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The characterization of in vivo urinary phospate stones by spectral CT. Urolithiasis 2022; 51:10. [DOI: 10.1007/s00240-022-01388-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
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Henderickx MMEL, Stoots SJM, de Bruin DM, Wijkstra H, Freund JE, Wiseman O, Ploumidis A, Skolarikos A, Somani BK, Sener TE, Emiliani E, Dragos L, Villa L, Talso M, Daudon M, Traxer O, Kronenberg P, Doizi S, Tailly T, Tefik T, Hendriks N, Beerlage HP, Baard J, Kamphuis GM. How reliable is endoscopic stone recognition? A comparison between visual stone identification and formal stone analysis. J Endourol 2022; 36:1362-1370. [PMID: 35651279 DOI: 10.1089/end.2022.0217] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To assess the diagnostic accuracy and intra-observer agreement of endoscopic stone recognition compared with formal stone analysis. INTRODUCTION Stone analysis is a corner stone in the prevention of stone recurrence. Although X-ray diffraction and infrared spectroscopy are the recommended techniques for reliable formal stone analysis, this is not always possible, and the process takes time and is costly. Endoscopic stone recognition could be an alternative as it would give immediate information on stone composition. MATERIAL AND METHODS Fifteen endourologists predicted stone composition based on 100 videos from ureterorenoscopy. Diagnostic accuracy was evaluated by comparing the prediction from visual assessment with stone analysis by X-ray diffraction. After 30 days, the videos were reviewed again in a random order to assess intra-observer agreement. RESULTS The median diagnostic accuracy for calcium oxalate monohydrate was of 54% in questionnaire 1 (Q1) and 59% in questionnaire 2 (Q2), whereas calcium oxalate dihydrate had a median diagnostic accuracy of 75% in Q1 and 50% in Q2. The diagnostic accuracy for calcium hydroxyphosphate was 10% in Q1 and 13% in Q2. The median diagnostic accuracy for calcium hydrogen phosphate dihydrate and calcium magnesium phosphate was 0% in both questionnaires. The median diagnostic accuracy for magnesium ammonium phosphate was in 20% in Q1 and 40% in Q2. The median diagnostic accuracy for uric acid was 22% in both questionnaires. Finally, there was a diagnostic accuracy of 60% in Q1 and 80% in Q2 for cystine. The intra-observer agreement ranged between 45-72%. CONCLUSION Diagnostic accuracy of endoscopic stone recognition is limited and intra-observer agreement is below the threshold of acceptable agreement.
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Affiliation(s)
- Michaël M E L Henderickx
- Amsterdam UMC Locatie Meibergdreef, 26066, Department of Urology, Amsterdam, North Holland, Netherlands;
| | - Simone J M Stoots
- Amsterdam UMC Locatie Meibergdreef, 26066, Department of Urology, Amsterdam, North Holland, Netherlands;
| | - D Martijn de Bruin
- Amsterdam UMC Locatie Meibergdreef, 26066, Biomedical Engineering & Physics, Amsterdam, North Holland, Netherlands.,Amsterdam UMC Locatie Meibergdreef, 26066, Department of Urology, Amsterdam, North Holland, Netherlands;
| | - Hessel Wijkstra
- Amsterdam UMC Locatie Meibergdreef, 26066, Department of Urology, Amsterdam, North Holland, Netherlands.,Eindhoven University of Technology, 3169, Department of Electrical Engineering, Eindhoven, Noord-Brabant, Netherlands;
| | - Jan Erik Freund
- Amsterdam UMC Locatie Meibergdreef, 26066, Department of Pathology, Amsterdam, North Holland, Netherlands;
| | - Oliver Wiseman
- Cambridge University Hospitals NHS Foundation Trust, Urology, 14 Herons Close, Cambridge, Cambridgeshire, United Kingdom of Great Britain and Northern Ireland, CB1 8NS;
| | | | - Andreas Skolarikos
- University of Athens, 2nd Department of Urology, 6 LASKAREOS ST, NEA ZOI PERISTERI, Athens, Greece, 12137;
| | - Bhaskar K Somani
- University Hospitals Southampton NHS Trust, Urology, Southampton, United Kingdom of Great Britain and Northern Ireland;
| | - Tarik Emre Sener
- Marmara University School of Medicine, Urology, Fevzi Çakmak Mah. Muhsin Yazıcıoğlu Cad. No: 10 Üst Kaynarca / Pendik / İSTANBUL, Istanbul, Turkey, 34890;
| | | | - Laurian Dragos
- Cambridge University Hospitals NHS Foundation Trust, 2153, Department of Urology, Cambridge, Cambridgeshire, United Kingdom of Great Britain and Northern Ireland;
| | - Luca Villa
- Università Vita-Salute San Raffaele, Urology, Via Olgettina, 60, Milan, Italy, 20132;
| | - Michele Talso
- ASST Fatebenefratelli Sacco, 472674, Urology - Ospedale Luigi Sacco University Hospital, Milano, Italy;
| | - Michel Daudon
- Hôpital Tenon, 55705, Department of Urology, Paris, Île-de-France, France.,Sorbonne Universite, 27063, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Paris, Île-de-France, France;
| | - Olivier Traxer
- Hopital Tenon, 55705, Department of Urology, Paris, Île-de-France, France.,Sorbonne Universite, 27063, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Paris, Île-de-France, France;
| | - Peter Kronenberg
- Hospital CUF Descobertas, 162265, Department of Urology , Lisboa, Lisboa, Portugal;
| | - Steeve Doizi
- Hopital Tenon, 55705, Department of Urology, Paris, Île-de-France, France.,Sorbonne Universite, 27063, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Paris, Île-de-France, France;
| | | | - Tzevat Tefik
- Istanbul University Istanbul Faculty of Medicine, 64041, Department of Urology, Istanbul, Istanbul, Turkey;
| | - Nora Hendriks
- Amsterdam UMC Locatie AMC, 26066, Department of Urology, Amsterdam, Netherlands;
| | - Harrie P Beerlage
- Amsterdam UMC Locatie Meibergdreef, 26066, Department of Urology, Amsterdam, North Holland, Netherlands;
| | - Joyce Baard
- Amsterdam UMC Locatie Meibergdreef, 26066, Department of Urology, Amsterdam, North Holland, Netherlands;
| | - Guido M Kamphuis
- Amsterdam UMC Locatie Meibergdreef, 26066, Department of Urology, Amsterdam, North Holland, Netherlands;
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Gao S, Chao Y, Li N, Li H, Zhao H, Liu X, Chen W, Dong X. An Integrated Proteomics and Metabolomics Strategy for the Mechanism of Calcium Oxalate Crystal-Induced Kidney Injury. Front Med (Lausanne) 2022; 9:805356. [PMID: 35308536 PMCID: PMC8927618 DOI: 10.3389/fmed.2022.805356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/07/2022] [Indexed: 02/01/2023] Open
Abstract
Renal fibrosis is the pathological repair reaction of the kidney to chronic injury, which is an important process of chronic kidney disease (CKD) progressing to end-stage renal failure. Nephrolithiasis is one of the most common renal diseases, with waist and abdomen pain, hematuria, urinary tract infection, and other clinical symptoms, which can increase the risk of renal fibrosis. Oxalate crystal-induced kidney injury is an early stage of nephrolithiasis; it is of great significance to explore the mechanism for the prevention and treatment of nephrolithiasis. A rodent model of calcium oxalate (CaOx) crystal-induced kidney injury was used in the present study, and a network analysis method combining proteomics and metabolomics was conducted to reveal the mechanism of crystal kidney injury and to provide potential targets for the intervention of nephrolithiasis. Using the metabolomics method based on the UHPLC-Q/TOF-MS platform and the iTRAQ quantitative proteomics method, we screened a total of 244 metabolites and 886 proteins from the kidney tissues that had significant changes in the Crystal group compared with that in the Control group. Then, the ingenuity pathway analysis (IPA) was applied to construct a protein-to-metabolic regulatory network by correlating and integrating differential metabolites and proteins. The results showed that CaOx crystals could induce inflammatory reactions and oxidative stress through Akt, ERK1/2, and P38 MAPK pathways and affect amino acid metabolism and fatty acid β-oxidation to result in kidney injury, thus providing an important direction for the early prevention and treatment of nephrolithiasis.
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Affiliation(s)
- Songyan Gao
- Institute of Translational Medicine, Shanghai University, Shanghai, China
| | - Yufan Chao
- School of Medicine, Shanghai University, Shanghai, China
| | - Na Li
- School of Medicine, Shanghai University, Shanghai, China
| | - Henghui Li
- School of Life Sciences, Shanghai University, Shanghai, China
| | - Hongxia Zhao
- School of Medicine, Shanghai University, Shanghai, China
| | - Xinru Liu
- Institute of Translational Medicine, Shanghai University, Shanghai, China
- *Correspondence: Xinru Liu
| | - Wei Chen
- Department of Nephrology, Changhai Hospital, Naval Military Medical University, Shanghai, China
- Wei Chen
| | - Xin Dong
- Institute of Translational Medicine, Shanghai University, Shanghai, China
- School of Medicine, Shanghai University, Shanghai, China
- Xin Dong
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Williams JC, Al-Awadi H, Muthenini M, Bledsoe SB, El-Achkar T, Evan AP, Coe F, Lingeman JE, Worcester EM. Stone morphology distinguishes two pathways of idiopathic calcium oxalate stone pathogenesis. J Endourol 2021; 36:694-702. [PMID: 34915736 PMCID: PMC9145590 DOI: 10.1089/end.2021.0685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introduction About 1-in-11 Americans will experience a kidney stone, but underlying causes remain obscure. The objective of the present study was to separate idiopathic calcium oxalate stone formers by whether or not they showed positive evidence of forming a stone on Randall's plaque (RP). Materials and Methods In patients undergoing either percutaneous or ureteroscopic procedures for kidney stone removal, all stone material was extracted, and analyzed using micro computed tomographic imaging (micro CT), in order to identify those attached to RP. 24-hour urines were collected weeks after the stone removal procedure and off of medications that would affect urine composition. Endoscopic video was analyzed for papillary pathology (RP, pitting, plugging, dilated ducts, loss of papillary shape) by an observer blinded to the data on stone type. Percent papillary area occupied by RP and ductal plugging was quantified using image analytic software. Results Patients having even 1 stone on RP (N=36) did not differ from Non-RP patients (N=37) in age, sex, BMI, or other clinical characteristics. Compared to the Non-RP group, RP stone formers had more numerous but smaller stones, more abundant papillary RP, and fewer ductal plugs, both by quantitative measurement of surface area (on average, 3 times more plaque area, but only 41% as much plug area as Non-RP) and by semi-quantitative visual grading. Serum and blood values did not differ between RP and Non-RP stone formers by any measure. Conclusions Growth of many small stones on plaque seems the pathogenetic scheme for the RP stone forming phenotype, whereas the Non-RP phenotype stone pathogenesis pathway is less obvious. Higher papillary plugging in Non-RP suggests that plugs play a role in stone formation, and that these patients have a greater degree of papillary damage. Underlying mechanisms that create these distinctive phenotypes are presently unknown.
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Affiliation(s)
- James C Williams
- Indiana University School of Medicine, Department of Anatomy, Cell Biology & Physiology, Indianapolis, Indiana, United States;
| | - Haider Al-Awadi
- Indiana University School of Medicine, Department of Anatomy, Cell Biology & Physiology, Indianapolis, Indiana, United States;
| | - Manognya Muthenini
- Indiana University School of Medicine, Department of Medicine, Indianapolis, Indiana, United States;
| | - Sharon B Bledsoe
- Indiana University School of Medicine, Anatomy, Cell Biology & Physiology, Indianapolis, Indiana, United States;
| | - Tarek El-Achkar
- Indiana University School of Medicine, Department of Medicine , Indianapolis, Indiana, United States;
| | - Andrew P Evan
- indiana University School of Medicine, Anatomy, Cell Biology & Physiology, Indianapolis, Indiana, United States;
| | - Fred Coe
- University of Chicago Pritzker School of Medicine, 12246, Medicine, Chicago, Illinois, United States;
| | - James E Lingeman
- Indiana University School of Medicine, Dept. of Urology, Indianapolis, Indiana, United States;
| | - Elaine M Worcester
- The University of Chicago, Section of Nephrology, Chicago, Illinois, United States;
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Williams JC, Lingeman JE, Daudon M, Bazin D. Using micro computed tomographic imaging for analyzing kidney stones. ACTA ACUST UNITED AC 2021; 24. [PMID: 34321982 DOI: 10.5802/crchim.89] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Stone analysis is a critical part of the clinical characterization of urolithiasis. This article reviews the strengths and limitations of micro CT in the analysis of stones. Using micro CT alone in a series of 757 stone specimens, micro CT identified the 458 majority calcium oxalate specimens with a sensitivity of 99.6% and specificity of 95.3%. Micro CT alone was also successful in identifying majority apatite, brushite, uric acid, and struvite stones. For some minor minerals-such as apatite in calcium oxalate or calcium salts in uric acid stones-micro CT enables the detection of minute quantities well below 1%. The addition of a standard for calibrating X-ray attenuation values improves the ability of micro CT to identify common stone minerals. The three-dimensional nature of micro CT also allows for the visualization of surface features in stones, which is valuable for the study of stone formation.
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Affiliation(s)
- James C Williams
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, Indiana (USA)
| | - James E Lingeman
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana (USA)
| | - Michel Daudon
- UMR S1155, INSERM/UPMC, 4 Rue de la Chine, 75970 Paris Cedex 20, France.,AP-HP, Hôpital Tenon, Explorations fonctionnelles multidisciplinaires, 4 Rue de la Chine, 75970 Paris Cedex 20, France
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Almeras C, Pradere B, Estrade V, Meria P, French Urological Association OBOTLCOT. Endoscopic Papillary Abnormalities and Stone Recognition (EPSR) during Flexible Ureteroscopy: A Comprehensive Review. J Clin Med 2021; 10:jcm10132888. [PMID: 34209668 PMCID: PMC8267668 DOI: 10.3390/jcm10132888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction: The increasing efficiency of the different lasers and the improved performance of endoscopic devices have led to smaller stone fragments that impact the accuracy of microscopic evaluation (morphological and infrared). Before the stone destruction, the urologist has the opportunity to analyze the stone and the papillary abnormalities endoscopically (endoscopic papillary recognition (EPR) and endoscopic stone recognition (ESR)). Our objective was to evaluate the value for those endoscopic descriptions. Methods: The MEDLINE and EMBASE databases were searched in February 2021 for studies on endoscopic papillary recognition and endoscopic stone recognition. Results: If the ESR provided information concerning the main crystallization process, EPR provided information concerning the origin of the lithogenesis and its severity. Despite many actual limitations, those complementary descriptions could support the preventive care of the stone formers in improving the diagnosis of the lithogenesis mechanism and in identifying high-risk stone formers. Conclusion: Until the development of an Artificial Intelligence recognition, the endourologist has to learn EPSR to minimize the distortion effect of the new lasers on the stone analysis and to improve care efficiency of the stone formers patients.
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Affiliation(s)
- Christophe Almeras
- Department of Urology, La Croix du Sud Clinic-RGDS, UroSud, 52 bis Chemin de Ribaute, Boite 301, 31130 Quint Fonsegrives, France
- French Urological Association (AFU), La Maison de l’Urologie, 11 rue Viète, 31017 Paris, France; (V.E.); (P.M.);
- Correspondence: ; Tel.: +33-53-202-7202; Fax: +33-53-202-7203
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria;
| | - Vincent Estrade
- French Urological Association (AFU), La Maison de l’Urologie, 11 rue Viète, 31017 Paris, France; (V.E.); (P.M.);
- Department of Urology, CHU Pellegrin, 33300 Bordeaux, France
| | - Paul Meria
- French Urological Association (AFU), La Maison de l’Urologie, 11 rue Viète, 31017 Paris, France; (V.E.); (P.M.);
- Department of Urology, Saint Louis Hospital, Denis Diderot University, 75010 Paris, France
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Abstract
The prevalence of urolithiasis in humans is increasing worldwide; however, non-surgical treatment and prevention options remain limited despite decades of investigation. Most existing laboratory animal models for urolithiasis rely on highly artificial methods of stone induction and, as a result, might not be fully applicable to the study of natural stone initiation and growth. Animal models that naturally and spontaneously form uroliths are an underused resource in the study of human stone disease and offer many potential opportunities for improving insight into stone pathogenesis. These models include domestic dogs and cats, as well as a variety of other captive and wild species, such as otters, dolphins and ferrets, that form calcium oxalate, struvite, uric acid, cystine and other stone types. Improved collaboration between urologists, basic scientists and veterinarians is warranted to further our understanding of how stones form and to consider possible new preventive and therapeutic treatment options.
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Kumar P, Patel M, Thomas V, Knight J, Holmes RP, Mitchell T. Dietary Oxalate Induces Urinary Nanocrystals in Humans. Kidney Int Rep 2020; 5:1040-1051. [PMID: 32647761 PMCID: PMC7335953 DOI: 10.1016/j.ekir.2020.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/09/2020] [Accepted: 04/27/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Crystalluria is thought to be associated with kidney stone formation and can occur when urine becomes supersaturated with calcium, oxalate, and phosphate. The principal method used to identify urinary crystals is microscopy, with or without a polarized light source. This method can detect crystals above 1 μm in diameter (microcrystals). However, analyses of calcium oxalate kidney stones have indicated that crystallite components in these calculi are 50–100 nm in diameter. Recent studies have suggested that nanocrystals (<200 nm) elicit more injury to renal cells compared to microcrystals. The purpose of this study was to determine whether (i) urinary nanocrystals can be detected and quantified by nanoparticle tracking analysis (NTA, a high-resolution imaging technology), (ii) early-void urine samples from healthy subjects contain calcium nanocrystals, and (iii) a dietary oxalate load increases urinary nanocrystal formation. Methods Healthy subjects consumed a controlled low-oxalate diet for 3 days before a dietary oxalate load. Urinary crystals were isolated by centrifugation and assessed using NTA before and 5 hours after the oxalate load. The morphology and chemical composition of crystals was assessed using electron microscopy, Fourier-transform infrared spectroscopy (FTIR), and ion chromatography-mass spectrometry (IC–MS). Results Urinary calcium oxalate nanocrystals were detected in pre-load samples and increased substantially following the oxalate load. Conclusion These findings indicate that NTA can quantify urinary nanocrystals and that meals rich in oxalate can promote nanocrystalluria. NTA should provide valuable insight about the role of nanocrystals in kidney stone formation.
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Affiliation(s)
- Parveen Kumar
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mikita Patel
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Vinoy Thomas
- Department of Materials Science and Engineering, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John Knight
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ross P Holmes
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tanecia Mitchell
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Almeras C, Daudon M, Estrade V, Gautier JR, Traxer O, Meria P. Classification of the renal papillary abnormalities by flexible ureteroscopy: evaluation of the 2016 version and update. World J Urol 2020; 39:177-185. [PMID: 32193654 PMCID: PMC7858204 DOI: 10.1007/s00345-020-03149-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 02/26/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction To assess the use of the 2016 proposed classification of the renal papillary abnormalities during flexible ureteroscopy that aims to standardize their description. Patients and methods We performed a prospective monocentric single operator collection of the data using this classification during 88 consecutive flexible ureteroscopies required for renal stones treatment. Outcome measurements and statistical analysis: data of stones analysis (microscopy and infrared spectrophotometry) and of serum and urines biochemical samples have been compared with the results of the classified endoscopic descriptions. Results Mean duration of description was 81.4 s. We reported that 83% of the patients had Randall plaques (RP), as only 4.5% of the patients had no abnormality. Concerning the papillary stones and anchored stones were observed in 30.7% and aspect of intraductal crystallization (Sc) in 15.9%. Erosions were present in 55.7% and extrophic papillae in 8%. Sa1 and Pa2 were significantly correlated to RP, anchored stones (Sa) to papillary erosions and calcium phosphate stones to intraductal crystallization. Hypercalciuria was significantly higher in Sa2 than Sa1 stones. Conclusions The different descriptions in the 2016 classification were confirmed by the results of this study. Papillary abnormalities are consequences of stones development. Their descriptions could also improve the follow-up and the diagnosis of a metabolic lithogenesis. We recommend their systematic description during ureteroscopy. Some improvements are proposed to update this classification.
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Affiliation(s)
- Christophe Almeras
- Department of Urology, La Croix du Sud Clinic, 52 chemin de Ribaute, 31130, Quint Fonsegrives, France.
| | - Michel Daudon
- Unit of Functional Explorations, Tenon Hospital, Pierre and Marie Curie University, Paris, France
| | | | - Jean Romain Gautier
- Department of Urology, La Croix du Sud Clinic, 52 chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Olivier Traxer
- Department of Urology, Tenon Hospital, Pierre and Marie Curie University, Paris, France
| | - Paul Meria
- Department of Urology, Saint-Louis Hospital, Denis Diderot University, Paris, France
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Evan AP, Coe FL, Worcester EM, Williams JC, Heiman J, Bledsoe S, Sommer A, Philips CL, Lingeman JE. Discrepancy Between Stone and Tissue Mineral Type in Patients with Idiopathic Uric Acid Stones. J Endourol 2020; 34:385-393. [PMID: 31880949 DOI: 10.1089/end.2019.0564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To describe the papillary pathology found in uric acid (UA) stone formers, and to investigate the mineral form of tissue deposits. Materials and Methods: We studied eight UA stone formers treated with percutaneous nephrolithotomy. Papillae were imaged intraoperatively using digital endoscopy, and cortical and papillary biopsies were taken. Biopsies were analyzed by light microscopy, micro-CT, and microinfrared spectroscopy. Results: As expected, urine pH was generally low. UA supersaturation exceeded one in all but one case, compatible with the stone material. By intraoperative imaging, the renal papillae displayed a heterogeneous mixture of plaque and plugging, ranging from normal to severe. All patients had mineral in ducts of Bellini and inner medullary collecting ducts, mainly apatite with lesser amounts of urate and/or calcium oxalate in some specimens. Papillary and cortical interstitial tissue injury was modest despite the tubule plugging. No instance was found of a stone growing attached to either plaque or plugs. Conclusions: UA stone formers resemble those with ileostomy in having rather low urine pH while forming tubule plugs that contain crystals that can only form at pH values above those of their bulk urine. This discrepancy between tissue mineral deposits and stone type suggests that local tubular pH exceeds that of the bulk urine, perhaps because of localized tubule injury. The manner in which UA stones form and the discordance between tubule crystals and stone type remain open research questions.
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Affiliation(s)
- Andrew P Evan
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Fredric L Coe
- Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - James C Williams
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Joshua Heiman
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sharon Bledsoe
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Andre Sommer
- Department of Chemistry and Biochemistry, Miami University, Oxford, Ohio
| | - Carrie L Philips
- Department of Pathology, Indiana University Health Partners, Indianapolis, Indiana
| | - James E Lingeman
- Department of Urology, International Kidney Stone Institute, Indiana University Health Partners, Indianapolis, Indiana
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Fernandez K, Korinek M, Camp J, Lieske J, Holmes D. Automatic detection of calcium phosphate deposit plugs at the terminal ends of kidney tubules. Healthc Technol Lett 2019; 6:271-274. [PMID: 32038870 PMCID: PMC6952263 DOI: 10.1049/htl.2019.0086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/02/2019] [Indexed: 11/20/2022] Open
Abstract
Kidney stones are a common urologic condition with a high amount of recurrence. Recurrence depends on a multitude of factors the incidence of precursors to kidney stones, plugs, and plaques. One method of characterising the stone precursors is endoscopic assessment, though it is manual and time-consuming. Deep learning has become a popular technique for semantic segmentation because of the high accuracy that has been demonstrated. The present Letter examined the efficacy of deep learning to segment the renal papilla, plaque, and plugs. A U-Net model with ResNet-34 encoder was tested; the Letter examined dropout (to avoid overtraining) and two different loss functions (to address the class imbalance problem. The models were then trained in 1666 images and tested on 185 images. The Jaccard-cross-entropy loss function was more effective than the focal loss function. The model with the dropout rate 0.4 was found to be more effective due to its generalisability. The model was largely successful at delineating the papilla. The model was able to correctly detect the plaques and plugs; however, small plaques were challenging. Deep learning was found to be applicable for segmentation of an endoscopic image for the papilla, plaque, and plug, with room for improvement.
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Affiliation(s)
- Katrina Fernandez
- Biomedical Imaging Resource, Mayo Clinic, Rochester, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - Mark Korinek
- Biomedical Imaging Resource, Mayo Clinic, Rochester, MN, USA
| | - Jon Camp
- Biomedical Imaging Resource, Mayo Clinic, Rochester, MN, USA
| | - John Lieske
- Department of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
| | - David Holmes
- Biomedical Imaging Resource, Mayo Clinic, Rochester, MN, USA
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12
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Abstract
The process of kidney stone formation is complex and still not completely understood. Supersaturation and crystallization are the main drivers for the etiopathogenesis of uric acid, xanthine and cystine stones but this physicochemical concept fails to adequately explain the formation of calcium-based nephrolithiasis, which represents the majority of kidney stones. Contemporary concepts of the pathogenesis of calcium-based nephrolithiasis focus on a nidus-associated stone formation of calcium-based nephrolithiasis on Randall's plaques or on plugs of Bellini's duct. Randall's plaques originate from the interaction of interstitial calcium supersaturation in the renal papilla, vascular and interstitial inflammatory processes and mineral deposits of calcifying nanoparticles on the basal membrane of the thin ascending branch of the loop of Henle; however, plugs of Bellini's duct are assumed to be caused by mineral deposits on the wall of the collecting ducts. Aggregation and overgrowth are influenced by the interaction of matrix proteins with calcium supersaturated urine, by an imbalance between promoters and inhibitors of stone formation in the calyceal urine. Current research has elucidated many factors contributing to stone formation by revealing novel insights into the physiology of nephron and papilla, by analyzing vascular, inflammatory and calcifying processes in the renal medulla, by examining the proteome, the microbiome, promoters and inhibitors of stone formation in the urine and by conducting the first genome-wide association studies; however, more future research is mandatory to fill the gap of knowledge and hopefully, to obtain novel prophylactic, therapeutic and metaphylactic tools beyond the current state of knowledge.
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Taguchi K, Hamamoto S, Okada A, Sugino T, Unno R, Ando R, Gao B, Tozawa K, Kohri K, Yasui T. Helper T-cell signaling and inflammatory pathway lead to formation of calcium phosphate but not calcium oxalate stones on Randall's plaques. Int J Urol 2019; 26:670-677. [PMID: 30919502 DOI: 10.1111/iju.13950] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/17/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To elucidate the difference in the lithogenesis of calcium oxalate and calcium phosphate stones. METHODS Renal papillary tissues were obtained from 23 idiopathic calcium oxalate and seven calcium phosphate stone patients who had undergone endoscopic lithotripsy. Samples were individually collected from two different regions in each patient: the papillary mucosa containing Randall's plaque and mucosa not containing Randall's plaque. A microarray analysis was carried out on those tissues to compare their gene expression patterns. Furthermore, a causal pathway analysis comparing their differences was carried out. RESULTS Cluster analysis showed that gene expression profiles of calcium phosphate stone patients markedly differed from those of calcium oxalate stone patients. Disease and function analysis showed that Randall's plaque-containing tissues of calcium phosphate stone-forming patients had significantly higher movement and migration of mononuclear leukocytes, and lower tendency toward infection and lymph node formation than Randall's plaque-containing tissues of calcium oxalate stone formers. Additional pathway analysis showed increased immune cell signaling in calcium phosphate formers, such as the helper T cell 1 and 2 pathways, which was confirmed by their messenger ribonucleic acid expression. CONCLUSIONS The present results show the upregulation of helper T-cell signaling pathways in Randall's plaque-containing papillae in calcium phosphate, but not in calcium oxalate stone formers. Thus, helper T-cell immune responses and the related inflammatory processes seem to lead to the formation of calcium phosphate stones on Randall's plaques.
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Affiliation(s)
- Kazumi Taguchi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuzo Hamamoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Atsushi Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Teruaki Sugino
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Rei Unno
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryosuke Ando
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Bing Gao
- Department of Cell Biology and Genetics, China-Japan Kidney Stone Research Center, Shenyang Medical College, Shenyang, China
| | - Keiichi Tozawa
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kenjiro Kohri
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Abstract
PURPOSE OF REVIEW The pathophysiological mechanisms in kidney stone formation are insufficiently understood. In order to achieve a better understanding of the complexity of stone formation, studies evaluating anatomical variations in the renal papillae have been performed. This review intends to illuminate recent findings. Moreover, new techniques to improve the understanding and interpretation of crystallization mechanisms are reviewed. RECENT FINDINGS Due to improvements of digital ureteroscopes, detailed endoscopic mapping of renal papillae is now possible. Connections between papillary morphology and histopathological changes in different subsets of stone formers have been documented. The formation of kidney stones seems to take place in relation to Randall's plaques, Ducts of Bellini or by free formation. Additionally, theories of kidney stone formation because of vascular injury or inflammatory events in the papillae have been suggested. SUMMARY Novel techniques including improved digital endoscopic visualization, microcomputed tomography (CT), electron microscopy and energy dispersive compositional analyses of kidney stones seem essential in the search for effective and reliable methods to understand stone forming processes, which ultimately should result in effective measures for more personalized stone prevention strategies in the future.
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Bhojani N, Paonessa JE, El Tayeb MM, Williams JC, Hameed TA, Lingeman JE. Sensitivity of Noncontrast Computed Tomography for Small Renal Calculi With Endoscopy as the Gold Standard. Urology 2018; 117:36-40. [PMID: 29625137 DOI: 10.1016/j.urology.2018.03.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To compare the sensitivity of noncontrast computed tomography (CT) with endoscopy for detection of renal calculi. Imaging modalities for detection of nephrolithiasis have centered on abdominal x-ray, ultrasound, and noncontrast CT. Sensitivities of 58%-62% (abdominal x-ray), 45% (ultrasound), and 95%-100% (CT) have been previously reported. However, these results have never been correlated with endoscopic findings. METHODS Idiopathic calcium oxalate stone formers with symptomatic calculi requiring ureteroscopy were studied. At the time of surgery, the number and the location of all calculi within the kidney were recorded followed by basket retrieval. Each calculus was measured and sent for micro-CT and infrared spectrophotometry. All CT scans were reviewed by the same genitourinary radiologist who was blinded to the endoscopic findings. The radiologist reported on the number, location, and size of each calculus. RESULTS Eighteen renal units were studied in 11 patients. Average time from CT scan to ureteroscopy was 28.6 days. The mean number of calculi identified per kidney was 9.2 ± 6.1 for endoscopy and 5.9 ± 4.1 for CT (P <.004). The mean size of total renal calculi (sum of the longest stone diameters) per kidney was 22.4 ± 17.1 mm and 18.2 ± 13.2 mm for endoscopy and CT, respectively (P = .06). CONCLUSION CT scan underreports the number of renal calculi, probably missing some small stones and being unable to distinguish those lying in close proximity to one another. However, the total stone burden seen by CT is, on average, accurate when compared with that found on endoscopic examination.
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Affiliation(s)
- Naeem Bhojani
- Department of Urology, University of Montreal, Montreal, Quebec, Canada
| | | | | | - James C Williams
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN
| | - Tariq A Hameed
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN
| | - James E Lingeman
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
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Sun AY, Hinck B, Cohen BR, Keslar K, Fairchild RL, Monga M. Inflammatory Cytokines in the Papillary Tips and Urine of Nephrolithiasis Patients. J Endourol 2018; 32:236-244. [PMID: 29338314 DOI: 10.1089/end.2017.0699] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Intrarenal inflammation has been implicated in the pathogenesis of nephrolithiasis, with prior work showing increased urine levels of IL-6, IL-8, and CCL-2 in stone patients. However, no studies have assessed for inflammation in the renal papillae. We sought to characterize novel papillary tip and urinary biomarkers in stone patients. MATERIALS AND METHODS Ninety-two patients with nephrolithiasis undergoing percutaneous nephrolithotomy were enrolled. Papillary tip biopsies, kidney urine, and bladder urine were collected, as well as voided urine from eight healthy volunteers. Quantitative polymerase chain reaction was performed to measure inflammatory gene expression. RESULTS Initial 84-gene polymerase chain reaction array revealed significant elevation of several cytokines in stone patients vs controls (fold change 2.3-694). Twenty-four genes were selected for final analysis. In 41 pairs of urine samples, levels of CCL5, CD40, FasL, RIPK2, SELE, TLR3, and IL-15 were significantly elevated in kidney vs bladder urine (p0.0001-0.04). In 23 triplets of samples, expression of these cytokines plus CCL2, CCL7, CCR2, CSF1, CXCL9, and CXCL10, was significantly greater in papillary tips vs urine samples (p0.001-0.05). Cytokine elevation was independent of maximum postoperative heart rate, respiratory rate, temperature, leukocyte count, urinary tract infection in the past year, presence or absence of antibiotics at the time of surgery, and stone composition (all p > 0.05). CONCLUSION Expression of CCL-2, CCL-5, CCL-7, CCR-2, CD40, CSF1, CXCL-9, CXCL-10, Fas-L, RIPK2, SELE, and TLR-3 is markedly elevated in the papillary tips, kidney urine, and bladder urine of nephrolithiasis patients. Cytokine elevation was independent of signs of systemic inflammation. These findings further support the role of inflammation in nephrolithiasis and imply that the inflammatory process likely begins at the renal papillae. These may represent novel biomarkers of stone disease, which may be useful in basic nephrolithiasis research, disease diagnosis, and prognosis.
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Affiliation(s)
- Andrew Y Sun
- 1 Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Bryan Hinck
- 1 Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Benjamin R Cohen
- 1 Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Karen Keslar
- 2 Department of Immunology, Cleveland Clinic , Cleveland, Ohio
| | | | - Manoj Monga
- 1 Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
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