A retrospective study on sex difference in patients with urolithiasis: who is more vulnerable to chronic kidney disease?

Bidirectional Impact of Varying Severity of Acute Kidney Injury on Calcium Oxalate Stone Formation

INTRODUCTION

Acute kidney injury (AKI) is a prevalent renal disorder. The occurrence of AKI may promote the formation of renal calcium oxalate stones by exerting continuous effects on renal tubular epithelial cells (TECs). We aimed to delineate the molecular interplay between AKI and nephrolithiasis.

METHODS

A mild (20 min) and severe (30 min) renal ischemia-reperfusion injury model was established in mice. Seven days after injury, calcium oxalate stones were induced using glyoxylate (Gly) to evaluate the impact of AKI on the formation of kidney stones. Transcriptome sequencing was performed on TECs to elucidate the relationship between AKI severity and kidney stones. Key transcription factors (TFs) regulating differential gene transcription levels were identified using motif analysis, and pioglitazone, ginkgetin, and fludarabine were used for targeted therapy to validate key TFs as potential targets for kidney stone treatment.

RESULTS

Severe AKI led to increased deposition of calcium oxalate crystals in renal, impaired kidney function, and upregulation of kidney stone-related gene expression. In contrast, mild AKI was associated with decreased crystal deposition, preserved kidney function, and downregulation of similar gene expression. Transcriptomic analysis revealed that genes associated with inflammation and cell adhesion pathways were significantly upregulated after severe AKI, while genes related to energy metabolism pathways were significantly upregulated after mild AKI. An integrative bioinformatic analysis uncovered a TF regulatory network within TECs, pinpointing that PKNOX1 was involved in the upregulation of inflammation-related genes after severe AKI, and inhibiting PKNOX1 function with pioglitazone could simultaneously reduce the increase of calcium oxalate crystals after severe AKI in kidney. On the other hand, motif analysis also revealed the protective role of STAT1 in the kidneys after mild AKI, enhancing the function of STAT1 with ginkgetin could reduce kidney stone formation, while the specific inhibitor of STAT1, fludarabine, could eliminate the therapeutic effects of mild AKI on kidney stones.

CONCLUSION

Inadequate repair of TECs after severe AKI increases the risk of kidney stone formation, with the upregulation of inflammation-related genes regulated by PKNOX1 playing a role in this process. Inhibiting PKNOX1 function can reduce kidney stone formation. Conversely, after mild AKI, effective cell repair through upregulation of STAT1 expression can protect TEC function and reduce stone formation, and activating STAT1 function can also achieve the goal of treating kidney stones.

Postmenopausal status increases the risk of uric acid stones

OBJECTIVE

This study investigated the impact of menopause on stone composition in women with urolithiasis.

STUDY DESIGN

A cross-sectional study was conducted from March 2013 to March 2018. Women with urolithiasis patients were divided into two groups according to their menopause status.

MAIN OUTCOME MEASURES

The clinical demographic characteristics, stone removal, stone composition, and urine chemistry were investigated. Univariate and multivariate survival analyses were performed to identify risk factors for the risk of uric acid stones.

RESULTS

Our study enrolled 1221 female patients with stone diseases, 783 (64.1 %) of whom were postmenopausal (66 patients surgically menopause and 717 patients naturally menopause). Postmenopausal women had higher rates of diabetes and hyperuricemia, a higher serum uric acid level, a higher urinary specific gravity, and a lower estimated glomerular filtration rate. Stone analysis revealed calcium oxalate stones in 66.2 % of the patients, apatite stones in 19.4 %, calcium oxalate and calcium phosphate stones in 7.7 %, uric acid stones in 4.4 %, struvite stones in 2.0 %, and brushite stones in 0.2 %. Postmenopausal women had a higher rate of uric acid stones. Multivariate analysis confirmed that postmenopausal status and hyperuricemia were independent risk factors of uric acid stones. Postmenopausal women required more invasive procedures to remove the stones, and they had lower self-voiding rates.

CONCLUSIONS

Postmenopausal women had higher rates of stone episodes, specifically related to uric acid stones. Given the prevalence and impact of chronic kidney diseases, factors that impede optimal renal function management in women must be identified to provide tailored treatment recommendations.

Prevalence of urolithiasis in Saudi Arabia: A systematic literature review

Urolithiasis is a common urological disease that can have a negative impact on health and quality of life in people worldwide. Multiple studies have investigated the prevalence of urolithiasis worldwide. However, research on this disease in Saudi Arabia is very limited. This review was conducted to investigate the prevalence of urolithiasis and its associations in Saudi Arabia. A standardized, systematic search strategy was conducted to identify observational studies that reported the prevalence of urolithiasis in Saudi Arabia. The search included published studies between January 2000 and October 2023. A variation in prevalence between regions was found and was reported to range from 6% to 19%. A significant association between urolithiasis and two factors, increasing age and family history, was found. Studies on urolithiasis are limited in Saudi Arabia. Despite this, it is evident that the prevalence of urolithiasis is comparable in other parts of the world. Public awareness and lifestyle modification efforts may help reduce this disease's impact on our population.

Prevalence of urolithiasis in China: a systematic review and meta-analysis

OBJECTIVE

To estimate the pooled prevalence, as well as the spatial and temporal distribution, of urolithiasis among subjects in China.

MATERIALS AND METHODS

We conducted a comprehensive search of both Chinese and English databases to retrieve literature pertaining to the prevalence of urolithiasis in the indigenous Chinese population. A random-effects meta-analysis model was employed to calculate the pooled prevalence of urolithiasis. Subgroup analyses were conducted based on factors such as time, region, gender, and sample size. Prevalence and spatial distribution maps were created based on provinces and latitude/longitude coordinates.

RESULTS

A total of 46 studies conducted in 22 provinces across China were included in this meta-analysis and the pooled prevalence of urolithiasis, kidney stones, ureteric calculi, urethral and bladder stones were 8.1% (95% confidence interval [CI] 5.6-11.1%), 7.8% (95% CI 5.8-10.0%), 3.2% (95% CI 0.6-5.7%), 0.5% (95% CI 0.1-0.9%). Most of the urolithiasis prevalence screening in China was concentrated between 100° E and 120° E, with higher rates observed in low latitude areas. Subgroup analysis of kidney stones revealed that Guangdong (12.7%) and Guangxi (10.3%) had the highest prevalence, with the eastern developed area exhibiting higher rates compared to the west. The prevalence in males was higher than in females (odds ratio 1.67, 95% CI 1.46-1.92), although the gender gap has significantly reduced since 2006. Moreover, a greater sample size is associated with a decreased prevalence of urolithiasis.

CONCLUSIONS

The prevalence of urolithiasis is increasing in China, and there are noteworthy regional or provincial disparities in occurrence. It is worth noting that the current number of screening studies in some areas is insufficient. Additional investigations with appropriate sample sizes should be supplemented in time.

Comparison of the efficacy and safety of holmium laser with the Moses technology and regular mode for stone treatment: a systematic review and meta-analysis

BACKGROUND

As a new pulse modality of holmium laser in retrograde intrarenal stone surgery, the MOSES technique can reduce the possibility of stone drifting and help to powder kidney stones in vitro and in animal experiments. However, there remains controversy about whether the MOSES mode needs to be used instead of the regular mode in clinical practice. This meta-review was conducted to evaluate the clinical efficacy and safety of MOSES technology for stone disease.

METHODS

PubMed, Embase, Web of Science, Cochrane Library, and CNKI were searched for relevant studies until September 2022, with 1 RCT and 6 nonrandomized studies included. We pulled data on adverse events, success rates and operative time to analyze based on the random effect model.

RESULTS

We found that using MOSES mode could shorten the operative time (standard mean difference [SMD] - 0.43; 95% confidence interval [CI] - 0.79 to  - 0.08; P = 0.016) than regular mode especially in a small sample study or in the Asian area. When the number of women is smaller than the number of men, the reduction of the duration was also significant. Stone-free rates of the two modes had no difference (relative risk [RR] 1.06; 95% CI 0.99-1.12; P = 0.30), and there was no publication bias. In terms of safety, no significant difference in complications was detected between the two approaches (RR 0.85; 95% CI 0.48-1.53; P = 0.81) without significant heterogeneity.

CONCLUSION

MOSES mode holmium laser was superior to the regular mode laser in terms of procedure time. There was no large disparity in stone-free rates or complications between the two modes. However, our conclusions should be confirmed in prospective studies with high evidence.

Factors Associated With Urolithiasis: A Hospital-Based Case-Control Study

BACKGROUND

Urolithiasis is a common preventable ailment. Previous studies showed that there are a lot of factors, such as dietary, health and environmental factors, which are likely to develop this condition. Only a few research have been conducted on urolithiasis in the UAE. Therefore, our study aimed to identify the factors associated with urolithiasis in the country, identify the symptoms of urolithiasis among the cases and identify the most common diagnostic methods.

METHODOLOGY

It was a case-control study design. The study population was adults above 18 years attending a tertiary care centre. Those who have confirmed diagnosis of urolithiasis and gave informed consent were considered cases and those who have not confirmed diagnosis of urolithiasis as controls. Patients with renal, bladder or urinary tract impairment or anomaly were excluded from the study. Ethical approval was obtained for the study.

RESULTS

Crude odds ratio (OR) showed that age, gender, past treatment for urinary stones, and lifestyle factors such as diet and smoking are risk factors while exercising is a protective factor. Age-adjusted OR found that past treatment for the urinary disease (OR=10.4), consumption of oily food (OR=11.5), consumption of fast food (OR=11.0) and consumption of energy drinks (OR=5.9) were the significant risk factors for urolithiasis.

CONCLUSION

We found that past urinary disease treatment and diet are vital in developing urinary stones. Higher consumption of salty, oily, sugary and protein foods increases the odds of urinary diseases. Public awareness programs are essential to educating people about urolithiasis risk factors and preventive measures.

Sex disparities and the risk of urolithiasis: a large cross-sectional study

BACKGROUND

Urolithiasis is one of the most common diseases in urology, with a lifetime prevalence of 14% and is more prevalent in males compared to females. We designed to explore sex disparities in the Chinese population to provide evidence for prevention measures and mechanisms of stone formation.

MATERIALS AND METHODS

A total of 98232 Chinese individuals who had undergone a comprehensive examination in 2017 were included. Fully adjusted odds ratios for kidney stones were measured using restricted cubic splines. Multiple imputations was applied for missing values. Propensity score matching was utilised for sensitivity analysis.

RESULTS

Among the 98232 included participants, 42762 participants (43.53%) were females and 55470 participants (56.47%) were males. Patients' factors might cast an influence on the development of kidney stone disease distinctly between the two genders. A risk factor for one gender might have no effect on the other gender. The risk for urolithiasis in females continuously rises as ageing, while for males the risk presents a trend to ascend until the age of around 53 and then descend.

CONCLUSIONS

Patients' factors might influence the development of kidney stones distinctly between the two genders. As age grew, the risk to develop kidney stones in females continuously ascended, while the risk in males presented a trend to ascend and then descend, which was presumably related to the weakening of the androgen signals.Key messagesWe found that patients' factors might cast an influence on the development of kidney stone disease distinctly between the two sexes.The association between age and urolithiasis presents distinct trends in the two sexesThe results will provide evidence to explore the mechanisms underlying such differences can cast light on potential therapeutic targets and promote the development of tailored therapy strategies in prospect.

[Urolithiasis-Therapy and recurrence prevention taking into account gender-specific aspects]

The prevalence of urolithiasis is steadily increasing worldwide in both genders. Diet and lifestyle, such as the rising prevalence of obesity and other metabolic syndrome traits, are considered key factors in this trend. Gender differences as a result of interventional therapy for urolithiasis have not been observed. However, iatrogenic injury to the male urethra is considered the most common reason for urethral strictures after endourologic (stone) therapy. In contrast, sepsis, as the major cause of urinary stone-related mortality, is more frequently reported in women after ureterorenoscopy and percutaneous nephrolithotomy. There are also differences in the frequency of various types of stones between men and women. Calcium oxalate and uric acid stones are more commonly observed in men, while carbonate apatite and struvite are diagnosed more often in women. Urinary stone analysis is therefore paramount for successful recurrence prevention. Diagnosis is based on the assignment of patients to the low-risk or high-risk group. The medical nutrition and pharmacological measures for the therapy of the respective type of stone are based on the risk factors in 24 h urine samples. A personalized approach that accounts for gender differences could further improve treatment, and recurrence prevention decisions for urinary stones.

Prevalence and trends of urolithiasis among adults

PURPOSE OF REVIEW

The purpose of this article is to review and synthesize the current literature on the epidemiology of urolithiasis.

RECENT FINDINGS

The global patterns of urolithiasis are changing, as the prevalence of urolithiasis appears to be increasing across the world. Geographical variation in the prevalence of urolithiasis is noted across countries and within each country. Although urolithiasis is more common among men and white race, recent data suggests a more prominent rise in the prevalence among women and African Americans. Yet, no conclusive explanations for these phenomena are reported so far.

SUMMARY

Urolithiasis is a highly prevalent condition with an increasing prevalence among women as compared with men closing the gender gap in urolithiasis. Further studies are needed to identify the potential causes for this observation.

Cardiac Diagnostic Feature and Demographic Identification (CDF-DI): An IoT Enabled Healthcare Framework Using Machine Learning

The incidence of cardiovascular diseases and cardiovascular burden (the number of deaths) are continuously rising worldwide. Heart disease leads to heart failure (HF) in affected patients. Therefore any additional aid to current medical support systems is crucial for the clinician to forecast the survival status for these patients. The collaborative use of machine learning and IoT devices has become very important in today's intelligent healthcare systems. This paper presents a Public Key Infrastructure (PKI) secured IoT enabled framework entitled Cardiac Diagnostic Feature and Demographic Identification (CDF-DI) systems with significant Models that recognize several Cardiac disease features related to HF. To achieve this goal, we used statistical and machine learning techniques to analyze the Cardiac secondary dataset. The Elevated Serum Creatinine (SC) levels and Serum Sodium (SS) could cause renal problems and are well established in HF patients. The Mann Whitney U test found that SC and SS levels affected the survival status of patients (p < 0.05). Anemia, diabetes, and BP features had no significant impact on the SS and SC level in the patient (p > 0.05). The Cox regression model also found a significant association of age group with the survival status using follow-up months. Furthermore, the present study also proposed important features of Cardiac disease that identified the patient's survival status, age group, and gender. The most prominent algorithm was the Random Forest (RF) suggesting five key features to determine the survival status of the patient with an accuracy of 96%: Follow-up months, SC, Ejection Fraction (EF), Creatinine Phosphokinase (CPK), and platelets. Additionally, the RF selected five prominent features (smoking habits, CPK, platelets, follow-up month, and SC) in recognition of gender with an accuracy of 94%. Moreover, the five vital features such as CPK, SC, follow-up month, platelets, and EF were found to be significant predictors for the patient's age group with an accuracy of 96%. The Kaplan Meier plot revealed that mortality was high in the extremely old age group (χ2 (1) = 8.565). The recommended features have possible effects on clinical practice and would be supportive aid to the existing medical support system to identify the possibility of the survival status of the heart patient. The doctor should primarily concentrate on the follow-up month, SC, EF, CPK, and platelet count for the patient's survival in the situation.

Kidney stone proteomics: an update and perspectives

INTRODUCTION

Main problems of kidney stone disease are its increasing prevalence and high recurrence rate after calculi removal in almost all areas around the globe. Despite enormous efforts in the past, its pathogenic mechanisms remain unclear and need further elucidations. Proteomics has thus become an essential tool to unravel such sophisticated disease mechanisms at cellular, subcellular, molecular, tissue, and whole organism levels.

AREAS COVERED

This review provides abrief overview of kidney stone disease followed by updates on proteomics for investigating urinary stone modulators, matrix proteins, cellular responses to different types/doses of calcium oxalate (CaOx) crystals, sex hormones and other stimuli, crystal-cell interactions, crystal receptors, secretome, and extracellular vesicles (EVs), all of which lead to better understanding of the disease mechanisms. Finally, the future challenges and translation of these obtained data to the clinic are discussed.

EXPERT OPINION

Knowledge from urinary proteomics for exploring the important stone modulators (either inhibitors or promoters) will be helpful for early detection of asymptomatic cases for prompt prevention of symptoms, complications, and new stone formation. Moreover, these modulators may serve as the new therapeutic targets in the future for successful treatment and prevention of kidney stone disease by medications or other means of intervention.