the association of these proteins with nephrolithiasis. Differences in form and abundance of several urine proteins including inter-α-trypsin inhibitor (ITI), prothrombin fragment 1 (PF1), CD59, and calgranulin B (calB) were found to be associated with stone formation. By multivariate discriminant analysis, measurements of forms of PF1, ITI, and calB in men and ITI and CD59 in women, classified 84% of men and 76% of women correctly by stone status. In contrast, standard urine chemistry RF identified only 70% of men correctly and failed to distinguish female SF from NS. Thus a small subset of protein measurements distinguished SF from NS far better than conventional RF in a population of relatives of calcium SF, illustrating the significant association of these proteins with stone disease. Variations in these proteins may serve as markers of stone disease activity or vulnerability to recurrence and may provide new insights into mechanisms of stone formation.

scholarly journals P0175DETERMINANTS OF RENAL PAPILLARY APPEARANCE IN RENAL STONE FORMERS: AN IN-DEPTH EXAMINATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Matteo Bargagli ◽  
Rossella De Leonardis ◽  
Mauro Ragonese ◽  
Angelo Totaro ◽  
Francesco Pinto ◽  
...  
Keyword(s):  
Kidney Stones ◽  
Kidney Stone ◽  
Medical Condition ◽  
Stone Formation ◽  
Blood Parameters ◽  
Stone Disease ◽  
Stone Composition ◽  
Stone Recurrence ◽  
Stone Formers

Abstract Background and Aims Nephrolithiasis is a medical condition characterized by high prevalence among the general population both in Europe and in the U.S. and it is responsible for high costs reaching up to $10 billion per year. It is associated with specific comorbidities such as obesity, arterial hypertension, diabetes mellitus, metabolic syndrome and chronic kidney disease. Kidney stones development is believed to start either from Randall’s plaques or from stone plugs. Both these lesions can be seen on renal papillary surfaces, but what promotes the formation of plaques and plugs is not entirely understood. The aim of this study is to investigate the association between the urinary metabolic milieu and a published endoscopic papillary evaluation score (PPLA). We also evaluated the correlation of PPLA score with kidney stone recurrence during follow-up. Method We prospectively enrolled 31 stone forming patients who undergone retrograde intrarenal surgery procedures. Visual inspection of the accessible renal papillae was performed in order to calculate the PPLA score based on the appearance of ductal plugging, surface pitting, loss of papillary contour and Randall’s plaque extension. Demographic information, blood samples, 24h urine collections and kidney stone events during follow-up were collected. Stone composition was analyzed using infrared-spectroscopy. Relative urinary supersaturations (RSS) for calcium oxalate (CaOx), calcium phosphate (CaPi) and uric acid (UA) were calculated using the Equil2 software. PPLA score > 3 was defined as high. Results Median follow-up period was 11 (min/max 5, 34) months. PPLA score was inversely correlated with BMI (rho = −0.39, p = 0.035) and history of recurrent kidney stones (median PPLA 5.0 vs 2.5, p = 0.029), these results were confirmed when PPLA was considered as a categorical variable (median BMI 27 vs 24, recurrent stone disease 12 vs 62%, p= 0.006). Furthermore, high PPLA score was associated with lower odds of new kidney stone events during follow-up (OR 0.154, 95% confidence interval 0.024, 0.998, p = 0.05). No significant correlations were found between PPLA score, stone composition, blood parameters, 24h urine solute excretions and RSS for CaOx, CaPi and UA. Conclusion Different papillary abnormalities seem to be linked to specific mechanisms of stone formation. Although data regarding PPLA score are inconsistent, it may be a valid asset for both medical and surgical management of nephrolithiasis. Larger, long-term prospective clinical studies need to be conducted to assess the validity of PPLA score system in evaluating risk of stone recurrence.

Evaluation of stone formers

2017 ◽  
Author(s):  
Muhammad Waqas Iqbal ◽  
Ghalib Jibara ◽  
Michael E. Lipkin ◽  
Glenn M. Preminger
Keyword(s):  
Stone Formation ◽  
Stone Disease ◽  
Metabolic Evaluation ◽  
Recurrence Rates ◽  
Preventative Measures ◽  
Stone Formers ◽  
Increased Risk ◽  
High Incidence ◽  
Recurrent Stone ◽  
Environmental Temperatures

Urolithiasis is among the most common urologic disorders with high incidence and recurrence rates. High environmental temperatures, prevalence of the Western diet, obesity, age, gender, and race are among the common risk factors associated with this disease. The primary goal of evaluating these patients is to provide a simple, economic, and effective workup, which yields information that is directly applicable to providing relevant medical preventative measures. The management of urolithiasis requires a relevant history, targeted physical exam, appropriate chemistry, urinary and stone analyses results, radiological imaging to accurately identify number, location, and size of stones, as well as a metabolic evaluation. All stone formers whether single or recurrent should have a basic evaluation to identify any factors that may predispose to recurrent stone formation. Comprehensive metabolic evaluations are offered to patients at increased risk of recurrence or morbidity from stone disease, or have difficult to treat stones.

scholarly journals Prevention of Calcium Nephrolithiasis: The Influence of Diuresis on Calcium Oxalate Crystallization in Urine

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Johannes M. Baumann ◽  
Roberto Casella
Keyword(s):  
Calcium Oxalate ◽  
Stone Formation ◽  
Stone Disease ◽  
Ion Concentration ◽  
Critical Parameters ◽  
Initial Development ◽  
Stone Formers ◽  
High Supersaturation ◽  
Recurrent Stone ◽  
Using Data

A high fluid intake is still the most evidence-based measure for the prevention of idiopathic stone disease. The recommendation of current guidelines on urolithiasis to increase diuresis to 2–2.5 L/day is mainly based on a single clinical study. The present paper shows the influence of diuresis on calcium oxalate (CaOx) crystallization and especially aggregation (AGN) which can explain the initial development of Ca stones on papillary calcifications as well as stone growth in the renal pelvic system. Diuresis determines the urinary transit time (UT) through the kidney and together with the afflux of Ca and Ox the state of urinary saturation with respect to CaOx being the most frequent stone mineral. High supersaturation inducing crystallization during UT and a high urinary ion concentration interfering with the inhibition of crystal AGN by urinary macromolecules seem to be critical parameters for stone formation. Using data from the literature the influence of diuresis on these parameters is evaluated for short-term recurrent stone formers (RSF), idiopathic stone patients, and healthy controls, the latter two collectives with and without excessive oxalate ingestion. This investigation suggests that a diuresis of 2 L/day may protect from stone formation even after dietary Ox excesses and in RSF. However, in RSF with a continuously high Ca and Ox afflux into urine a permanent high diuresis is required which is difficult to sustain over 24 hours.

The Role of Inhibitors and other Factors in the Pathogenesis of Recurrent Calcium-Containing Renal Stones

1977 ◽  
Vol 53 (2) ◽  
pp. 141-148 ◽  
Author(s):  
J. M. Baumann ◽  
S. Bisaz ◽  
R. Felix ◽  
H. Fleisch ◽  
U. Ganz ◽  
...  
Keyword(s):  
Inhibitory Activity ◽  
Stone Formation ◽  
Renal Stones ◽  
Urinary Calcium ◽  
Stone Disease ◽  
Calcium Excretion ◽  
Crystal Formation ◽  
Inorganic Pyrophosphate ◽  
Control Subjects ◽  
Stone Formers

1. In order to assess the relative importance of possible pathogenetic factors in the formation of calcium-containing renal stones, a group of 18 patients (12 men, six women) with active, recurrent stone disease were compared with 16 age-matched control subjects (10 men, six women) given an identical diet. 2. Fifteen (83%) of the patients showed at least one, eight (44%) showed two, and one (6%) patient showed three abnormalities that might predispose to stone formation. 3. Increased urinary calcium excretion was the most common abnormality (11 patients, 61%), particularly in the women (83%). 4. A diminished excretion of inhibitors of crystal formation of calcium phosphate was the next most common abnormality, which occurred in eight patients (44%), all of whom were men. It was largely attributable to a diminished excretion of inorganic pyrophosphate (PPi). The PPi/orthophosphate ratios were also lower in the stone-formers. Significant differences in residual inhibitory activity after enzymatic removal of PPi between control subjects and stone-formers could not be found in 24 h urine samples but were present during certain times of the day. Pyrophosphate showed a higher inhibitory activity in urine than in control solutions, this enhancement being absent in stone-formers. 5. Nine (50%) of the patients, but only one of the control subjects, produced crystal aggregates greater than 50 μm in diameter after an oral load of oxalate.

scholarly journals Urinary metabolic profile and stone composition in kidney stone formers with and without heart disease

2021 ◽  
Author(s):  
Matteo Bargagli ◽  
Shabbir Moochhala ◽  
William G. Robertson ◽  
Giovanni Gambaro ◽  
Gianmarco Lombardi ◽  
...  
Keyword(s):  
Kidney Stone ◽  
Heart Valves ◽  
Randomized Clinical Trials ◽  
Urine Analysis ◽  
Stone Formation ◽  
Coronary Revascularization ◽  
Stone Disease ◽  
Stone Composition ◽  
Stone Formers ◽  
Increased Risk

Abstract Objective Kidney stone disease seems to be associated with an increased risk of incident cardiovascular outcomes; the aim of this study is to identify differences in 24-h urine excretory profiles and stone composition among stone formers with and without cardiovascular disease (CVD). Methods Data from patients attending the Department of Renal Medicine’s metabolic stone clinic from 1995 to 2012 were reviewed. The sample was divided according to the presence or absence of CVD (myocardial infarction, angina, coronary revascularization, or surgery for calcified heart valves). Univariable and multivariable regression models, adjusted for age, sex, BMI, hypertension, diabetes, eGFR, plasma bicarbonate and potential renal acid load of foods were used to investigate differences across groups. Results 1826 patients had available data for 24-h urine analysis. Among these, 108 (5.9%) had a history of CVD. Those with CVD were older, have higher prevalence of hypertension and diabetes and lower eGFR. Univariable analysis showed that patients with CVD had significantly lower 24-h urinary excretions for citrate (2.4 vs 2.6 mmol/24 h, p = 0.04), magnesium (3.9 vs 4.2 mmol/24 h, p = 0.03) and urinary pH (6.1 vs 6.2, p = 0.02). After adjustment for confounders, differences in urinary citrate and magnesium excretions remained significant. No differences in the probability of stone formation or stone compositions were found. Conclusions Stone formers with CVD have lower renal alkali excretion, possibly suggesting higher acid retention in stone formers with cardiovascular comorbidities. Randomized clinical trials including medications and a controlled diet design are needed to confirm the results presented here. Graphic abstract

scholarly journals Urolithiasis is associated with low serum testosterone levels in men

2015 ◽  
Vol 87 (1) ◽  
pp. 83 ◽  
Author(s):  
Alper Otunctemur ◽  
Emin Ozbek ◽  
Suleyman Sami Cakir ◽  
Murat Dursun ◽  
Emre Can Polat ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Stone Formation ◽  
Serum Testosterone ◽  
Early Morning ◽  
Stone Disease ◽  
Chi Square ◽  
Testosterone Levels ◽  
History Of ◽  
Group 2 ◽  
Group 1

Objective: To evaluate the relationship among urolithiasis, metabolic syndrome (MetS) and serum testosterone (T) level in men. Material and Methods: 513 men older than 18 years were enrolled in this study: 313 of the subjects had a history of stones (group 1) and 200 had no history of stones (controls, group 2). Early morning T levels were recorded and anthropometric measurements were invastigated to evaluate MetS. Analyses were completed using chi-square tests. Result: Serum T level was lower in stone forming patients than coltrol subjects and 161 (%51.4) men in group 1 and 92 (%46) men in group 2 were diagnosed with metabolic syndrome. T level was found lower limit (< 285 ng/dl) in the MetS and urolithiasis group (p 0.002, OR 2.71). Conclusions: We found low testosterone levels in the patients with stone disease and prevalance of the MetS in men with urolithiasis was higher than in men without stone disease. Our findings show that levels of testosterone had no effect on stone formation, but the factors that cause stone formation can have an effect on the level of testosterone.

scholarly journals Hypertensive and Metabolic Issues in Nephrolithiasis with Pregnancy

2019 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Blood Pressure ◽  
Research Group ◽  
Stone Formation ◽  
Renal Stones ◽  
P Values ◽  
The Metabolic Syndrome ◽  
Stone Formers ◽  
Potential Marker ◽  
Stone Former

Background: Renal stones are correlated clinically with forthcoming development of hypertension, diabetes, and the metabolic syndrome. Objective of the study: To evaluate and investigate whether stone formation before pregnancy is correlated with metabolic and hypertensive medical development emergence in gestation. The research team hypothesis was based on that stone development is considered a potential marker of metabolic disease and will be linked with greater risk for maternal complications in pregnancy. Methodology: We conducted a two-group cohort study of women who delivered infants at El Sahel teaching Hospital 2015to 20118. Women with abdominal imaging investigate (computed tomography or sonography) before pregnancy were incorporated in the analysis. 923 cases were assessed for eligibility for the study 817 cases were eligible consequently they were categorized into stone formers (126 cases) and non-stone formers (691 cases .finally 110 cases were enrolled for each arm of the study 8 cases were lost during follow up in the stone former research group and 6 cases were lost during follow up in non-stone former research group. Gestational outcomes in women with documented renal stones by imaging were compared with those of women without stones on imaging. Females with preexisting chronic kidney disease, hypertension, and diabetes were excluded. Results: Stone former research group had statistically significantly more frequent hypertension, gestational hypertension, preeclampsia and preterm (p values=0.005,0.035,0.034,0.017, consecutively) as well as higher Maximum systolic blood pressure, diastolic blood pressure and glucose tolerance test (p values<0.001,0.030,0.039, consecutively). Conclusions: In women without preexisting diabetes, hypertension, and CKD, a history of nephrolithiasis was associated with gestational diabetes and hypertensive disorders of pregnancy, especially in women with high first trimester body mass index.

Epidemiology of nephrolithiasis

2015 ◽  
Author(s):  
Eric N. Taylor ◽  
Gary C. Curhan
Keyword(s):  
Risk Factors ◽  
Kidney Stone ◽  
Fluid Intake ◽  
Stone Formation ◽  
Epidemiologic Studies ◽  
Stone Disease ◽  
History Of ◽  
Treatment Plans ◽  
Urinary Citrate ◽  
Risk Of Stone Formation

Nephrolithiasis is common, costly, and painful. The prevalence of nephrolithiasis, defined as a history of stone disease, varies by age, sex, race, and geography while the incidence of nephrolithiasis, defined as the first stone event, varies by age, sex, and race. Epidemiologic studies have quantified the burden of kidney stone disease and expand our understanding of risk factors. A variety of dietary, non-dietary, and urinary risk factors contribute to the risk of stone formation and the importance of these varies by age, sex, and body mass index.Low fluid intake, high urinary oxalate or calcium or uric acid, and low urinary citrate are all associated with nephrolithiasis. These results from epidemiologic studies can be considered in the clinical setting when devising treatment plans to reduce stone recurrence.

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