Effects of COVID-19 pandemics on urinary metabolites in kidney stone patients: our kidney stone prevention clinic experience

Background The dietary habits and lifestyle changes during the COVID-19 pandemic could affect the urinary risk factors in kidney stone formers. In this study, we investigated the effects of the COVID-19 pandemic on 24-h urine metabolites, as a surrogate for dietary intake, in patients with kidney stones, in Tehran, Iran. Methods We evaluated the medical records of all patients with urolithiasis who visited in our stone prevention clinic from the beginning of COVID-19 in Iran to 1 year later (Feb 2020–Feb 2021) and compared it with the patients’ medical records in the same period a year before COVID-19 (Feb 2019–Feb 2020). Results The results of our stone prevention clinic showed a decrease in the number of visits during COVID-19. Twenty-four-hour urine urea, sodium, and potassium were significantly lower, and 24-h urine magnesium was significantly higher during COVID-19. Higher 24-h urine oxalate was only shown in patients with the first-time visit, whereas lower 24-h urine uric acid and citrate were only shown in patients with the follow-up visits. Conclusions COVID-19 pandemics may change some of the dietary habits of the patients, including lower salt, protein, and fruit and vegetable intake. Although economic issues, restricted access, or sanitation issues may be the reason for the undesirable dietary changes, the importance of a quality diet should be discussed with all patients, as possible. Since the number of patients visited in the stone clinic was lower during COVID-19, virtual visits could be an excellent alternative to motivate patients with kidney stones.

An innovative method for rapid detection of urinary oxalate in goats with urolithiasis

Background: Oxalate is a natural and abundant metabolic by-product; as a highly oxidized organic compound with powerful chelating activity, in high concentrations it can cause morbidity and mortality in both animals and humans. Elevated levels in urine (i.e., hyperoxaluria) have been found to correlate with several human diseases, especially urolithiasis or kidney stone disease (KSD)- a disease also prevalent in goats. Current methods for measuring oxalate are highly technical, cumbersome, and time-consuming, which often forces clinics to utilize expensive diagnostic laboratories. Therefore, in this study, we designed an innovative device, Oxalometer, to measure urinary oxalate in goats. Results: The results indicate that the Oxalometer performed as accurately as the standard commercially available test. The Oxalometer was able to measure higher levels of urinary oxalate in goats with urolithiasis compared to non-urolithiasis goats. The data demonstrate the accuracy and sensitivity of the Oxalometer. Conclusions: This proof-of-concept study supports the future application of the device in determining on-the-spot oxalate levels in patients and brings kidney stone prevention to point-of-care practice for ruminants.

Effect of Herbal Formulation “Cystone®” on Urolithiasis

Context: The study aimed to systematically review the clinical data on the efficacy of Cystone® as an herbal treatment for urolithiasis. Methods: Full text randomized clinical trials comparing Cystone® with placebo or citrate in patients with urolithiasis for urinary stone prevention or treatment were evaluated. Three databases, including PubMed, Scopus, and Cochrane Library, were searched from January 2000 to December 2017. The main outcomes were the reductions in calculi number/size and urinary excretion rate of calcium, oxalate, and urate. The secondary outcome was the adverse effects of Cystone®. Documents were screened by two reviewers for eligibility. The Jadad score was used for quality assessment. The data were analyzed using the comprehensive meta-analysis version 2.2.064 software. Results: Of 532 relevant studies, five were finally included. Cystone® was effective in the decrement of stone size in comparison with placebo (95% CI: 0.63, 9.13). There was a significant difference in the excretion rate of uric acid but not calcium compared to the placebo. Cystone® had no significant side effects. Conclusions: Cystone® is more effective than a placebo in the treatment of urinary tract stones. It significantly induces stone size decrement and clearance compared to placebo. The low quality of reports is a major limitation in the applicability of these results.

Patient’s perception of kidney stone prevention within the emergency department and its adherence factors: A single institution study.

Background: No known data in the literature assessing practice of kidney stone prevention in the emergency department (ED) is available. Objectives: Assess patient perception and compliance to kidney stone prevention given within the emergency department. It also indirectly detects the attitude and practice patterns of primary care providers in kidney stone prevention. Materials and Methods This is a qualitative study done in a single institution from January 2018 to January 2019 that includes 99 patients that were diagnosed with kidney or ureteral stone in ED and were discharged home, all of them where stone formers. They were asked to fill a self- administered questionnaire when they are able to read, or interviewed by the resident within the ED when they are unable to read. Results The majority of patients (68%) did not receive any instructions about kidney stones prevention within the ED. Most of patients who follow instructions if it was given were educated (90 %), had an insurance coverage (85%), and had an income higher than $1000 per month (76%), (p<0.05). Seventy one percents of patients believe in the effectiveness of stone prevention if it was provided and most of them are interested in learning about these preventive strategies (82%). Reasons for not following the instructions about kidney stones prevention measures were the cost (53.1%) following by the lack of explanation by ED physicians (18.8%). The majority of patients (62.6%) prefer to receive kidney stones prevention measures from urologists. Conclusion: Most of patients in our institute did not receive kidney stones prevention measures in ED despite that they declared their interest in following these measures. Most of the time they did not adhere to those measures due to socioeconomic factors and lack of clarifications. If these instructions were given within the ED, it could lead to an acceptable compliance rate.

Patient’s perception of kidney stone prevention within the emergency department and its adherence factors: A single institution study

BackgroundNo known data in the literature assessing practice of kidney stone prevention in the emergency department (ED) is available. Objectives: Assess patient perception and compliance to kidney stone prevention given within the emergency department. It also indirectly detects the attitude and practice patterns of primary care providers in kidney stone prevention.Materials and MethodsThis is a qualitative study done in a single institution from January 2018 to January 2019 that includes 99 patients that were diagnosed with kidney or ureteral stone in ED and were discharged home, all of them where stone formers. They were asked to fill a self- administered questionnaire when they are able to read, or interviewed by the resident within the ED when they are unable to read.ResultsThe majority of patients (68%) did not receive any instructions about kidney stones prevention within the ED. Most of patients who follow instructions if it was given were educated (90 %), had an insurance coverage (85%), and had an income higher than $1000 per month (76%), (p<0.05). Seventy one percents of patients believe in the effectiveness of stone prevention if it was provided and most of them are interested in learning about these preventive strategies (82%). Reasons for not following the instructions about kidney stones prevention measures were the cost (53.1%) following by the lack of explanation by ED physicians (18.8%). The majority of patients (62.6%) prefer to receive kidney stones prevention measures from urologists.ConclusionMost of patients in our institute did not receive kidney stones prevention measures in ED despite that they declared their interest in following these measures. Most of the time they did not adhere to those measures due to socioeconomic factors and lack of clarifications. If these instructions were given within the ED, it could lead to an acceptable compliance rate.