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Yao L, Yang P. Relationship between remnant cholesterol and risk of kidney stones in U.S. Adults: a 2007-2016 NHANES analysis. Ann Med 2024; 56:2319749. [PMID: 38733306 PMCID: PMC11089921 DOI: 10.1080/07853890.2024.2319749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/10/2024] [Indexed: 05/13/2024] Open
Abstract
PURPOSE Remnant cholesterol (RC) is the cholesterol content of triglyceride-rich lipoproteins. This study aimed to investigate the association between RC levels and kidney stones in U.S. adults. METHODS Data were obtained from the 2007 to 2016 National Health and Nutrition Examination Survey (NHANES). A total of 10,551 participants with complete data were included and analyzed in this study. Univariate and multivariate logistic regression analysis, restricted cubic spline function, subgroup analysis and mediation analysis were preformed to estimate the independent relationship between RC levels and kidney stones. RESULTS Participants with stone formation had higher levels of RC than those with without stone formation (25.78 ± 13.83 vs 23.27 ± 13.04, p< 0.001). The results of logistic regression analysis and dose-response risk curves revealed a positive nonlinear association between RC levels and risk of kidney stones [univariate: adjusted odds ratio (aOR) =2.388, 95% CI: 1.797-3.173, p< 0.001; multivariate: aOR = 1.424, 95% CI: 1.050-1.929, p = 0.023]. Compared with the discordantly low RC group, the discordantly high RC group was associated with increased risk of kidney stones (aOR = 1.185, 95% CI: 1.013-1.386, p= 0.034). Similar results were demonstrated according to the discordance of different clinical cut points. And metabolic syndrome parameters and vitamin D levels parallelly mediated the association between RC and kidney stone risk. CONCLUSIONS Higher RC levels were independently associated with an increased risk of kidney stone incidence.
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Affiliation(s)
- Lei Yao
- Department of Urology, The People’s Hospital of Yingshang, Yingshang, Anhui, China
| | - Peigang Yang
- Department of Urology, The People’s Hospital of Yingshang, Yingshang, Anhui, China
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Wu J, Yu H, Zhu Z, Chen J, Chen Z, Chen H. Association between tea consumption and risk of kidney stones: results from dose-response meta-analysis of prospective studies and Mendelian randomization analysis. Int Urol Nephrol 2024; 56:1835-1841. [PMID: 38212471 DOI: 10.1007/s11255-023-03918-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/11/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE The association between tea consumption and kidney stones is inconsistent in observational studies. Thus, we performed a dose-response meta-analysis of prospective cohort studies and a two-sample Mendelian randomization (MR) analysis to identify this association. METHODS The prospective cohort studies reporting the relationship between tea consumption and kidney stones were searched from PubMed, the Cochrane Library, EMBASE, and Web of Science from inception to December 1, 2023. For MR analysis, the summary-level data for tea consumption and kidney stones were extracted from the UK Biobank available data and the 8th release of the FinnGen consortium, respectively. The inverse-variance weighted (IVW) method was the primary analytical method. RESULTS In our dose-response meta-analysis, four prospective cohort studies involving 1,263,008 participants were included, and tea consumption was found to have significant associations with kidney stones (RR: 0.80, 95% CI: 0.73-0.87). We also observed a substantially linear negative relationship between tea consumption and the risk of kidney stones. In MR analysis, the IVW method indicated that tea consumption was inversely associated with kidney stones (OR: 0.71, 95% CI: 0.53-0.94). CONCLUSION Our study confirmed a causal relationship between tea consumption and kidney stones, and higher tea consumption may reduce the risk of kidney stones.
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Affiliation(s)
- Jian Wu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hao Yu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zewu Zhu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jinbo Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyong Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Awuah Boadi E, Shin S, Choi BE, Ly K, Raub CB, Bandyopadhyay BC. Sex-specific Stone-forming Phenotype in Mice During Hypercalciuria/Urine Alkalinization. J Transl Med 2024; 104:102047. [PMID: 38452902 PMCID: PMC11103239 DOI: 10.1016/j.labinv.2024.102047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/31/2024] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
Sex differences in kidney stone formation are well known. Females generally have slightly acidic blood and higher urine pH when compared with males, which makes them more vulnerable to calcium stone formation, yet the mechanism is still unclear. We aimed to examine the role of sex in stone formation during hypercalciuria and urine alkalinization through acetazolamide and calcium gluconate supplementation, respectively, for 4 weeks in wild-type (WT) and moderately hypercalciuric [TRPC3 knockout [KO](-/-)] male and female mice. Our goal was to develop calcium phosphate (CaP) and CaP+ calcium oxalate mixed stones in our animal model to understand the underlying sex-based mechanism of calcium nephrolithiasis. Our results from the analyses of mice urine, serum, and kidney tissues show that female mice (WT and KO) produce more urinary CaP crystals, higher [Ca2+], and pH in urine compared to their male counterparts. We identified a sex-based relationship of stone-forming phenotypes (types of stones) in our mice model following urine alkalization/calcium supplementation, and our findings suggest that female mice are more susceptible to CaP stones under those conditions. Calcification and fibrotic and inflammatory markers were elevated in treated female mice compared with their male counterparts, and more so in TRPC3 KO mice compared with their WT counterparts. Together these findings contribute to a mechanistic understanding of sex-influenced CaP and mixed stone formation that can be used as a basis for determining the factors in sex-related clinical studies.
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Affiliation(s)
- Eugenia Awuah Boadi
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, Washington, DC
| | - Samuel Shin
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, Washington, DC; Department of Biomedical Engineering, The Catholic University of America, Washington DC
| | - Bok-Eum Choi
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, Washington, DC
| | - Khanh Ly
- Department of Biomedical Engineering, The Catholic University of America, Washington DC
| | - Christopher B Raub
- Department of Biomedical Engineering, The Catholic University of America, Washington DC
| | - Bidhan C Bandyopadhyay
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, Washington, DC; Department of Biomedical Engineering, The Catholic University of America, Washington DC; Division of Renal Diseases and Hypertension, Department of Medicine, The George Washington University, Washington DC.
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Lepine HL, Vicentini FC, Mazzucchi E, Molina WR, Marchini GS, Torricelli FC, Batagello CA, Danilovic A, Nahas WC. Intraoperative computed tomography for detection of residual stones in endourology procedures: systematic review and meta-analysis. Int Braz J Urol 2024; 50:250-260. [PMID: 38598828 DOI: 10.1590/s1677-5538.ibju.2024.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Success rates in endourological procedures, notably percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS), have demonstrated suboptimal outcomes, leading to more reinterventions and radiation exposure. Recently, the use of intraoperative computed tomography (ICT) scans has been hypothesized as a promising solution for improving outcomes in endourology procedures. With this considered, we conducted a comprehensive systematic review and meta-analysis encompassing all available studies that evaluate the impact of the use of intraoperative CT scans on surgical outcomes compared to conventional fluoroscopic-guided procedures. METHODS This systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were systematically searched up to December of 2023. This study aimed to directly compare the use of an ICT scan with the standard non-ICT-guided procedure. The primary endpoint of interest was success rate, and the secondary endpoints were complications and reintervention rates, while radiation exposure was also evaluated. Data extraction and quality assessment were performed following Cochrane recommendations. Data was presented as an Odds ratio with 95%CI across trials and a random-effects model was selected for pooling of data. RESULTS A comprehensive search yielded 533 studies, resulting in the selection of 3 cohorts including 327 patients (103 ICT vs 224 in non-ICT). Primary outcome was significantly higher in the experimental group versus the control group (84.5% vs 41.4% respectively, 307 patients; 95% CI [3.61, 12.72]; p<0.00001; I2=0). Reintervention rates also decreased from 32.6% in the control to 12.6% in the ICT group (OR 0.34; 95%CI [0.12,0.94]; p =0.04; I2= 48%), whereas complication rates did not exhibit significant differences. Radiation exposure was also significantly reduced in two of the included studies. CONCLUSION This meta-analysis highlights a favorable outcome with intraoperative CT scan use in PCNL procedures, showing a considerable increase in SFR when compared to standard fluoroscopy and nephroscopy. Despite limited studies, our synthesis underscores the potential of ICT scans to significantly reduce residual stones and their consequences for endourology patients, as reinterventions and follow-up ionizing radiation studies.
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Affiliation(s)
- Henrique L Lepine
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fabio C Vicentini
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Wilson R Molina
- Department of Urology, Endourology Section, University of Kansas, Kansas City, KS, USA
| | - Giovanni S Marchini
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fabio C Torricelli
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Carlos A Batagello
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alexandre Danilovic
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - William C Nahas
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Gombedza FC, Shin S, Sadiua J, Stackhouse GB, Bandyopadhyay BC. The Rise in Tubular pH during Hypercalciuria Exacerbates Calcium Stone Formation. Int J Mol Sci 2024; 25:4787. [PMID: 38732005 PMCID: PMC11084476 DOI: 10.3390/ijms25094787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
In calcium nephrolithiasis (CaNL), most calcium kidney stones are identified as calcium oxalate (CaOx) with variable amounts of calcium phosphate (CaP), where CaP is found as the core component. The nucleation of CaP could be the first step of CaP+CaOx (mixed) stone formation. High urinary supersaturation of CaP due to hypercalciuria and an elevated urine pH have been described as the two main factors in the nucleation of CaP crystals. Our previous in vivo findings (in mice) show that transient receptor potential canonical type 3 (TRPC3)-mediated Ca2+ entry triggers a transepithelial Ca2+ flux to regulate proximal tubular (PT) luminal [Ca2+], and TRPC3-knockout (KO; -/-) mice exhibited moderate hypercalciuria and microcrystal formation at the loop of Henle (LOH). Therefore, we utilized TRPC3 KO mice and exposed them to both hypercalciuric [2% calcium gluconate (CaG) treatment] and alkalineuric conditions [0.08% acetazolamide (ACZ) treatment] to generate a CaNL phenotype. Our results revealed a significant CaP and mixed crystal formation in those treated KO mice (KOT) compared to their WT counterparts (WTT). Importantly, prolonged exposure to CaG and ACZ resulted in a further increase in crystal size for both treated groups (WTT and KOT), but the KOT mice crystal sizes were markedly larger. Moreover, kidney tissue sections of the KOT mice displayed a greater CaP and mixed microcrystal formation than the kidney sections of the WTT group, specifically in the outer and inner medullary and calyceal region; thus, a higher degree of calcifications and mixed calcium lithiasis in the kidneys of the KOT group was displayed. In our effort to find the Ca2+ signaling pathophysiology of PT cells, we found that PT cells from both treated groups (WTT and KOT) elicited a larger Ca2+ entry compared to the WT counterparts because of significant inhibition by the store-operated Ca2+ entry (SOCE) inhibitor, Pyr6. In the presence of both SOCE (Pyr6) and ROCE (receptor-operated Ca2+ entry) inhibitors (Pyr10), Ca2+ entry by WTT cells was moderately inhibited, suggesting that the Ca2+ and pH levels exerted sensitivity changes in response to ROCE and SOCE. An assessment of the gene expression profiles in the PT cells of WTT and KOT mice revealed a safeguarding effect of TRPC3 against detrimental processes (calcification, fibrosis, inflammation, and apoptosis) in the presence of higher pH and hypercalciuric conditions in mice. Together, these findings show that compromise in both the ROCE and SOCE mechanisms in the absence of TRPC3 under hypercalciuric plus higher tubular pH conditions results in higher CaP and mixed crystal formation and that TRPC3 is protective against those adverse effects.
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Affiliation(s)
- Farai C. Gombedza
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, 50 Irving Street, NW, Washington, DC 20422, USA; (F.C.G.); (S.S.); (J.S.)
| | - Samuel Shin
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, 50 Irving Street, NW, Washington, DC 20422, USA; (F.C.G.); (S.S.); (J.S.)
- Department of Biomedical Engineering, The Catholic University of America, 620 Michigan Avenue NE, Washington, DC 20064, USA
| | - Jaclyn Sadiua
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, 50 Irving Street, NW, Washington, DC 20422, USA; (F.C.G.); (S.S.); (J.S.)
| | - George B. Stackhouse
- Urology Service, Veterans Affairs Medical Center, 50 Irving Street, NW, Washington, DC 20422, USA;
| | - Bidhan C. Bandyopadhyay
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, 50 Irving Street, NW, Washington, DC 20422, USA; (F.C.G.); (S.S.); (J.S.)
- Department of Biomedical Engineering, The Catholic University of America, 620 Michigan Avenue NE, Washington, DC 20064, USA
- Division of Renal Diseases & Hypertension, Department of Medicine, The George Washington University, Washington, DC 20037, USA
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Danilovic A, Suartz CV, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Nahas WC, Mazzucchi E. Play it safe: renal function after bilateral flexible ureteroscopy for kidney stones. World J Urol 2024; 42:226. [PMID: 38594574 DOI: 10.1007/s00345-024-04924-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
PURPOSE We searched for perioperative renal function deterioration risk factors in patients that underwent bilateral flexible ureteroscopy (fURS) for kidney stones. METHODS From August 2016 to February 2020, symptomatic patients > 18 years old with bilateral kidney stones up to 20 mm in each side were prospectively studied. Serum creatinine samples were collected on admission to surgery, immediate postoperative (IPO), on POD 3, 10, and 30. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) without a race coefficient. RESULTS Thirty patients underwent bilateral fURS. Comparing to preoperative eGFR, median IPO and POD3 eGFR (p < 0.001) were significantly lower, and POD10 (p = 0.092) and POD30 (p = 0.648) were similar to preoperative eGFR. During follow-up, 22/30 (73.3%), 14/30 (46.7%), and 7/30 (23.3%) of the patients presented a decrease > 10% eGFR, > 20% eGFR, and > 30% eGFR, respectively. Multivariate analysis demonstrated that lower preoperative eGFR is a risk factor for eGFR < 60 mL/min/1.73 m2, p = 0.019 [1.021-1.263; 1.136]; ASA > 1 is a risk factor for decrease of eGFR > 10%, p = 0.028 [1.25-51.13; 8.00]; longer operative time is a risk factor for decrease of eGFR > 20%, p = 0.042 [1.00-1.05; 1.028]; and operative time ≥ 120 min is a risk factor for decrease of eGFR > 30%, p = 0.026 [0.016-0.773; 0.113]. CONCLUSIONS Renal function suffers a reversible decrease after bilateral fURS. Our study suggests that adequate selection of patients and maintaining operative time < 120 min are relevant factors in preventing acute renal function deterioration following bilateral fURS.
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Affiliation(s)
- Alexandre Danilovic
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil.
| | - Caio Vinicius Suartz
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - Fabio Cesar Miranda Torricelli
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - Giovanni Scala Marchini
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - Carlos Batagello
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - Fabio Carvalho Vicentini
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - William C Nahas
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Eduardo Mazzucchi
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
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Cheraghian B, Meysam A, Hashemi SJ, Hosseini SA, Malehi AS, Khazaeli D, Rahimi Z. Kidney stones and dietary intake in adults: a population-based study in southwest Iran. BMC Public Health 2024; 24:955. [PMID: 38575950 PMCID: PMC10993538 DOI: 10.1186/s12889-024-18393-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The prevalence of kidney stones is on the rise globally. Several risk factors, including lifestyle, contribute to the formation of kidney stones. Nevertheless, there is a contentious debate about the relationship between diet and kidney stones. Therefore, our study aimed to assess the relationship between macronutrients and micronutrients and the formation of kidney stones. METHODS This population-based cross-sectional study was conducted in the baseline phase of the Hoveyzeh Cohort Study, focusing on adults aged 35-70 in southwest Iran. The information on demographic characteristics, anthropometrics, kidney stone history, and food frequency was collected. Chi-square and t-tests were utilized to assess the relationship between categorical and numerical variables with kidney stones. The ANCOVA and logistic regression models were used to evaluate the relationships while controlling for confounding factors. RESULTS Among 10,009 participants, the overall prevalence of kidney stones was 18.77% (95% CI: 17.99-19.53). A higher intake of carbohydrates [OR = 1.02 (95% CI:1.002-1.03), p = 0.026] and copper [OR = 1.04 (95% CI:1.01-1.09), p = 0.025] were found to be associated with kidney stones. No associations were found between the other assessed macronutrients or micronutrients and kidney stones (p-tvalues > 0.05). CONCLUSION Our study's findings indicate a correlation between diet and the formation of kidney stones. However, the relationship between dietary factors and kidney stones is complex, and further research is needed.
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Affiliation(s)
- Bahman Cheraghian
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alipour Meysam
- Department of Nutrition, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
| | - Seyed Jalal Hashemi
- Alimentary Tract Research Center, Clinical Sciences Research Institute, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Ahmad Hosseini
- Nutrition and Metabolic Diseases Research Center, Clinical Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amal Saki Malehi
- Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Dinyar Khazaeli
- Department of Urology, School of Medicine, Chronic Renal Failure Research Center Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Rahimi
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Zhao E, Gao Y, Xiao R, Zhang C. Patterns of weight change during adulthood and incidence of nephrolithiasis: a population-based study. Int J Obes (Lond) 2024; 48:461-468. [PMID: 38071395 DOI: 10.1038/s41366-023-01434-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 04/02/2024]
Abstract
BACKGROUND There is some evidence to suggest that there may be a link between body mass index (BMI) and the development of kidney stones, it remains unclear whether weight change was associated with the presence of kidney stone. AIMS The objective of this study was to investigate the potential association between changes patterns in weight during adulthood and the incidence of kidney stone. METHODS This study included 14472 participants aged 30-75 years, whose BMI was recorded at both baseline and 10 years prior to the survey. We categorized individuals into five weight change patterns: stable healthy, non-obesity to obesity, obesity to non-obesity, stable obesity, and maximum overweight. Odds ratios (OR) and 95% confidence intervals (CI) relating weight change to incident kidney stone were calculated using logistic regression models adjusting for covariates. The non-linear association between absolute weight change was investigated using the restricted cubic spline (RCS) regression. The supposed population attributable fraction (PAF) for the weight change patterns was calculated. RESULTS After adjusting for all confounders, participants changing from non-obesity to obesity, obesity to non-obesity, and stable obesity had significantly higher risks of kidney stone than those with healthy weight during adulthood (OR = 1.59, 95% CI:1.18-2.13; OR = 1.78, 95% CI: 1.47-2.16; OR = 1.80, 95% CI: 1.48-2.19, respectively). A U-shaped association was observed, and the risk of kidney stone was lowest in participants with stable healthy BMI. If the population had maintained a healthy BMI, a 28.7% (95% CI: 18.6%-37.5%) lower incidence of kidney stones was observed. CONCLUSIONS This study found that changes in weight during adulthood are linked to the risk of developing kidney stones. Maintaining healthy weight during adulthood is important for reducing the risk of developing kidney stones.
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Affiliation(s)
- Enfa Zhao
- Department of Ultrasound, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Yuan Gao
- Department of Ultrasound, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Rong Xiao
- Department of Ultrasound, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Chaoxue Zhang
- Department of Ultrasound, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
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Rodgers AL, Arzoz-Fabregas M, Roca-Antonio J, Dolade-Botias M, Shivappa N, Hébert JR. Correlation research demonstrates that an inflammatory diet is a risk factor for calcium oxalate renal stone formation. Clin Nutr ESPEN 2024; 60:320-326. [PMID: 38479930 DOI: 10.1016/j.clnesp.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/11/2023] [Accepted: 02/01/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND AND AIMS Previous studies have demonstrated associations between the Dietary Inflammatory Index (DII®), an analytical tool which evaluates the inflammatory potential of the diet according to the pro- and anti-inflammatory properties of its components, and renal stone formation. However, these have not comprehensively addressed important parameters such as stone type, gender, DII scores in stone formers (SFs) and healthy controls (Cs) and associations of DII with urine and blood chemistries. These were adopted as the survey parameters for the present study, the purpose of which was to test whether the contributory role of an inflammatory diet on stone formation could be further confirmed. METHODS 97 calcium oxalate (CaOx) SFs and 63 Cs, matched for age and gender each completed a semi-quantitative food frequency questionnaire from which nutrient composition was computed. These data were used to calculate the DII® score. To control the effect of energy intake, energy-adjusted DII scores were calculated per 1000 kcal consumed (E-DII™). A single blood sample and two consecutive overnight (8h) urine samples were collected from a subset (n = 59 SFs and n = 54 Cs) of the overall number of particpants (n = 160). These were analysed for renal stone risk factors. Data were analysed using regression models fit in R software. RESULTS E-DII scores were found to fit the data better than DII, so they were used throughout. E-DII scores were significantly more positive (more pro-inflammatory) in SFs than in controls in the combined gender group (-0.34 vs. -1.73, p < 0.0001) and separately in males (-0.43 vs. -1.78, p = 0.01) and females (-0.26 vs. - 1.61, p = 0.05). In blood, a significant negative correlation was seen between E-DII and HDL cholesterol. In urine significant positive correlations were seen between E-DII and each of calcium (ρ = 0.25, p = 0.02), phosphate (ρ = 0.48, p < 0.001), magnesium (ρ = 0.33, p < 0.0001) and uric acid (ρ = 0.27, p = 0.004) concentrations. A significant negative correlation was seen between E-DII and urinary volume ρ = -0.27, p = 0.003). There was no correlation between E-DII scores and the relative supersaturations of urinary CaOx, calcium phosphate (brushite) and uric acid. CONCLUSIONS Our findings provide hitherto unreported quantitative evidence in support of the notion that the diet of calcium oxalate renal stone patients is significantly more pro-inflammatory than that of healthy controls.
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Affiliation(s)
| | | | | | | | - Nitin Shivappa
- Cancer Prevention and Control Program, University of South Carolina, USA; Department of Epidemiology and Biostatistics, University of South Carolina, USA; Connecting Health Innovations, Columbia, SC, USA.
| | - James R Hébert
- Cancer Prevention and Control Program, University of South Carolina, USA; Department of Epidemiology and Biostatistics, University of South Carolina, USA; Connecting Health Innovations, Columbia, SC, USA.
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10
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Lin FX, Xu ZP. Deficient butyrate metabolism in the gut microbiome: an emerging risk factor for recurrent kidney stone disease. Urolithiasis 2024; 52:47. [PMID: 38520555 DOI: 10.1007/s00240-024-01558-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/16/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Fu-Xiang Lin
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Foshan, 528000, Guangdong, People's Republic of China
| | - Zhan-Ping Xu
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Foshan, 528000, Guangdong, People's Republic of China.
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11
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Liu H, Wang J, Tao L, Hao Y. Association between DCP levels and kidney stone prevalence in US female adults based on NHANES data. Sci Rep 2024; 14:6457. [PMID: 38499640 PMCID: PMC10948765 DOI: 10.1038/s41598-024-56832-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 03/12/2024] [Indexed: 03/20/2024] Open
Abstract
Our study aimed to evaluate the correlation between levels of 2,4-DCP(2,4-Dichlorophenol) and 2,5-DCP(2,5-Dichlorophenol) and the prevalence of kidney stones in US female adults. Participants were chosen from the National Health and Nutrition Examination Survey database, spanning the years 2007-2016. Dose-response curves were analyzed using logistic regression, subgroup analyses, and other statistical methods to evaluate the relationship between 2,4-DCP and 2,5-DCP levels and the prevalence of kidney stones. The final study included 3220 participants aged over 20 years, with 252 females reporting a history of kidney stones. After accounting for all interfering variables, we found that every 0.1 ug/ml increase in 2.4-DCP correlated with a 1% rise in kidney stone prevalence (OR = 1.01, 95% CI 1.00, 1.01), whereas the same increase in 2.5-DCP was linked to a 27% growth in prevalence (OR = 1.27, 95% CI 1.01, 1.61). Sensitivity analysis was performed by triangulating 2,4-DCP and 2,5-DCP levels. The dose-response curves demonstrated a linear positive relationship between 2,4-DCP and 2,5-DCP levels and the risk of stone development. Our findings indicate a positive correlation between 2,4-DCP and 2,5-DCP levels and the prevalence of kidney stones in US female adults. This association is of clinical significance; however, a direct causal relationship cannot be definitively established.
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Affiliation(s)
- Heqian Liu
- Department of Urology, The Second People's Hospital of Wuhu City (Affiliated Wuhu Hospital of East China Normal University), Wuhu, 241000, China
| | - Jiawei Wang
- Department of Urology, The Second People's Hospital of Wuhu City (Affiliated Wuhu Hospital of East China Normal University), Wuhu, 241000, China
| | - Lingsong Tao
- Department of Urology, The Second People's Hospital of Wuhu City (Affiliated Wuhu Hospital of East China Normal University), Wuhu, 241000, China
| | - Yunwu Hao
- Department of Urology, Lu'an Hospital Affiliated of Anhui Medical University, Lu'an, 237000, Anhui, China.
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12
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Wei B, Tan W, He S, Yang S, Gu C, Wang S. Association between drinking status and risk of kidney stones among United States adults: NHANES 2007-2018. BMC Public Health 2024; 24:820. [PMID: 38491490 PMCID: PMC10941453 DOI: 10.1186/s12889-024-18307-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the relationship between drinking status and kidney stones occurrence among United States (US) adults who consume alcohol. METHODS We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES 2007-2018). Questionnaires yielded information on alcohol consumption and kidney health. Drinking status was categorized into four groups-former, mild, moderate, and heavy-based on alcohol consumption patterns. The aim was to explore the relationship between drinking status and the prevalence of kidney stones occurrence. For this analysis, we examined a group of individuals diagnosed with kidney stones. With survey weights applied, the total weight of the group was 185,690,415. RESULTS We used logistic regression to measure the relationship between drinking status and the likelihood of developing kidney stones. In a fully adjusted model, former drinkers were less likely to have previously experienced kidney stones (OR 0.762, 95% CI 0.595-0.977, P < 0.05). In subgroup analysis, heavy alcohol consumption was associated with a significantly reduced likelihood of kidney stones occurrence in various populations. The adjusted odds ratios (with 95% confidence intervals) of kidney stones risk for heavy alcohol consumption were 0.745 (0.566-0.981) for young individuals, 0.566 (0.342-0.939) for older individuals, 0.708 (0.510-0.981) for individuals of white race, 0.468 (0.269-0.817) for individuals with underweight/normal BMI, 0.192 (0.066-0.560) for widowed people, 0.538 (0.343-0.843) for smoking individuals, 0.749 (0.595-0.941) for individuals without a cancer history, and 0.724 (0.566-0.925) for individuals without a stroke history. CONCLUSIONS In US adults who consume alcohol, a negative linear relationship is apparent between drinking status and the prevalence of kidney stones, with heavy drinking showing a lower prevalence compared to former drinkers. However, the causal relationship between drinking status and kidney stones requires further investigation in future research endeavors.
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Affiliation(s)
- Baian Wei
- The Second School of Clinical Medical , Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Wenyue Tan
- The Second School of Clinical Medical , Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Shuien He
- The Second School of Clinical Medical , Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Shijian Yang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Chiming Gu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Shusheng Wang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.
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Elbaset MA, Taha DE, Anas M, Elghareeb A, Abouelkheir RT, Ashour R, Sheir KZ, Osman Y. Ureteral wall thickness as a predictor for non-invasive treatment success for steinstrasse. Can we save time? World J Urol 2024; 42:151. [PMID: 38478098 PMCID: PMC10937774 DOI: 10.1007/s00345-024-04874-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/23/2023] [Indexed: 03/17/2024] Open
Abstract
PURPOSE We aimed to define factors affecting the non-invasive overall treatment success (medical expulsive therapy (MET) ± shock wave lithotripsy (SWL)) for uncomplicated ureteral steinstrasse (SS) clearance. METHODS We retrospectively evaluated consecutive patients who underwent SWL for renal stones between 2017 and 2021. Patients with uncomplicated SS were included. All patient's demographic and radiological data, e.g., age, gender, pre-SWL stenting, SS site, type, leading stone size in widest diameter (< 10 mm and ≥ 10 mm), ureteral wall thickness (UWT) in mm against the leading stone were collected. If SS was diagnosed, medical treatment was given for 4 weeks. In case of MET failure, either SWL for the leading stones + MET or direct URS was done. Non-invasive treatment success (SFR) was considered if complete clearance of SS occurred with no complications or the need for invasive intervention. RESULTS A total of 145 patients were included with mean age of 45.9 ± 12.4 years. SFR in case of MET only occurred in 27.9%. Complications happened in 26 patients (17.9%). Non-invasive treatment SFR was achieved in 78 patients (53.8%) totally where SS type I, leading stone size ≤ 10 mm type and decreased UWT around the leading stone increased treatment success. CONCLUSION Ureteral wall thickness is an important factor predicting SS management success. Besides the decreased UWT, non-invasive management should be offered for type I SS with leading stone ≤ 10 mm.
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Affiliation(s)
- M A Elbaset
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
- Urology Department, Horus University, New Damietta, Egypt.
| | - Diaa-Eldin Taha
- Urology Department, KafrELshiekh University, KafrELshiekh, Egypt
| | - Marwan Anas
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Elghareeb
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Rasha T Abouelkheir
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Rawdy Ashour
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - K Z Sheir
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Yasser Osman
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Simon J, Kleinclauss F, Chabannes É, Bouiller K, Frontczak A. Urinary tract infection after flexible ureterorenoscopy for urolithiasis in patients with positive treated preoperative urinalysis. Urolithiasis 2024; 52:45. [PMID: 38466446 DOI: 10.1007/s00240-024-01546-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/10/2024] [Indexed: 03/13/2024]
Abstract
Prevalence of kidney stones is increasing worldwide, flexible ureterorenoscopy (f-URS) is the most common surgical treatment. Postoperative urinary tract infection (PUTI) is the primary complication. Some risk factors are classically associated with PUTI, especially preoperative positive urinalysis (POPU). We aimed to identify risk factors for PUTI after f-URS for urolithiasis in patients with treated POPU, and to identify the different pre and postoperative pathogens. Retrospective, single-center study of all f-URS for urolithiasis between January 2004 and December 2020. Procedures with treated POPU were categorized as PUTI or no PUTI (NPUTI). We examined demographics, preoperative, perioperative and postoperative characteristics in each group. Among 1934 procedures analyzed, 401 (20.7%) had POPU; these were categorized into NPUTI (n = 352, 87.8%) and PUTI (n = 49, 12.2%). By univariate analysis, only preoperative stenting duration (76.3 in NPUTI group vs 107.7 days in PUTI group, p = 0.001) was significantly associated with a higher risk of PUTI in univariate analysis. Germ distribution was similar in both groups. We compared pre- and postoperative microbiological data for interventions with PUTI, and found that only 8.7% of pathogens were identical between pre and postoperative urinalysis. Our study shows that the rate of PUTI is higher for patients with a POPU and that preoperative stent duration is the sole risk factor in patients with POPU. The low concordance rate (8.7%) between POPU and post-operative pathogens highlights the need for further research on obtaining sterile preoperative urinalysis, or performing intraoperative culture (urines, stent or stone), to treat PUTI early with an adapted antibiotic therapy.
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Affiliation(s)
- Jeanne Simon
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 25000, Besançon, France
- University of Franche-Comté, 25000, Besançon, France
| | - François Kleinclauss
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 25000, Besançon, France
- University of Franche-Comté, 25000, Besançon, France
- Nanomedicine Lab, Imagery and Therapeutics, EA 4662, Besançon, France
| | - Éric Chabannes
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 25000, Besançon, France
| | - Kevin Bouiller
- Department of Infectious Disease, University Hospital of Besançon, 25000, Besançon, France
- UMR-CNRS 6249 Chrono-Environnement, Université Bourgogne Franche-Comté, 25000, Besançon, France
| | - Alexandre Frontczak
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 25000, Besançon, France.
- University of Franche-Comté, 25000, Besançon, France.
- Nanomedicine Lab, Imagery and Therapeutics, EA 4662, Besançon, France.
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15
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Pulido-Contreras E, Primo-Rivera MA, Garcia-Padilla MA, Rios-Melgarejo C. Ureteral stent after PCNL: is leaving the threads through the percutaneous tract safe and better tolerated? World J Urol 2024; 42:77. [PMID: 38340266 DOI: 10.1007/s00345-023-04767-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/10/2023] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVE To assess safety, urinary symptoms, and feasibility of JJ stent removal with exteriorized threads through the percutaneous tract after percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS Prospective, transversal, comparative, experimental, randomized 1-to-1 cohort study in 52 patients who underwent "tubeless" PCNL from October 2020 to November 2022. Group A with threads through the urethra and Group B through the percutaneous tract. The validated USSQ (Ureteral Stent Symptom Questionnaire) was applied in the Urology office a week after the procedure, and the JJ stent was withdrawn by pulling the threads. Hemoglobin and urine culture, and pre- and post-surgery were evaluated. RESULTS There is a statistically significant difference in favor of group B when comparing urinary symptoms (p = 0.008), body pain (p = 0.009), and general condition (p = 0.042), mainly for non-urgency incontinence, frequency of analgesic use, and dysuria. There were significant differences between groups (p = 0.028, p = 0.026, p = 0.027, respectively). There is no association with urinary infections (p = 0.603) nor an increased risk of bleeding (p = 0.321). CONCLUSION The removal of the JJ stent with exteriorized threads through the percutaneous tract after PCNL in the office is a feasible and safe procedure if it is removed before 8 days and has better tolerance regarding the urinary symptoms.
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Affiliation(s)
- Enrique Pulido-Contreras
- Urology Department, Unidad Médica de Alta Especialidad No. 1 Bajío, Instituto Mexicano del Seguro Social (IMSS), Lopez Mateos S/N, 37320, León, Guanajuato, Mexico.
| | - Miguel Angel Primo-Rivera
- Urology Department, Hospital General Regional No 1, Instituto Mexicano del Seguro Social (IMSS), Oriente 6, 94300, Orizaba, Veracruz, Mexico
| | - Miguel Angel Garcia-Padilla
- Urology Department, Unidad Médica de Alta Especialidad No. 1 Bajío, Instituto Mexicano del Seguro Social (IMSS), Lopez Mateos S/N, 37320, León, Guanajuato, Mexico
| | - Carlos Rios-Melgarejo
- Urology Department, Unidad Médica de Alta Especialidad No. 1 Bajío, Instituto Mexicano del Seguro Social (IMSS), Lopez Mateos S/N, 37320, León, Guanajuato, Mexico
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16
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Caglar U, Erbin A, Ucpinar B, Ayranci A, Sarilar O, Yanaral F, Baykal M, Ozgor F, Akbulut F. Failed insertion of ureteral access sheath during flexible ureterorenoscopy: a randomized controlled trial comparing second session flexible ureterorenoscopy or same session mini percutaneous nephrolithotomy. Int Urol Nephrol 2024; 56:433-439. [PMID: 37807032 DOI: 10.1007/s11255-023-03820-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/24/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE To compare different treatment approaches in patients with failed ureteral access sheath placement during first flexible ureterorenoscopy (f-URS) session. METHODS Patients with kidney stones measuring 1-2 cm, presented to our urology clinic between September 2020 and September 2021, were included in the study for evaluation. The study was designed prospectively (Clinical-Trials number NCT05911945). Patients were randomized into two groups, in case of a failed ureteral access sheath placement during the first f-URS session. In group 1, JJ stent was placed for dilation and second session of f-URS was planned. In group 2, mini percutaneous nephrolithotomy (mPNL) was performed in the same session. RESULTS Twenty-four patients were included in each group. Pre-operative demographic data and stone characteristics of the patients in each group were comparable. Operation time, fluoroscopy time, and hospital stay were significantly higher in the mini-PNL group. When SF-36 values were compared, physical function, pain, role limitation, and general health value scores were improved in both groups after treatment. The improvement in physical function and pain parameters was statistically significant in the mPNL group. In patients with failed ureteral access sheath placement, placing a JJ stent for dilation and postponing f-URS for 4-6 weeks provides the advantages of low hospitalization time for each admission, shorter fluoroscopy and operation time. CONCLUSIONS Performing mPNL in the same session, results in better improvements in SF-36 parameters such as pain and physical function compared to f-URS. The success and complication rates of the two procedures were comparable.
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Affiliation(s)
- Ufuk Caglar
- Department of Urology, Haseki Training and Research Hospital, Ugur Mumcu Mahallesi, Belediye Sokak, No:7, Sultangazi, Istanbul, Turkey.
| | - Akif Erbin
- Department of Urology, Haseki Training and Research Hospital, Ugur Mumcu Mahallesi, Belediye Sokak, No:7, Sultangazi, Istanbul, Turkey
| | - Burak Ucpinar
- Department of Urology, Haseki Training and Research Hospital, Ugur Mumcu Mahallesi, Belediye Sokak, No:7, Sultangazi, Istanbul, Turkey
| | - Ali Ayranci
- Department of Urology, Haseki Training and Research Hospital, Ugur Mumcu Mahallesi, Belediye Sokak, No:7, Sultangazi, Istanbul, Turkey
| | - Omer Sarilar
- Department of Urology, Haseki Training and Research Hospital, Ugur Mumcu Mahallesi, Belediye Sokak, No:7, Sultangazi, Istanbul, Turkey
| | - Fatih Yanaral
- Department of Urology, Haseki Training and Research Hospital, Ugur Mumcu Mahallesi, Belediye Sokak, No:7, Sultangazi, Istanbul, Turkey
| | - Murat Baykal
- Department of Urology, Haseki Training and Research Hospital, Ugur Mumcu Mahallesi, Belediye Sokak, No:7, Sultangazi, Istanbul, Turkey
| | - Faruk Ozgor
- Department of Urology, Haseki Training and Research Hospital, Ugur Mumcu Mahallesi, Belediye Sokak, No:7, Sultangazi, Istanbul, Turkey
| | - Fatih Akbulut
- Department of Urology, Haseki Training and Research Hospital, Ugur Mumcu Mahallesi, Belediye Sokak, No:7, Sultangazi, Istanbul, Turkey
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Tasian GE, Dickinson K, Park G, Marchesani N, Mittal A, Cheng N, Ching CB, Chu DI, Walton R, Yonekawa K, Gluck C, Muneeruddin S, Kan KM, DeFoor W, Rove K, Forrest CB. Distinguishing characteristics of pediatric patients with primary hyperoxaluria type 1 in PEDSnet. J Pediatr Urol 2024; 20:88.e1-88.e9. [PMID: 37848358 DOI: 10.1016/j.jpurol.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/04/2023] [Accepted: 10/01/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Primary hyperoxaluria type 1 (PH1) is an autosomal recessive inborn error of metabolism that causes oxalate deposition, leading to recurrent calcium oxalate kidney stones, chronic kidney disease and systemic oxalosis, which produces a broad range of serious life-threatening complications. Patients with PH1 have delayed diagnosis due to the rarity of the disease and the overlap with early-onset kidney stone disease not due to primary hyperoxaluria. OBJECTIVE The objective of this study was to determine the clinical features of individuals <21 years of age with PH1 that precede its diagnosis. We hypothesized that a parsimonious set of features could be identified that differentiate patients with PH1 from patients with non-primary hyperoxaluria-associated causes of early-onset kidney stone disease. STUDY DESIGN We determined the association between clinical characteristics and PH1 diagnosis in a case-control study conducted between 2009 and 2021 in PEDSnet, a clinical research network of eight US pediatric health systems. Each patient with genetically confirmed PH1 was matched by sex and PEDSnet institution to up to 4 control patients with kidney stones without PH of any type. We obtained patient characteristics and diagnostic test results occurring before to less than 6 months after study entrance from a centralized database query and from manual chart review. Differences were examined using standardized differences and multivariable regression. RESULTS The study sample included 37 patients with PH1 and 147 controls. Patients with PH1 were younger at diagnosis (median age of 3 vs 13.5 years); 75 % of children with PH1 were less than 8 years-old. Patients with PH1 were more likely to have combinations of nephrocalcinosis on ultrasound or CT (43 % vs 3 %), lower eGFR at diagnosis (median = 52 mL/min/1.73 m2 vs 114 mL/min/1.73 m2), and have normal mobility. Patients with PH1 had higher proportion of calcium oxalate monohydrate kidney stones than controls (median = 100 % vs 10 %). There were no differences in diagnosis of failure to thrive, stone size, or echocardiography results. CONCLUSIONS Children with PH1 are characterized by presentation before adolescence, nephrocalcinosis, decreased eGFR at diagnosis, and calcium oxalate monohydrate stone composition. If externally validated, these characteristics could facilitate earlier diagnosis and treatment of children with PH1.
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Affiliation(s)
- Gregory E Tasian
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Kimberley Dickinson
- Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Grace Park
- Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nicole Marchesani
- Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Christina B Ching
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - David I Chu
- Department of Surgery, Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Ryan Walton
- Department of Surgery, Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Karyn Yonekawa
- Department of Pediatrics, Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - Caroline Gluck
- Department of Pediatrics, Division of Nephrology, Nemours Children's Health, Wilmington, DE, USA
| | - Samina Muneeruddin
- Department of Pediatrics, Division of Nephrology, Nemours Children's Health, Wilmington, DE, USA
| | - Kathleen M Kan
- Department of Surgery, Division of Urology, Stanford University, Palo Alto, CA, USA
| | - William DeFoor
- Department of Surgery, Division of Urology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA
| | - Kyle Rove
- Department of Pediatric Urology, Division of Urology, Children's Hospital Colorado, Aurora, CO, USA
| | - Christopher B Forrest
- Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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18
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He Q, Wei X, Wu E, Luo R, Yu L, Liang W. Comparison of percutaneous nephrolithotomy and flexible ureterorenoscopy in the treatment of single upper ureteral calculi measuring 1 to 2 centimeters: a retrospective study. BMC Urol 2024; 24:23. [PMID: 38281932 PMCID: PMC10822141 DOI: 10.1186/s12894-024-01408-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024] Open
Abstract
PURPOSE To compare the efficacy and safety of micropercutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy (FURS) in the treatment of single upper ureteral calculi measuring 1 to 2 centimeters. METHODS This study is a retrospective analysis that combines a review of medical records with an outcomes management database. A total of 163 patients who underwent MPCNL and 137 patients who had FURS were identified between January 2017 and December 2021. Demographic data, operation time, hospitalization time, stone-free rate, and complication rate were collected and analyzed. RESULTS Preoperative general data of sex, age, BMI, serum creatinine, time of stone existence, stone hardness, stone diameter, preoperative hydronephrosis, and preoperative infection of the MPCNL group have no statistically significant difference with that of the FURS group. All MPCNL or FURS operations in both groups were successfully completed without any instances of reoperation or conversion to another surgical procedure. Patients who underwent MPCNL had a considerably reduced operation time (49.6 vs. 72.4 min; P<0.001), but a higher duration of hospitalization (9.1 vs. 3.9 days; P<0.001) compared to those who underwent FURS. The stone-free rate in the MPCNL group was superior to that of the FURS group, with a percentage of 90.8% compared to 71.5% (P<0.001). There was no statistically significant disparity in the rate of complications between the two groups (13.5% vs. 15.3%; P = 0.741). CONCLUSION Both MPCNL and FURS are viable and secure surgical choices for individuals with solitary upper ureteral calculi measuring 1 to 2 cm. The FURS procedure resulted in a shorter duration of hospitalization compared to MPCNL. However, it had a comparatively lower rate of successfully removing the stones and required a longer duration for the operation.There were no substantial disparities observed in the complication rate between the two groups.FURS is the preferable option for treating uncomplicated upper ureteral calculi, whereas MPCNL is the preferable option for treating complicated upper ureteral calculi.Prior to making treatment options, it is crucial to take into account the expertise of surgeons, the quality of the equipment, and the preferences of the patient. TRIAL REGISTRATION No.
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Affiliation(s)
- Qinghua He
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, 545000, Guangxi Province, China
| | - Xuedong Wei
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, 545000, Guangxi Province, China
| | - Eran Wu
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, 545000, Guangxi Province, China
| | - Raoshan Luo
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, 545000, Guangxi Province, China
| | - Lizhi Yu
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, 545000, Guangxi Province, China
| | - Weiming Liang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, 545000, Guangxi Province, China.
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Li X, Xie Y, Tang L, Li D, Wang J, Sheng H, Chen K, Xiao S, Li J, Yang M. A two-sample mendelian randomization analysis excludes causal relationships between non-alcoholic fatty liver disease and kidney stones. Front Endocrinol (Lausanne) 2024; 14:1343367. [PMID: 38269249 PMCID: PMC10807291 DOI: 10.3389/fendo.2023.1343367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Abstract
Objectives Non-alcoholic fatty liver disease (NAFLD) has been linked to an increased risk of kidney stones in prior observational studies, However, the results are inconsistent, and the causality remains to be established. We aimed to investigate the potential causal relationship between NAFLD and kidney stones using two-sample Mendelian randomization (MR). Methods Genetic instruments were used as proxies for NAFLD. Summary-level data for the associations of exposure-associated SNPs with kidney stones were obtained from the UK Biobank study (6536 cases and 388,508 controls) and the FinnGen consortium (9713 cases and 366,693 non-cases). MR methods were conducted, including inverse variance weighted method (IVW), MR-Egger, weighted median, and MR-PRESSO. MR-Egger Regression Intercept and Cochran's Q test were used to assess the directional pleiotropy and heterogeneity. Results cALT-associated NAFLD did not exhibit an association with kidney stones in the Inverse variance weighted (IVW) methods, in both the FinnGen consortium (OR: 1.02, 95%CI: 0.94-1.11, p = 0.632) and the UKBB study (OR: 1.000, 95%CI: 0.998-1.002, p = 0.852). The results were consistent in European ancestry (FinnGen OR: 1.05, 95%CI: 0.98-1.14, p = 0.144, UKBB OR: 1.000, 95%CI: 0.998-1.002, p = 0.859). IVW MR analysis also did not reveal a significant causal relationship between NAFLD and the risk of kidney stone for the other three NAFLD-related traits, including imaging-based, biopsy-confirmed NAFLD, and more stringent biopsy-confirmed NAFLD. The results remained consistent and robust in the sensitivity analysis. Conclusions The MR study did not provide sufficient evidence to support the causal associations of NAFLD with kidney stones.
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Affiliation(s)
- Xintao Li
- Department of Traditional Chinese Medicine, The Sixth Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing, China
- Department of Urology, The Third Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Department of Urology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Yongpeng Xie
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lu Tang
- Department of Urology, The Third Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Di Li
- Department of Urology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Jun Wang
- Department of Urology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Haibo Sheng
- Department of Urology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Kaikai Chen
- Department of Urology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Shuwei Xiao
- Department of Urology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Jianye Li
- Department of Urology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Minghui Yang
- Department of Traditional Chinese Medicine, The Sixth Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing, China
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20
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Wang Y, Liu S, Zhao Q, Wang N, Liu X, Zhang T, He G, Zhao G, Jiang Y, Chen B. Analysis of Dietary Patterns Associated with Kidney Stone Disease Based on Data-Driven Approaches: A Case-Control Study in Shanghai. Nutrients 2024; 16:214. [PMID: 38257107 PMCID: PMC10818537 DOI: 10.3390/nu16020214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/31/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
The main objective of this study was to analyze dietary patterns using data-driven approaches and to explore preventive or risk dietary factors for kidney stone disease (KSD). A case-control matching study was conducted in adults (n = 6396) from a suburb of Shanghai. A food frequency questionnaire was used to assess the consumption of various types of food, and B-ultrasound was used to identify kidney stones. Principal component analysis and regression were used to generate dietary patterns and further explore the relationship between dietary patterns and KSD. LASSO regression and post-selection inference were used to identify food groups most associated with KSD. Among males, the "balanced but no-sugary-beverages pattern" (OR = 0.78, p < 0.05) and the "nuts and pickles pattern" (OR = 0.84, p < 0.05) were protective dietary patterns. Among females, "high vegetables and low-sugary-beverages pattern" (OR = 0.83, p < 0.05) and "high-crustaceans and low-vegetables pattern" (OR = 0.79, p < 0.05) were protective dietary patterns, while the "comprehensive pattern with a preference for meat" (OR = 1.06, p < 0.05) and "sugary beverages pattern" (OR = 1.16, p < 0.05) were risk dietary patterns. We further inferred that sugary beverages (p < 0.05) were risk factors and pickles (p < 0.05) and crustaceans (p < 0.05) were protective factors.
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Affiliation(s)
- Yifei Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (G.H.)
| | - Shaojie Liu
- Department of Clinical Nutrition, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China;
- Key Lab of Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; (Q.Z.); (N.W.); (X.L.); (T.Z.); (G.Z.)
| | - Qi Zhao
- Key Lab of Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; (Q.Z.); (N.W.); (X.L.); (T.Z.); (G.Z.)
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
| | - Na Wang
- Key Lab of Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; (Q.Z.); (N.W.); (X.L.); (T.Z.); (G.Z.)
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
| | - Xing Liu
- Key Lab of Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; (Q.Z.); (N.W.); (X.L.); (T.Z.); (G.Z.)
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
| | - Tiejun Zhang
- Key Lab of Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; (Q.Z.); (N.W.); (X.L.); (T.Z.); (G.Z.)
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
| | - Gengsheng He
- Department of Nutrition and Food Hygiene, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (G.H.)
- Key Lab of Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; (Q.Z.); (N.W.); (X.L.); (T.Z.); (G.Z.)
| | - Genming Zhao
- Key Lab of Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; (Q.Z.); (N.W.); (X.L.); (T.Z.); (G.Z.)
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
| | - Yonggen Jiang
- Songjiang District Center for Disease Control and Prevention, Shanghai 201620, China;
| | - Bo Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (G.H.)
- Key Lab of Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; (Q.Z.); (N.W.); (X.L.); (T.Z.); (G.Z.)
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Manoharan V, Sharma G, Devana SK, Sharma S, Avti P, Chandramouli S. A prospective case-control study on the evaluation of oxidative stress in renal stone formers. Urolithiasis 2024; 52:18. [PMID: 38165517 DOI: 10.1007/s00240-023-01514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024]
Abstract
Association of increased oxidative stress (OS) with the pathophysiology of renal stone formation has not been explored greatly in the field of urolithiasis. In this prospective case-control study, we measured 24-h urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels in patients with urolithiasis and compared them with matched healthy controls. We also measured 24-h urinary uric acid, calcium, oxalate, and citrate levels in patients with renal stone disease and studied their relation with urinary 8-OHdG levels. Seventy-five cases of renal stone disease and 75 well-matched controls were included. Median 24-h urinary 8-OHdG levels were significantly higher in cases compared to controls (7.6 vs. 3.7 µg/g of creatinine; p < 0.000). Receiver-operating curve (ROC) analysis for 8-OHdG between cases and controls revealed an area under the curve of 0.90. At 8-OHdG (µg/g of creatinine) value of 5 or more, a sensitivity and a specificity of 84% each were obtained. A positive correlation between 8-OHdG (µg/g of creatinine) and 24-h urinary oxalate level was noted (r = 0.461, p = 0.000). No correlation between 8-OHdG (µg/g of creatinine) and other variables was noted. On multivariate linear regression analysis, we noted 24-h urinary oxalate levels to be an independent predictor of urinary 8-OHdG levels. OS is significantly higher in patients with renal stone diseases compared to healthy controls. Urinary oxalate levels were significantly correlated with urinary 8-OHdG levels.
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Affiliation(s)
- V Manoharan
- Department of Urology, PGIMER, Chandigarh, India
| | - G Sharma
- Department of Urology, PGIMER, Chandigarh, India
| | - S K Devana
- Department of Urology, PGIMER, Chandigarh, India.
| | - S Sharma
- Department of Biochemistry, PGIMER, Chandigarh, India
| | - P Avti
- Department of Biophysics, PGIMER, Chandigarh, India
| | - S Chandramouli
- Department of General Surgery, PGIMER, Chandigarh, India
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22
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Rungrasameviriya P, Santilinon A, Atichartsintop P, Hadpech S, Thongboonkerd V. Tight junction and kidney stone disease. Tissue Barriers 2024; 12:2210051. [PMID: 37162265 PMCID: PMC10832927 DOI: 10.1080/21688370.2023.2210051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/30/2023] [Indexed: 05/11/2023] Open
Abstract
Defects of tight junction (TJ) are involved in many diseases related to epithelial cell functions, including kidney stone disease (KSD), which is a common disease affecting humans for over a thousand years. This review provides brief overviews of KSD and TJ, and summarizes the knowledge on crystal-induced defects of TJ in renal tubular epithelial cells (RTECs) in KSD. Calcium oxalate (CaOx) crystals, particularly COM, disrupt TJ via p38 MAPK and ROS/Akt/p38 MAPK signaling pathways, filamentous actin (F-actin) reorganization and α-tubulin relocalization. Stabilizing p38 MAPK signaling, reactive oxygen species (ROS) production, F-actin and α-tubulin by using SB239063, N-acetyl-L-cysteine (NAC), phalloidin and docetaxel, respectively, successfully prevent the COM-induced TJ disruption and malfunction. Additionally, genetic disorders of renal TJ, including mutations and single nucleotide polymorphisms (SNPs) of CLDN2, CLDN10b, CLDN14, CLDN16 and CLDN19, also affect KSD. Finally, the role of TJ as a potential target for KSD therapeutics and prevention is also discussed.
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Affiliation(s)
- Papart Rungrasameviriya
- Nawamethee Project, Doctor of Medicine Program, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Aticha Santilinon
- Nawamethee Project, Doctor of Medicine Program, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Palita Atichartsintop
- Nawamethee Project, Doctor of Medicine Program, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sudarat Hadpech
- Medical Proteomics Unit, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Visith Thongboonkerd
- Medical Proteomics Unit, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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23
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Sas DJ, Mara K, Mehta RA, Seide BM, Banks CJ, Danese DS, McGregor TL, Lieske JC, Milliner DS. Natural history of urine and plasma oxalate in children with primary hyperoxaluria type 1. Pediatr Nephrol 2024; 39:141-148. [PMID: 37458799 PMCID: PMC11044200 DOI: 10.1007/s00467-023-06074-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/13/2023] [Accepted: 06/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Primary hyperoxaluria type 1 (PH1) is a rare, severe genetic disease causing increased hepatic oxalate production resulting in urinary stone disease, nephrocalcinosis, and often progressive chronic kidney disease. Little is known about the natural history of urine and plasma oxalate values over time in children with PH1. METHODS For this retrospective observational study, we analyzed data from genetically confirmed PH1 patients enrolled in the Rare Kidney Stone Consortium PH Registry between 2003 and 2018 who had at least 2 measurements before age 18 years of urine oxalate-to-creatinine ratio (Uox:cr), 24-h urine oxalate excretion normalized to body surface area (24-h Uox), or plasma oxalate concentration (Pox). We compared values among 3 groups: homozygous G170R, heterozygous G170R, and non-G170R AGXT variants both before and after initiating pyridoxine (B6). RESULTS Of 403 patients with PH1 in the registry, 83 met the inclusion criteria. Uox:cr decreased rapidly over the first 5 years of life. Both before and after B6 initiation, patients with non-G170R had the highest Uox:cr, 24-h Uox, and Pox. Patients with heterozygous G170R had similar Uox:cr to homozygous G170R prior to B6. Patients with homozygous G170R had the lowest 24-h Uox and Uox:cr after B6. Urinary oxalate excretion and Pox tend to decrease over time during childhood. eGFR over time was not different among groups. CONCLUSIONS Children with PH1 under 5 years old have relatively higher urinary oxalate excretion which may put them at greater risk for nephrocalcinosis and kidney failure than older PH1 patients. Those with homozygous G170R variants may have milder disease. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- David J Sas
- Division of Pediatric Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
| | - Kristin Mara
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Ramila A Mehta
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Barbara M Seide
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Carly J Banks
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | | | - John C Lieske
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Dawn S Milliner
- Division of Pediatric Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
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Hill H, Talamini S, Vetter J, Nottingham C. Complications of tubeless versus standard percutaneous nephrolithotomy. Int Urol Nephrol 2024; 56:63-67. [PMID: 37668868 DOI: 10.1007/s11255-023-03772-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/26/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE The necessity of nephrostomy tube after percutaneous nephrolithotomy (PCNL) has been called into question in modern series. We sought to examine differences in postoperative complications and outcomes of tubeless PCNL versus standard PCNL at our institution. METHODS A retrospective review of our institutional stone database was conducted from January 2016 to December 2021 for patients who had undergone either tubeless PCNL, defined by placement of only an internal ureteral stent, or standard PCNL, which involved placement of an externalized nephrostomy tube. Patients were excluded if they underwent totally tubeless PCNL. RESULTS A total of 438 patients were included for analysis: 329 patients underwent tubeless PCNL and 109 patients underwent standard PCNL. Between tubeless and standard groups, there was no difference in readmission rates 6.1% vs. 9.2% (p = 0.268), Clavien 2 or > complications 18.5% vs. 19.3% (p = 0.923), and Clavien 3 or > complications 4.0% vs. 7.3% (p = 0.151). The tubeless group experienced shorter operative duration 121.5 vs. 144.8 min (p = 0.012), shorter length of stay 2.5 vs. 3.8 days (p = 0.002), and higher stone-free rates 72.3% vs. 60.2% (p = 0.014), but also increased blood transfusion rates 6.4% vs. 0.9% (p = 0.022). CONCLUSION In comparing tubeless with standard PCNL, there was no difference in readmission rates, or significant Clavien complication rates. Patients undergoing tubeless PCNL experienced higher stone-free rates, but more number of patients required postoperative blood transfusion. The decision to leave a nephrostomy tube after PCNL appears unlikely to impact overall complication rates and can be left to surgeon experience and case-based discretion.
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Affiliation(s)
- Hayden Hill
- Department of Surgery, Division of Urology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
| | - Susan Talamini
- Department of Surgery, Division of Urology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Joel Vetter
- Department of Surgery, Division of Urology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Charles Nottingham
- Department of Surgery, Division of Urology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Meng W, Zhang H, Wang J, Chen B, Jiang Z, Ma L, Guan Y. Retrospective study of single-use digital flexible ureteroscopic lithotripsy versus miniaturized percutaneous nephrolithotomy for 1.5-2.5cm lower pole renal stones. Int Urol Nephrol 2024; 56:55-62. [PMID: 37656387 DOI: 10.1007/s11255-023-03771-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Retrospective analysis was performed on the clinical information of patients with 1.5-2.5 cm lower pole renal stones treated by single-use digital flexible ureteroscopic lithotripsy (fURS) and miniaturized percutaneous nephrolithotomy (MPCNL) in affiliated hospital of the Nantong University from January 2020 to December 2022. To compare the safety and efficacy of single-use fURS and MPCNL in the treatment from 1.5cm to 2.5cm lower pole renal stones. METHODS Clinical information of 141 patients were collected and divided into single-use fURS group and MPCNL group according to their treatment methods, including 83 patients in the single-use fURS group and 58 patients in the MPCNL group. Baseline data, data on the clinical characteristics of stones, laboratory examination data, operation time, and postoperative data of the two groups were collected. Statistical analysis was made on the collected data to analyze the differences and causes between the two groups of patients. RESULTS There was no significant difference in the baseline data and preoperative clinical features of 141 patients between the two groups (P > 0.05). In comparison of postoperative serum indexes, the drop values of hemoglobin and creatinine in single-use fURS group were lower than those in MPCNL group, and the difference was statistically significant (P < 0.05). The stone free rate was higher in the MPCNL group than in the single-use fURS group on the first day after surgery. At the 1st month after surgery, the two groups were similar. At 3rd month after surgery, the single-use fURS group was slightly higher than the MPCNL group, with no statistical significance (P > 0.05). The total complication rate in single-use fURS group was slightly lower than that in MPCNL group, but there was no statistical significance (P > 0.05). CONCLUSIONS Single-use fURS has similar safety and efficacy to MPCNL in the treatment of 1.5-2.5cm lower pole renal stones. Single-use fURS may be a new option for the treatment of these stones.
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Affiliation(s)
- Wei Meng
- Department of Urology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, 226001, China
| | - Huajun Zhang
- Dalian Medical University, Dalian, 116000, China
| | - Jiahao Wang
- Department of Urology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, China
| | - Bo Chen
- Department of Urology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, 226001, China
| | - Zhaosheng Jiang
- Department of Urology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, 226001, China
| | - Limin Ma
- Department of Urology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, 226001, China.
| | - Yangbo Guan
- Department of Urology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, 226001, China.
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Maline GE, Goldfarb DS. Climate change and kidney stones. Curr Opin Nephrol Hypertens 2024; 33:89-96. [PMID: 37725125 DOI: 10.1097/mnh.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
PURPOSE OF REVIEW Kidney stones affect an increasing proportion of the population. We suggest that these trends are in part influenced by exposure to higher temperatures as a result of climate change and urbanization. The changing epidemiology of kidney stones is a topic worthy of discussion due to the economic and healthcare burden the condition poses as well as the quality-of-life disruption faced by individuals with kidney stones. RECENT FINDINGS The relationship between heat and kidney stones is well supported. Exposure to high temperatures has been shown to increase risk for stone development within a short time frame. Effects are modified by factors such as sex, comorbid conditions, and population vulnerability and adaptability. Urban heat islands (UHIs) likely exaggerate the effect of increasing global surface temperature. The concentration of UHIs often coincides with historic redlining practices in the United States, potentially contributing to observed disparities in kidney health among minoritized populations. As global surface temperature increases and urbanization trends continue, a greater proportion of the world's population is exposed to significant temperature extremes each year, leading to the expectation that kidney stone prevalence will continue to increase. SUMMARY This work describes the effect of increasing global surface temperature as a result of climate change on kidney stone disease and kidney health. These effects may result in further perpetuation of significant kidney stone related social disparities. We suggest strategies to mitigate the effects of heat exposure on stone formation.
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Affiliation(s)
| | - David S Goldfarb
- NYU Grossman School of Medicine
- Nephrology Division, NYU Grossman School of Medicine and Nephrology Section Harbor VA Healthcare System, New York, New York, USA
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Ito H, Sakamaki K, Fukuda T, Yamamichi F, Watanabe T, Tabei T, Inoue T, Matsuzaki J, Kobayashi K. Models to predict the surgical outcome of mini-ECIRS (endoscopic combined intrarenal surgery) for renal and/or ureteral stones. Sci Rep 2023; 13:22848. [PMID: 38129560 PMCID: PMC10739798 DOI: 10.1038/s41598-023-50022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
To establish a safer and more efficient treatment strategy with mini-endoscopic combined intrarenal surgery (ECIRS), the present study aimed to develop models to predict the outcomes of mini-ECIRS in patients with renal and/or ureteral stones. We retrospectively analysed consecutive patients with renal and/or ureteral stones who underwent mini-ECIRS at three Japanese tertiary institutions. Final treatment outcome was evaluated by CT imaging at 1 month postoperatively and stone free (SF) was defined as completely no residual stone or residual stone fragments ≤ 2 mm. Three prognostic models (multiple logistic regression, classification tree analysis, and machine learning-based random forest) were developed to predict surgical outcomes using preoperative clinical factors. Clinical data from 1432 ECIRS were pooled from a database registered at three institutions, and 996 single sessions of mini-ECIRS were analysed in this study. The overall SF rate was 62.3%. The multiple logistic regression model consisted of stone burden (P < 0.001), number of involved calyces (P < 0.001), nephrostomy prior to mini-ECIRS (P = 0.091), and ECOG-PS (P = 0.110), wherein the area under the curve (AUC) was 70.7%. The classification tree analysis consisted of the number of involved calyces with an AUC of 61.7%. The random forest model showed that the top predictive variable was the number of calyces involved, with an AUC of 91.9%. Internal validation revealed that the AUCs for the multiple logistic regression model, classification tree analysis and random forest models were 70.4, 69.6 and 85.9%, respectively. The number of involved calyces, and a smaller stone burden implied a SF outcome. The machine learning-based model showed remarkably high accuracy and may be a promising tool for physicians and patients to obtain proper consent, avoid inefficient surgery, and decide preoperatively on the most efficient treatment strategies, including staged mini-ECIRS.
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Affiliation(s)
- Hiroki Ito
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan.
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Kentaro Sakamaki
- Faculty of Health Data Science, Juntendo University, Tokyo, Japan
| | - Tetsuo Fukuda
- Department of Urology, Ohguchi East General Hospital, Yokohama, Japan
| | | | | | - Tadashi Tabei
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Hospital, Kobe, Japan
| | - Junichi Matsuzaki
- Department of Urology, Ohguchi East General Hospital, Yokohama, Japan
| | - Kazuki Kobayashi
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
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Sarwal A, Yamauchi J, Raghavan D, Shihab F, Fornadi K, Rofaiel G, Zimmerman M, Campsen J, Baker N, Akhila Ganireddy Y, Aviles-Ovalle L, Baker T, Hall IE, Molnar MZ. Throwing stones: kidney stone incidence in living kidney donor candidates with increased metabolic risk. Ren Fail 2023; 45:2226763. [PMID: 37357461 PMCID: PMC10294741 DOI: 10.1080/0886022x.2023.2226763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023] Open
Affiliation(s)
- Amara Sarwal
- Department of Internal Medicine, Division of Nephrology & Hypertension, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Junji Yamauchi
- Department of Internal Medicine, Division of Nephrology & Hypertension, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Divya Raghavan
- Department of Internal Medicine, Division of Nephrology & Hypertension, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Fuad Shihab
- Department of Internal Medicine, Division of Nephrology & Hypertension, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Katalin Fornadi
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - George Rofaiel
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Michael Zimmerman
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Jeffrey Campsen
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Nicholas Baker
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Yamini Akhila Ganireddy
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Leonardo Aviles-Ovalle
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Talia Baker
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Isaac E. Hall
- Department of Internal Medicine, Division of Nephrology & Hypertension, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Miklos Z. Molnar
- Department of Internal Medicine, Division of Nephrology & Hypertension, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
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Geraghty R, Lombardo R, Yuan C, Davis N, Tzelves L, Petrik A, Jung H, Gambaro G, Tailly T, Neisius A, Skolarikos A, Somani B. Outcomes of Flexible Ureteroscopy vs Extracorporeal Shock Wave Lithotripsy for Renal Stones in Pediatric Patients: A European Association of Urology Urolithiasis Guidelines Systematic Review and Meta-Analysis. J Urol 2023; 210:876-887. [PMID: 37669621 DOI: 10.1097/ju.0000000000003696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/30/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE We sought to determine which treatment between flexible ureteroscopy and shock wave lithotripsy has a better stone-free rate in pediatric patients (<18 years) with renal or proximal ureteric stones (<2 cm). Subanalysis for all outcomes for randomized controlled trials only. MATERIALS AND METHODS Using PubMed, Web of Science, and the Cochrane database, we identified studies (randomized clinical trials and prospective comparative nonrandomized studies) published until August 2022 reporting surgical outcomes of pediatrics patients undergoing flexible ureteroscopy and shock wave lithotripsy with renal or proximal ureteric stones <2 cm (PROSPERO ID: CRD42022378790). Only randomized controlled trials were considered for meta-analysis. Stone-free rate, operative time, and complications were analyzed. Analysis was performed in R. RESULTS A total of 6 studies identified, of which 3 were randomized clinical trials and 4 had data on renal stones. A total of 669 patients were analyzed. Mean age ranged from 4.4 to 12.4 years. The shock wave lithotripsy group presented a range of stone-free rate between 21 and 90% while the flexible ureteroscopy group presented a range of stone-free rates between 37% and 97%. Meta-analysis of randomized controlled trials only (n=302) demonstrated significantly higher stone-free rate in flexible ureteroscopy vs shock wave lithotripsy (RR = 1.17, 95% CI: 1.04-1.33, P = 0.01), operative time (mean difference = +16.4 minutes, 95% CI: 7.3-25.5, P < 0.01) and hospital stay (mean difference = +0.25 days, 95% CI: 0.14-0.36, P < 0.001). But no difference in fluoroscopy exposure time (mean difference = -21.0 seconds, 95% CI: -42.6 to 0.56, P = 0.07), Clavien I-II (RR = 1.23, 95% CI: 0.71-2.12, P = 0.45) or Clavien III-V complications (RR = 1.04, 95% CI: 0.32-3.42, P = 0.95). CONCLUSIONS Flexible ureteroscopy has a significantly higher stone-free rate than shock wave lithotripsy, with no difference in complication rate or fluoroscopy exposure time, and significantly higher operative times and hospital stay. However, the current evidence base for this is weak and further randomized trials are needed.
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Affiliation(s)
- Robert Geraghty
- Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK
| | | | - Cathy Yuan
- Division of Gastroenterology & Cochrane UGPD Group, Department of Medicine, Health Sciences Center, McMaster University, Hamilton, Ontario, Canada
| | - Niall Davis
- Department of Urology, Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Lazaros Tzelves
- Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece
| | - Ales Petrik
- Department of Urology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Helene Jung
- Department of Urology, University of Southern Denmark, Odense, Denmark
| | - Giovanni Gambaro
- Division of Nephrology and Dialysis, Department of Medicine, University of Verona, Verona, Italy
| | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
| | - Andreas Neisius
- Department of Urology, Bruederkrankenhaus Trier, Johannes Gutenberg University Mainz, Trier, Germany
| | - Andreas Skolarikos
- Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Shringi S, Raker CA, Tang J. Dietary Magnesium Intake and Kidney Stone: The National Health and Nutrition Examination Survey 2011-2018. R I Med J (2013) 2023; 106:20-25. [PMID: 38015780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND The association between dietary magnesium intake (DMI) and kidney stone (KS) disease is not clear. AIM To determine the association between DMI and prevalent KS disease defined as self-report of any previous episode of KS. METHODS We examined The National Health and Nutrition Examination Survey (NHANES) 2011-2018 and used logistic regression analyses adjusting for demographics, BMI, histories of hypertension, diabetes, thiazide use, cigarette smoking, alcohol drinking, relevant dietary and supplemental intakes to determine the independent association between DMI and prevalent KS disease. RESULTS A total of 19,271 participants were eligible for the final analysis, including 1878 prevalent KS formers. Mean DMI among stone formers was 295.4 mg/day, as compared to 309.6 mg/day among non-stone formers (p=0.02). Higher DMI was strongly associated with lower odds of prevalent KS disease in univariate analysis regardless of when DMI was analyzed as a continuous variable (OR=0.94, 95% CI: 0.89-0.99, p=0.02) or when the extreme quartiles of DMI were compared (OR=0.74, 95% CI: 0.60-0.92, p=0.007). In the multivariable-adjusted regression analysis, those in the highest quartile of DMI compared to the lowest quartile (≥379 mg vs. <205 mg) had significantly reduced odds of prevalent KS (OR=0.70, 95% CI: 0.52-0.93, p=0.01). When DMI was analyzed as a continuous variable, there was a trend toward reduced odds of prevalent KS disease with higher DMI (OR=0.92 per 100 mg, 95% CI: 0.84-1.01, p=0.07). CONCLUSIONS Our study suggests that higher DMI is associated with a reduced risk of KS disease. Future prospective studies are needed to clarify the causal relationship between DMI and KS disease.
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Affiliation(s)
- Sandipan Shringi
- Fellow, Division of Kidney Diseases and Hypertension, Alpert Medical School of Brown University, Providence, RI
| | - Christina A Raker
- Lifespan Biostatistics, Epidemiology, Research Design, and Informatics Core, Division of Kidney Diseases and Hypertension, Alpert Medical School of Brown University, Providence, RI
| | - Jie Tang
- Division of Kidney Diseases and Hypertension, Alpert Medical School of Brown University, Providence, RI
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Lovegrove CE, Bešević J, Wiberg A, Lacey B, Littlejohns TJ, Allen NE, Goldsworthy M, Kim J, Hannan FM, Curhan GC, Turney BW, McCarthy MI, Mahajan A, Thakker RV, Holmes MV, Furniss D, Howles SA. Central Adiposity Increases Risk of Kidney Stone Disease through Effects on Serum Calcium Concentrations. J Am Soc Nephrol 2023; 34:1991-2011. [PMID: 37787550 PMCID: PMC10703081 DOI: 10.1681/asn.0000000000000238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/25/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
SIGNIFICANCE STATEMENT Kidney stone disease is a common disorder with poorly understood pathophysiology. Observational and genetic studies indicate that adiposity is associated with an increased risk of kidney stone disease. However, the relative contribution of general and central adipose depots and the mechanisms by which effects of adiposity on kidney stone disease are mediated have not been defined. Using conventional and genetic epidemiological techniques, we demonstrate that general and central adiposity are independently associated with kidney stone disease. In addition, one mechanism by which central adiposity increases risk of kidney stone disease is by increasing serum calcium concentration. Therapies targeting adipose depots may affect calcium homeostasis and help to prevent kidney stone disease. BACKGROUND Kidney stone disease affects approximately 10% of individuals in their lifetime and is frequently recurrent. The disease is linked to obesity, but the mechanisms mediating this association are uncertain. METHODS Associations of adiposity and incident kidney stone disease were assessed in the UK Biobank over a mean of 11.6 years/person. Genome-wide association studies and Mendelian randomization (MR) analyses were undertaken in the UK Biobank, FinnGen, and in meta-analyzed cohorts to identify factors that affect kidney stone disease risk. RESULTS Observational analyses on UK Biobank data demonstrated that increasing central and general adiposity is independently associated with incident kidney stone formation. Multivariable MR, using meta-analyzed UK Biobank and FinnGen data, established that risk of kidney stone disease increases by approximately 21% per one standard deviation increase in body mass index (BMI, a marker of general adiposity) independent of waist-to-hip ratio (WHR, a marker of central adiposity) and approximately 24% per one standard deviation increase of WHR independent of BMI. Genetic analyses indicate that higher WHR, but not higher BMI, increases risk of kidney stone disease by elevating adjusted serum calcium concentrations (β=0.12 mmol/L); WHR mediates 12%-15% of its effect on kidney stone risk in this way. CONCLUSIONS Our study indicates that visceral adipose depots elevate serum calcium concentrations, resulting in increased risk of kidney stone disease. These findings highlight the importance of weight loss in individuals with recurrent kidney stones and suggest that therapies targeting adipose depots may affect calcium homeostasis and contribute to prevention of kidney stone disease.
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Affiliation(s)
| | - Jelena Bešević
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Akira Wiberg
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Ben Lacey
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Thomas J. Littlejohns
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Naomi E. Allen
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Michelle Goldsworthy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Jihye Kim
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Fadil M. Hannan
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Gary C. Curhan
- Channing Division of Network Medicine and Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ben W. Turney
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Mark I. McCarthy
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Genentech, South San Francisco, Califirnia
| | - Anubha Mahajan
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Genentech, South San Francisco, Califirnia
| | - Rajesh V. Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Michael V. Holmes
- Medical Research Council, Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Dominic Furniss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Sarah A. Howles
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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32
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Owino C, Mutugi A, Tang J. Hyperoxaluria - A Major Metabolic Risk for Kidney Stone Disease. R I Med J (2013) 2023; 106:14-19. [PMID: 38015779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Hyperoxaluria is a clinically relevant metabolic entity that portends a high morbidity burden. Primarily manifesting as kidney stone disease and chronic kidney disease, advanced hyperoxaluria can also affect major organs, including the brain, heart, liver, bone, and the skin. It is categorized based on etiology into primary and secondary hyperoxaluria. Pathology is attributed to excess de novo oxalate production in the former and multifactorial exogenous oxalate absorption or excess intake of its precursors in the latter. Diagnosis often involves demonstrating elevated urinary oxalate levels, especially in patients with normal kidney function. Here in this review, we will perform an in-depth discussion of various causes of hyperoxaluria and describe treatment options. In view of the significant morbidity burden associated with hyperoxaluria, patients could benefit from heightened clinician awareness to aid in the timely diagnosis and management of this condition.
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Affiliation(s)
- Christopher Owino
- Visiting scholar, Division of Kidney Diseases and Hypertension, Alpert Medical School of Brown University, Providence, RI. Medical resident, Department of Medicine, Moi University Teaching and Referral Hospital, Eldoret, Kenya
| | - Ann Mutugi
- Visiting scholar, Division of Kidney Diseases and Hypertension, Alpert Medical School of Brown University, Providence, RI. Medical resident, Department of Medicine, Moi University Teaching and Referral Hospital, Eldoret, Kenya
| | - Jie Tang
- Associate Professor of Medicine, Division of Kidney Diseases and Hypertension, Alpert Medical School of Brown University, Providence, RI
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Langman CB, Assimos D, Blank M, Calle J, Grauer A, Kausz A, Milliner D, Nazzal L, Smith K, Tasian G, Thompson A, Wood KD, Worcester E, Yang S, Malley MA, Knauf F, Lieske JC. End Point Considerations for Clinical Trials in Enteric Hyperoxaluria. Clin J Am Soc Nephrol 2023; 18:1637-1644. [PMID: 37342976 PMCID: PMC10723917 DOI: 10.2215/cjn.0000000000000234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Abstract
Enteric hyperoxaluria is a medical condition characterized by elevated urinary oxalate excretion due to increased gastrointestinal oxalate absorption. Causative features include fat malabsorption and/or increased intestinal permeability to oxalate. Enteric hyperoxaluria has long been known to cause nephrolithiasis and nephrocalcinosis, and, more recently, an association with CKD and kidney failure has been shown. Currently, there are no US Food and Drug Administration-approved therapies for enteric hyperoxaluria, and it is unclear what end points should be used to evaluate the efficacy of new drugs and biologics for this condition. This study represents work of a multidisciplinary group convened by the Kidney Health Initiative to review the evidence supporting potential end points for clinical trials in enteric hyperoxaluria. A potential clinical outcome is symptomatic kidney stone events. Potential surrogate end points include ( 1 ) an irreversible loss of kidney function as a surrogate for progression to kidney failure, ( 2 ) asymptomatic kidney stone growth/new stone formation observed on imaging as a surrogate for symptomatic kidney stone events, ( 3 ) urinary oxalate and urinary calcium oxalate supersaturation as surrogates for the development of symptomatic kidney stone events, and ( 4) plasma oxalate as a surrogate for the development of the clinical manifestations of systemic oxalosis. Unfortunately, because of gaps in the data, this Kidney Health Initiative workgroup was unable to provide definitive recommendations. Work is underway to obtain robust information that can be used to inform trial design and medical product development in this space.
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Affiliation(s)
- Craig B. Langman
- Feinberg School of Medicine, Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Dean Assimos
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Melanie Blank
- Office of Therapeutic Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Juan Calle
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Dawn Milliner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Lama Nazzal
- Department of Medicine, Division of Nephrology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Kimberly Smith
- Office of Medical Policy, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Greg Tasian
- University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aliza Thompson
- Division of Cardiology and Nephrology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Kyle D. Wood
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elaine Worcester
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Sixun Yang
- Division of Vaccines and Related Products Applications, Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | | | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John C. Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Nephrology, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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Berezhnoy A G, Dunaevskaya S S, Ershov A V. [The efficiency of totally tubeless percutaneous nephrolithotomy: analysis of 40 cases]. Urologiia 2023:68-71. [PMID: 38156686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Previously, the placement of a nephrostomy tube was considered standard practice during percutaneous nephrolithotomy (PCNL) to ensure repeat access and kidney assessment. However, some publications have shown that in certain cases, a totally tubeless approach may be a viable alternative, provided that PCNL is performed properly and safely. AIM To analyze the results and complications of totally tubeless PCNL. MATERIALS AND METHODS A retrospective analysis of 40 patients with renal stones who underwent totally tubeless PCNL using a single percutaneous access of 16 Ch or 26 Ch at the urology department of NUZ KB "RJD-Medicine", Krasnoyarsk, Russia, from September 2021 to March 2023, was carried out. Factors that could affect the efficiency and safety of PCNL were analyzed. RESULTS The mean duration of the procedure was 39.6 +/- 14.4 minutes. The average decrease in hemoglobin level was 5.9 +/- 5.5. Narcotic analgesics were used postoperatively in 17.5% (7) of patients. The mean length of stay was 4.7 +/- 1.1 days. Transient fever was observed in 4 (10%) cases. In one case, an exacerbation of chronic pyelonephritis developed. There were no cases of significant bleeding during the PCNL, and no patients required blood transfusion. CONCLUSIONS Our results confirm that totally tubeless PNL is a safe alternative to standard procedure and is not associated with an increased risk of early postoperative complications. This technique is efficient and safe for kidney stones and may be recommended for a select group of patients.
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Affiliation(s)
- G Berezhnoy A
- FGBOU VO Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky of the Ministry of Health of Russia, Krasnoyarsk, Russia
- NUZ KB RJD-Medicine, Krasnoyarsk, Russia
| | - S Dunaevskaya S
- FGBOU VO Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky of the Ministry of Health of Russia, Krasnoyarsk, Russia
- NUZ KB RJD-Medicine, Krasnoyarsk, Russia
| | - V Ershov A
- FGBOU VO Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky of the Ministry of Health of Russia, Krasnoyarsk, Russia
- NUZ KB RJD-Medicine, Krasnoyarsk, Russia
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Szczesniewski JJ, Boronat Catalá J, García-Cano Fernández AM, Rodríguez Castro PM, Torres Pérez D, Llanes González L. Vacuum-assisted access sheath in supine mini-percutaneous nephrolithotomy (mini-PCNL). Actas Urol Esp 2023; 47:681-687. [PMID: 37355205 DOI: 10.1016/j.acuroe.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION The vacuum-assisted access sheath is a new device for the treatment of kidney stones with percutaneous nephrolithotomy (PCNL). OBJECTIVE Our aim was to compare the stone-free rate (SFR) and complications between standard mini percutaneous nephrolithotomy (Mini-PCNL) and vacuum-assisted PCNL (Va-PCNL). METHODS Retrospective study of patients undergoing Mini-PCNL and Va-PCNL from January 2018 to June 2022. Va-PCNL was performed with a disposable sheath (ClearPetra®) with continuous high-flow irrigation and vacuum fluid dynamics for easier stone fragment removal. Baseline patient characteristics, surgical outcomes, perioperative and postoperative data were collected. We compared SFR and complications. RESULTS A total of 136 patients were identified, 57 (41,9%) underwent Va-PCNL and 79 (58,15%) Mini-PCNL. Mean operative time was significantly shorter in the Va-PCNL group (95 min.) than in Mini-PCNL (146 min; P = ,001) group. The tubeless technique was performed more frequently in Va-PCNL group (61,4% vs. 34,2%; P = ,002). We did not observe any differences in postoperative complications. The mean hospital stay was significantly lower in Va-PCNL with 1,7 ± 1,9 days per patient compared with 2,7 ± 1,5 days in the Mini-PCNL group (P = ,001). There were no differences in SFR at 3 months between Va-PCNL (71,9%) and Mini-PCNL (71,8%; P =v ,848). CONCLUSION Patients treated with Va-PCNL had comparable results to Mini-PCNL, showing equal SFR with similar infectious complications rates. Potential benefits of Va-PCNL include shorter operative time and postoperative stay.
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Affiliation(s)
- J J Szczesniewski
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
| | - J Boronat Catalá
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | | | | | - D Torres Pérez
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - L Llanes González
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain; Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain
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Abstract
BACKGROUND This study aimed to investigate the association between different metabolic syndrome-body mass index (MetS-BMI) phenotypes and the risk of kidney stones. MATERIALS AND METHODS Participants aged 20-80 years from six consecutive cycles of the NHANES 2007-2018 were included in this study. According to their MetS status and BMI, the included participants were allocated into six mutually exclusive groups: metabolically healthy normal weight (MHN)/overweight (MHOW)/obesity (MHO) and metabolically unhealthy normal weight (MUN)/overweight (MUOW)/obesity (MUO). To explore the association between MetS-BMI phenotypes and the risk of kidney stones, binary logistic regression was used to determine the odds ratios (ORs). RESULTS A total of 13,589 participants were included. It was revealed that all the phenotypes with obesity displayed higher risks of kidney stones (OR = 1.38, p < 0.01 for MHO & OR = 1.80, p < 0.001 for MUO, in the fully adjusted model). The risk increased significantly when metabolic dysfunction coexisted with overweight and obesity (OR = 1.39, p < 0.05 for MUOW & OR = 1.80, p < 0.001 for MUO, in the fully adjusted model). Of note, the ORs for the MUO and MUOW groups were higher than those for the MHO and MHOW groups, respectively. CONCLUSIONS Obesity and unhealthy metabolic status can jointly increase the risk of kidney stones. Assessing the metabolic status of all individuals may be beneficial for preventing kidney stones.
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Affiliation(s)
- Zhenyang Ye
- Department of Urology, West China Xiamen Hospital of Sichuan University, Xiamen, P.R. China
- Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Changjing Wu
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Yang Xiong
- Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Fuxun Zhang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Jinyang Luo
- Department of Urology, West China Xiamen Hospital of Sichuan University, Xiamen, P.R. China
- Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Lijing Xu
- Department of Urology, West China Xiamen Hospital of Sichuan University, Xiamen, P.R. China
- Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Jia Wang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Yunjin Bai
- Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China
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Sharif S, Tang J, Lynch MR. Diet Interventions for Calcium Kidney Stone Disease. R I Med J (2013) 2023; 106:26-30. [PMID: 38015781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Kidney stone disease is a common condition with an increasing prevalence. Diet is an important, modifiable risk factor of an individual's risk of developing kidney stone disease, particularly for those without genetic causes of kidney stone disease. Prospective and epidemiological evidence suggest that adequate fluid intake, limited sodium ingestion, and sufficient calcium and potassium intake can decrease the risk of developing kidney stones. Metabolic risk factors for KSD found on 24-hour urine studies can be used to tailor dietary modifications recommended to reduce subsequent risk of kidney stone formation.
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Affiliation(s)
- Sairah Sharif
- Divisions of Nephrology and Critical Care Medicine, Stony Brook University, Stony Brook, New York
| | - Jie Tang
- Division of Nephrology, Department of Medicine, Warren Alpert Medical School of Brown University; Brown Medicine, Providence, Rhode Island
| | - Matthew R Lynch
- Division of Nephrology, Department of Medicine, Warren Alpert Medical School of Brown University; Brown Medicine, Providence, Rhode Island
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Mahar NA, Qureshi HH, Mustafa G, Memon MM, Kalwar SR, Sultan G. Percutaneous Nephrolithotomy in Anomalous Kidney. J Coll Physicians Surg Pak 2023; 33:1414-1417. [PMID: 38062599 DOI: 10.29271/jcpsp.2023.12.1414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To assess the stone-free rate (SFR) subsequent to percutaneous nephrolithotomy (PCNL) in patients with anatomically anomalous kidneys. STUDY DESIGN Cross-sectional study. Place and Duration of the Study: Department of Urology, Sindh Institute of Urology and Transplantation Karachi, from 23 July 2020 till 30 October 2021. METHODOLOGY Sixty-five patients of renal stone disease with abnormal kidneys, aged 18-60 years of both genders were enrolled in this cross-sectional study. Demographic information like age, gender, stone size, duration of disease, and type of abnormality were noted. After PCNL, stone-free status was determined after 2 weeks of the procedure by performing ultrasound KUB. RESULTS A total of 65 patients were included in this study with mean age of 36.37 ± 12.86 years [Range: 18-60]. There were 76.9% of males and 23.1% of females. Regarding anatomical malformation, 46.2% were malrotated kidneys, 16.9% were horseshoe kidneys, 16.9% were partial Duplex system, 9.2% had bifid pelvis. Median duration of the disease was 12 (IQR=10). Forty-one patients (63.1%) had single and 24 (36.9%) had multiple number of stones with average size of 3.26 ± 1.14 cm. SFR after PCNL in patients with abnormal kidneys was 70.77% (46/65) while 29.23% (19/65) were observed with residual fragments. Out of 19 cases with residual fragments, 10 (53.2%) had stone size <1 cm and 9 (47.4%) had stone of 1 to 3 cm. Sixteen out of 19 patients with residual stones were treated with ESWL (most required: one session), and re-do PCNL was performed in three cases. CONCLUSION PCNL is an effective and safe operation in anatomically anomalous kidneys. For satisfactory outcomes, it requires extreme care and exceptional surgical skill. KEY WORDS Malrotated kidney, Duplex system, Kidney anomaly, Horseshoe kidney, PCNL, Extracorporeal shockwave lithotripsy (ESWL).
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Affiliation(s)
- Naveed Ahmed Mahar
- Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Harris Hassan Qureshi
- Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Ghullam Mustafa
- Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Mohsin Mustafa Memon
- Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Sara Rasheed Kalwar
- Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Gauhar Sultan
- Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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González-Enguita C, Bueno-Serrano G, López de Alda-González A, García-Giménez R. Environmental Conditions as Determinants of Kidney Stone Formation. ACS Appl Bio Mater 2023; 6:5030-5036. [PMID: 37913796 PMCID: PMC10863387 DOI: 10.1021/acsabm.3c00722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
Urolithiasis is a disease characterized by the presence of stones in the urinary tract, whether in the kidneys, ureters, or bladder. Its origin is multiple, and causes can be cited as hereditary, environmental, dietary, anatomical, metabolic, or infectious factors. A kidney stone is a biomaterial that originates inside the urinary tract, following the principles of crystalline growth, and in most cases, it cannot be eliminated naturally. In this work, 40 calculi from the Don Benito, Badajoz University Hospital are studied and compared with those collected in Madrid to establish differences between both populations with the same pathology and located in very different geographical areas. Analysis by cathodoluminescence offers information on the low crystallinity of the phases and their hydration states, as well as the importance of the bonds with the Ca cation in all of the structures, which, in turn, is related to environmental and social factors of different population groups such as a high intake of proteins, medications, bacterial factors, or possible contamination with greenhouse gases, among other factors.
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Affiliation(s)
- Carmen González-Enguita
- Hospital
Universitario Fundación Jiménez Díaz, Avenida Reyes Católicos,
2, 28040 Madrid, Spain
| | - Gonzalo Bueno-Serrano
- Hospital
Universitario Fundación Jiménez Díaz, Avenida Reyes Católicos,
2, 28040 Madrid, Spain
| | | | - Rosario García-Giménez
- Departamento
de Geología y Geoquímica, Facultad de Ciencias, Universidad Autónoma, 28049 Madrid, Spain
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Hoffman K, Shah R, Ismail M, Satyavada S, Alkhayyat M, Mansoor E, Cooper G. Incidence of Kidney Stones After Bariatric Surgeries: Comparing Roux-en-Y Gastric Bypass and Sleeve Gastrectomy. J Gastrointest Surg 2023; 27:2336-2341. [PMID: 37783913 DOI: 10.1007/s11605-023-05849-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/08/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION/PURPOSE The two most common procedures performed to treat obesity are Roux-En-Y gastric bypass (RNYGB) and laparoscopic sleeve gastrectomy (LSG). Due to changes in enteric absorption, bariatric surgery increases rates of nephrolithiasis. As population-based data are limited, we aimed to compare the incidence of kidney stones after RNYGB and LSG. MATERIALS AND METHODS We queried Explorys (Cleveland, OH), a database that aggregated data from 26 healthcare systems. We identified patients who were newly diagnosed with nephrolithiasis 3, 6, and 12 months after their RNYGB or LSG. Additionally, a multivariate analysis was conducted to investigate the association of nephrolithiasis with RNYGB as compared to LSG. This analysis adjusted for other risk factors, including age above 65, male gender, Caucasian race, diabetes mellitus, hypertension, primary hyperparathyroidism, gout, and obesity. RESULTS From 1999 to 2019, there were 11,480 patients who underwent RNYGB and 22,770 patients who underwent LSG. The incidence of nephrolithiasis in the RNYGB cohort at all three time points was higher than in the LSG cohort (3 months, 7.1% vs. 2.4%; 6 months, 6.6% vs. 2.0%; 1 year, 5.8% vs. 1.4%; P < 0.001). After the multivariate analysis, it was found that, though both RNYGB and LSG were independently associated with the development of nephrolithiasis, the risk of nephrolithiasis was higher in those who underwent RNYGB compared to those who underwent LSG (OR 1.594, 95% CI 1.494 to 1.701, P < 0.001). CONCLUSION RNYGB is associated with a higher risk of nephrolithiasis when compared to LSG.
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Affiliation(s)
- Kyle Hoffman
- Division of Gastroenterology, Hepatology, and Nutrition, UPMC, Mezzanine Level, C-Wing, PUH, 200 Lothrop St, Pittsburgh, PA, 15213, USA.
- Department of Medicine, University Hospitals, Cleveland, OH, USA.
| | - Raj Shah
- Division of Gastroenterology, Hepatology, and Endoscopy, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Mayada Ismail
- Division of Gastroenterology, Hepatology, and Nutrition, University at Buffalo, Buffalo, NY, USA
| | - Sagarika Satyavada
- Division of Gastroenterology and Hepatology, University of Texas at Austin, Austin, TX, USA
| | - Mo'tasem Alkhayyat
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Emad Mansoor
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Gastroenterology and Hepatology Section, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
| | - Gregory Cooper
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Digestive Health Institute, University Hospitals Cleveland Medical Center/Seidman Cancer Center, Cleveland, OH, USA
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Zayed S, Goldfarb DS, Joshi S. Popular Diets and Kidney Stones. Adv Kidney Dis Health 2023; 30:529-536. [PMID: 38453270 DOI: 10.1053/j.akdh.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 03/09/2024]
Abstract
Popular diets often influence dietary patterns, which have different implications for kidney stone risk. Despite the wide variety of popular diets, some general principles can be gleaned from investigating their potential impact on nephrolithiasis. Plant-based diets, including Dietary Approaches to Stop Hypertension, Mediterranean, flexitarian, and vegetarian diets, may protect against nephrolithiasis when they consist largely of unprocessed plant foods, while carbohydrate-restricted diets (including high-protein diets and the ketogenic diet) may raise kidney stone risk. Patients should be advised to consume a diet rich in whole plants, particularly fruits and vegetables, and minimize their consumption of animal proteins. Accompanying fruits and vegetables that are higher in oxalate content with more water and some dairy intake may also be useful. (We address the oxalate content of fruits and vegetables further below). Calcium consumption is an important component of decreasing the risk of kidney stones, as higher dietary calcium from dairy or nondairy sources is independently associated with lower kidney stone risk. Patients should also be advised to be conscious of fat intake, as fat in the intestinal lumen may complex with calcium and therefore increase urinary oxalate excretion. Finally, patients should avoid consumption of processed foods, which often contain added fructose and high sodium content, two factors that increase kidney stone risk.
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Affiliation(s)
- Sara Zayed
- New York University Grossman School of Medicine, New York, NY; Department of Medicine, New York University Grossman School of Medicine, New York, NY.
| | - David S Goldfarb
- New York University Grossman School of Medicine, New York, NY; Department of Medicine, New York University Grossman School of Medicine, New York, NY; Nephrology Section, New York Harbor VA Healthcare System, New York, NY
| | - Shivam Joshi
- Department of Medicine, New York University Grossman School of Medicine, New York, NY; Department of Veterans Affairs, Orlando VAMC, Orlando, FL.
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Singh A, Kulshreshtha M, Reddy SJ, Hegde P, Chawla A, Raj KS. Concurrent two surgeon approach for bilateral synchronous percutaneous nephrolithotomy: Initial experience at a University Teaching Hospital. Urologia 2023; 90:659-662. [PMID: 36718499 DOI: 10.1177/03915603221148793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Percutaneous nephrolithotomy (PNL) has long been considered the bench-mark intervention for complicated urinary stones and has undergone important advancements since it was first described. Given the proven safety and efficacy of PNL, simultaneous bilateral PNL has been attempted for bilateral renal calculi to cut down on total procedure costs. To further cut down on operative time, concurrent bilateral synchronous PNL (BS-PNL) has been performed involving two surgeons, each operating concurrently on one renal unit. We performed a retrospective study to evaluate the safety and efficacy of BS-PNL in patients who consented for the procedure. Mean operative time taken from percutaneous access to skin closure was 78 min which was lower than that taken during the single surgeon approach for simultaneous bilateral PNL. Two (12%) out of 16 renal units required multiple punctures for stone clearance. Sheath size varied between 26Fr to 30Fr depending on the stone burden. Mean duration of hospital stay was 2 days. Fourteen (88%) out of 16 renal units had complete stone clearance. Fifteen (94%) out of 16 renal units had a double J stent placed for drainage. Only two patients had complications in the form of postoperative fever. In the background of already proven safety and efficacy of SB-PNL, the concurrent two surgeon approach appears to be feasible and safe with additional advantage of reduced operative time. However, the number of patients in this series were limited and a bigger and preferably multi-institutional study would be required before we can come to a definitive conclusion.
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Affiliation(s)
- Anshuman Singh
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Mayank Kulshreshtha
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Suraj Jayadeva Reddy
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Padmaraj Hegde
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Arun Chawla
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Kothuri Sricharan Raj
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Spiardi R, Goldfarb DS, Tasian GE. Role of Climate Change in Urologic Health: Kidney Stone Disease. Eur Urol Focus 2023; 9:866-868. [PMID: 37839975 DOI: 10.1016/j.euf.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
Kidney stones are rising in incidence and prevalence worldwide. Given the temperature dependence of kidney stone presentations, climate change is projected to further increase the burden of disease for individuals and society. PATIENT SUMMARY: This mini-review reports current knowledge on climate change in relation to kidney stone disease. Kidney stones are more common in patients living in parts of the world that are hotter and more humid. Kidney stone problems are also more common after periods of high heat, which have a greater impact on men than on women. As temperatures rise with climate change, it is likely that the occurrence of kidney stones and the costs associated with their diagnosis and treatment will increase as well.
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Affiliation(s)
- Ryan Spiardi
- Renal-Electrolyte and Hypertension Division, Penn Presbyterian Medical Center, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David S Goldfarb
- Nephrology Division, NYU Langone Health and NYU Grossman School of Medicine, New York, NY, USA; Nephrology Section, NY Harbor VA Healthcare System, New York, NY, USA
| | - Gregory E Tasian
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Kumar P, Laurence E, Crossman DK, Assimos DG, Murphy MP, Mitchell T. Oxalate disrupts monocyte and macrophage cellular function via Interleukin-10 and mitochondrial reactive oxygen species (ROS) signaling. Redox Biol 2023; 67:102919. [PMID: 37806112 PMCID: PMC10565874 DOI: 10.1016/j.redox.2023.102919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/22/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023] Open
Abstract
Oxalate is a small compound found in certain plant-derived foods and is a major component of calcium oxalate (CaOx) kidney stones. Individuals that consume oxalate enriched meals have an increased risk of forming urinary crystals, which are precursors to CaOx kidney stones. We previously reported that a single dietary oxalate load induces nanocrystalluria and reduces monocyte cellular bioenergetics in healthy adults. The purpose of this study was to extend these investigations to identify specific oxalate-mediated mechanisms in monocytes and macrophages. We performed RNA-Sequencing analysis on monocytes isolated from healthy subjects exposed to a high oxalate (8 mmol) dietary load. RNA-sequencing revealed 1,198 genes were altered and Ingenuity Pathway Analysis demonstrated modifications in several pathways including Interleukin-10 (IL-10) anti-inflammatory cytokine signaling, mitochondrial metabolism and function, oxalic acid downstream signaling, and autophagy. Based on these findings, we hypothesized that oxalate induces mitochondrial and lysosomal dysfunction in monocytes and macrophages via IL-10 and reactive oxygen species (ROS) signaling which can be reversed with exogenous IL-10 or Mitoquinone (MitoQ; a mitochondrial targeted antioxidant). We exposed monocytes and macrophages to oxalate in an in-vitro setting which caused oxidative stress, a decline in IL-10 cytokine levels, mitochondrial and lysosomal dysfunction, and impaired autophagy in both cell types. Administration of exogenous IL-10 and MitoQ attenuated these responses. These findings suggest that oxalate impairs metabolism and immune response via IL-10 signaling and mitochondrial ROS generation in both monocytes and macrophages which can be potentially limited or reversed. Future studies will examine the benefits of these therapies on CaOx crystal formation and growth in vivo.
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Affiliation(s)
- Parveen Kumar
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emma Laurence
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David K Crossman
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dean G Assimos
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael P Murphy
- MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge, CB2 0XY, UK
| | - Tanecia Mitchell
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.
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Lin W, Ye Q, Lin ME. Relationship between the weight-adjusted-waist index and kidney stone: a population-based study. World J Urol 2023; 41:3141-3147. [PMID: 37783845 DOI: 10.1007/s00345-023-04620-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/06/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND At present, a growing number of studies have shown a positive association between obesity and kidney stone, while traditional anthropometric measures, such as body mass index (BMI) and Waist circumference (WC), have limited ability to assess the risk of kidney stone. Therefore, this study aimed to investigate the association between the weight-adjusted-waist index (WWI) and the risk of kidney stone. METHOD Data from the National Health and Nutrition Examination Survey (NHANES) between 2009 and 2016 were used. A total of 17,292 participants from NHANES were included in the study. Multivariate logistic regression and restricted cubic splines (RCS) were used to investigate the relationship between WWI and kidney stone. Interaction analysis was performed for subgroups to verify the results. Meanwhile, the receiver operating characteristic curve (ROC) was used to analyze the efficacy of different anthropometric indices in predicting the risk of kidney stone. RESULTS After adjusting for potential confounding factors, we found a positive and independent association between kidney stone and WWI. After adjusting for all covariates, a one-unit increase in WWI was associated with a 36% increase in the risk of kidney stones. Dose-response curve analysis showed that WWI was non-linear correlated with the prevalence of kidney stone. In ROC analysis, WWI showed better discrimination for kidney stone (area under the curve: 0.612; 95% CI: 0.599-0.626; optimal cutoff value: 11.063) compared with other indices. CONCLUSION In this study, increased WWI was strongly associated with the risk of kidney stone.
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Affiliation(s)
- Weilong Lin
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, 515041, China
| | - Qianyi Ye
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, 515041, China
| | - Ming-En Lin
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, 515041, China.
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Chasan O, Mirioglu S, Artan AS, Gursu M, Kazancioglu R, Elcioglu OC. Assessment of metabolic risk factors for nephrolithiasis in patients with autosomal dominant polycystic kidney disease: a cross-sectional study. Clin Exp Nephrol 2023; 27:912-918. [PMID: 37493903 DOI: 10.1007/s10157-023-02378-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 07/07/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Nephrolithiasis is more common in autosomal dominant polycystic kidney disease (ADPKD) than in the normal population. We aimed to investigate the anatomical and metabolic factors that may be associated with nephrolithiasis in patients with ADPKD METHODS: In this cross-sectional study, a total of 180 participants were included. Eighty-five patients with ADPKD [42 patients with nephrolithiasis (PKD N +) and 43 without nephrolithiasis (PKD N -)] were recruited. Forty-seven nephrolithiasis patients without ADPKD (N) and 48 healthy controls (HC) were selected as control groups. 24-h urine collections were measured in all participants. 24-h urine citrate, calcium, urate, oxalate, magnesium and sodium, serum electrolytes, and eGFRs were compared. RESULTS Total kidney volumes were not different between patients with PKD N + and PKD N -. Hypocitraturia was common in all patients with ADPKD (69.4%), and it was not different between PKD N + (76.2%) and PKD N- (62.8%). However, hypocitraturia was statistically higher in PKD N + and PKD N - than in N (38.3%) and HC (12.5%) (p<0.05). 24-h urine calcium, urate, and oxalate levels were similar between PKD N + and PKD N - CONCLUSIONS: Hypocitraturia was found to be significantly higher in patients with ADPKD than in healthy adults and other kidney stone patients.
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Affiliation(s)
- Onour Chasan
- Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
- Division of Endocrinology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Safak Mirioglu
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Adnan Menderes Blv Fatih, 34093, Istanbul, Turkey
| | - Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Adnan Menderes Blv Fatih, 34093, Istanbul, Turkey
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Meltem Gursu
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Adnan Menderes Blv Fatih, 34093, Istanbul, Turkey
| | - Rumeyza Kazancioglu
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Adnan Menderes Blv Fatih, 34093, Istanbul, Turkey
| | - Omer Celal Elcioglu
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Adnan Menderes Blv Fatih, 34093, Istanbul, Turkey.
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Wang X, Zhang J, Ma Z, Yang Y, Dang Y, Cao S, Shi X, Ouyang C, Pan J, Hu X. Association and interactions between mixed exposure to trace elements and the prevalence of kidney stones: a study of NHANES 2017-2018. Front Public Health 2023; 11:1251637. [PMID: 37965524 PMCID: PMC10642183 DOI: 10.3389/fpubh.2023.1251637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Background The association between exposure to trace elements mixture and the prevalence of kidney stones and the interactions between elements are unclear. The aim of this study was to explore the association between exposure to trace elements mixture and the prevalence of kidney stones and the interactions between the elements. Methods A total of 1,244 participants (139 kidney stone formers and 1,105 non-stone former participants) in NHANES 2017-2018 were included. The exposure to trace elements was evaluated by measuring their concentration in urine samples. Three methods, Logistic regression, quantile-based g computation (qgcomp), and Bayesian kernel machine regression (BKMR), were used for analysis. Results According to the results from qgcomp and BKMR, a negative association was found between exposure to the 13 trace elements and the prevalence of kidney stones [OR = 0.50 (0.32, 0.78)]. Subgroup analysis revealed that Co, As, and iodine in the whole population, Co, As, and Ni in males, and Cs, iodine, and Sb in females, were most strongly associated with kidney stones. Kidney stone was found to be positively correlated with Co and negatively correlated with the other elements. Besides, there were significant interactions between Ni and Pb in the whole population, Co and iodine in males, and Pb and iodine in females. Conclusion There was a negative association between exposure to the mixture of 13 trace elements and the prevalence of kidney stones.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Xiaobin Hu
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, China
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Bitkin A, Özlü DN, Ekşi M, Kargı T, Fakir AE, Ayten A, Polat H, Taşçı Aİ. A comparative analysis of the efficacy and safety of mini-percutaneous nephrolithotomy performed in the supine and prone positions for the treatment of pediatric kidney stones: a single-center experience. Urolithiasis 2023; 51:122. [PMID: 37847257 DOI: 10.1007/s00240-023-01497-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023]
Abstract
Mini-percutaneous nephrolithotomy (MPCNL), which has a smaller tract size (14-20 Fr) than conventional percutaneous nephrolithotomy, has been shown to be safe and effective in pediatric patients with large and complex upper urinary tract stones. This study aimed to compare the efficacy and safety of MPCNL between the supine and prone positions in a pediatric population. The data of pediatric patients who underwent MPCNL at our center between January 2010 and March 2023 were retrospectively analyzed. According to the surgical position, the patients were divided into the prone (Group P) and supine (Group S) groups. In both groups, dilatation was performed using 14-18 Fr metallic dilators. The two groups were compared in terms of perioperative data, postoperative stone-free rates (SFRs), and complications. There were 36 (59%) patients in Group P and 25 (41%) patients in Group S. Stones were mostly located in the pelvis (49.2%) and second most frequently in the lower pole (27.9%). Fluoroscopy time was shorter in Group S but did not statistically significantly differ compared to Group P (p = 0.181). However, operation time was statistically significantly shorter in Group S (73.8 ± 35 vs. 99.8 ± 37.4 min, p = 0.008). Although there was no significant difference, relatively higher SFR were detected in Group S (88% vs. 83%, p = 0.725). Endoscopic combined intrarenal surgery (ECIRS) was performed on six (24%) patients in Group S, and the SFR was 100% among these patients. There was no significant difference between the two groups in terms of the presence of complications (16.7% vs. 16%, p = 0.945). Both supine and prone MPCNL appear to be safe and effective in the pediatric age group, with similar stone-free and complication rates. In the supine procedure, the operation time is shortened compared to the prone. In addition, simultaneous retrograde access has the potential to increase the overall success rate of surgery.
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Affiliation(s)
- Alper Bitkin
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey.
| | - Deniz Noyan Özlü
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Mithat Ekşi
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Taner Kargı
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Ali Emre Fakir
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Ali Ayten
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Hakan Polat
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Ali İhsan Taşçı
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
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49
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Hartung FO, Müller KJ, Herrmann J, Grüne B, Michel MS, Rassweiler-Seyfried MC. Comparison of endoscopic versus CT assessment of stone-free status after percutaneous nephrolithotomy (PCNL). Urolithiasis 2023; 51:120. [PMID: 37801124 PMCID: PMC10558392 DOI: 10.1007/s00240-023-01495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
This study is aimed to determine whether postoperative low dose computed tomography (LDCT) imaging is necessary after percutaneous nephrolithotomy (PCNL), or the surgeon's intraoperative assessment of residual fragments (RF) is sufficient and avoidance of postoperative imaging with reduction of radiation exposure can be achieved. Data of all 610 patients who underwent PCNL in prone position in our institution from February 2009 to September 2020 was collected. Parameters such as age, gender, BMI, ASA-Classification, stone related parameters and the surgeon's assessment of stone-free status were analyzed. The LDCT performed postoperatively was compared to the intraoperative assessment of the surgeon regarding RF. The mean age of patients was 52.82 years; the mean BMI was 28.18 kg/m2. In 418 cases, the surgeon made a clear statement about the presence of RF and postoperative LDCT was carried out. The discrepancy between the two methods (surgeon´s assessment vs. LDCT) was significant at p < 0.0001. The sensitivity, specificity, positive and negative predictive value of the surgeon when assessing RF were 24.05%, 99.45%, 98.28% and 50%. Stone free rate (SFR) after primary PCNL was 45.57%. The overall SFR at discharge was 96.23%. Although the surgeon´s assessment of RF was reliable, postoperative LDCT imaging should still be performed if endoscopic stone clearance is suspected due to the high false negative rate and the low negative predictive value. The optimal timing of postoperative imaging following PCNL remains unclear.
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Affiliation(s)
- F. O. Hartung
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - K. J. Müller
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - J. Herrmann
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - B. Grüne
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - M. S. Michel
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - M. C. Rassweiler-Seyfried
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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Mohamed ER, Elmogazy HM, Zanaty AK, Elsharkawi AM, Riad AM, Badawy AA. Extracorporeal shock wave lithotripsy for treatment of large pediatric renal pelvic stone burden more than 2 cm. J Pediatr Urol 2023; 19:561.e1-561.e11. [PMID: 37414650 DOI: 10.1016/j.jpurol.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The high recurrence rates in pediatric urolithiasis indicate the need for none invasive or a minimally invasive treatment such as SWL. Therefore, EAU, ESPU and AUA recommend SWL as a first line treatment for renal calculi ≤ 2, and RIRS or PCNL for renal calculi > 2 cm. SWL is superior to RIRS and PCNL as it is inexpensive, outpatient procedure, and it has a high SFR in well selected cases specially pediatrics. On the other hand, SWL therapy has a limited efficacy with a lower SFR, and high retreatment rate and/or additional interventions for treatment of larger and harder renal calculi. OBJECTIVE We carried out this study to evaluate the efficacy and safety of SWL for treatment of renal stones > 2 cm to extend its indications for pediatric renal calculi. METHODS Between January 2016 and April 2022, we reviewed the records of patients with renal calculi treated by SWL, mini-PCNL, RIRS and open surgery in our institution. Forty-nine eligible children aged 1-5 years old, presented with renal pelvic and/or calyceal calculi measuring 2-3.9 cm and underwent SWL therapy were picked up and participated in the study. The data of an additional eligible 79 children with the same age and had renal pelvic and/or calyceal calculi > 2 cm up to stag horn calculi and underwent mini-PCNL, RIRS and open renal surgery were also picked up and participated in the study. We retrieved the following preoperative data from the records of the eligible patients; age, gender, weight, length, radiological findings (stone size, side, site, number and radio-density), renal function tests, routine laboratory findings, and urine analysis. The outcomes data in the form of; operative time, fluoroscopy time, hospital stay, SFRs, retreatment rates and complication rates were also retrieved from the records of patients treated with SWL and other techniques. Also, we collected the SWL characteristics in terms of; position, number and frequency of shocks, voltage, time of the session and U/S monitoring to assess stone fragmentation. All SWL procedures were performed according to the institution's standards. RESULTS The mean age of patients treated with SWL was 3.23 ± 1.19 years old, the mean size of the treated calculi was 2.31 ± 0.49 and the mean length of the SSD was 8.2 ± 1.4 cm. All patients had NCCT scan and the mean radio-density of the treated calculi was 572 ± 169.08 HUs based on NCCT scans Table (1). Single- and two-session SFRs of SWL therapy were 75.5% (37/49 patients) and 93.9% (46/49 patients), respectively. The overall success rate was 95.9% (47/49 patients) after three-session of SWL. Complications experienced by 7 patients (14.3%) in the form of fever (4.1%), vomiting (4.1%), abdominal pain (4/1%), and hematuria (2%). All complications were managed in outpatient settings. Our results were obtained on the basis of preoperative NCCT scans for all patients and postoperative plain KUB films and real-time abdominal U/S. Furthermore, single-session SFRs for SWL, mini-PCNL, RIRS and open surgery were 75.5%, 82.1%, 73.7% and 90.6%, respectively. Two-session SFRs by the same technique were 93.9%, 92.8%, and 89.5% for SWL, mini-PCNL and RIRS, respectively. A lower overall complication rate and higher overall SFR were found with SWL therapy compared to other techniques, Fig. (1). DISCUSSION Being a non-invasive outpatient procedure with a low complication rate and good spontaneous passage of stone fragments is the main advantage of SWL. In this study, the overall SFR is 93.9% where 46 out of 49 patients were completely rendered stone free after three session of SWL with overall success rate 95.9%. Badawy et al. reported overall success rates of 83.4% for renal stones with a mean stone size of 12.5 ± 7.2 mm. In children with renal stones measuring 18.2 mm, Ramakrishnan et al. reported a 97% SFR in accordance with our results. The high overall success rate (95.9%) and SFR (93.9%) in our research were attributed to the regular use of ramping procedure, low shock wave rate, percussion diuretics inversion (PDI) approach and alpha blocker therapy in all participants and short SSD. The limitations of our study are small sample of patients and its retrospective nature. CONCLUSION The non-invasive nature and replicability of the SWL procedure, along with the high success and low complication rates, give us a new insight to consider its application for treating pediatric renal calculi > 2 cm over the other more invasive techniques. Short SSD, the use of ramping procedure, low shock wave rate, 2 min break, PDI approach and alpha blockers therapy help better success of SWL. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | | | - Ahmed Kalaf Zanaty
- Urology Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | | | - Ahmed Mahmoud Riad
- Urology Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
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