Fructose-Rich Diet Is a Risk Factor for Metabolic Syndrome, Proximal Tubule Injury and Urolithiasis in Rats

Excessive consumption of fructose (FR) leads to obesity, metabolic syndrome (MS) and insulin resistance, which are known risk factors for kidney stones. The epidemiological study has suggested the association between fructose consumption and urolithiasis, but the precise mechanism is still not well understood. Male Wistar rats were assigned for 8 weeks to three groups with different FR content in diet: RD (n = 5)-regular diet with a FR < 3%; F10 (n = 6)-regular diet with an addition of 10% Fr in drinking water; F60 (n = 5)-60% FR as a solid food. Serum concentration of FR, creatinine (Cr), insulin (Ins), triglycerides (Tg), homocysteine (HCS), uric acid (UA), calcium (Ca), phosphate (Pi), magnesium (Mg) and sodium (Na) were measured. Based on 24 h urine collection the following tests were performed: urine pH, proteinuria (PCR), excretion of N-Acetyl-(D)-Glucosaminidase (NAG), monocyte chemoattractant protein (MCP-1), uric acid (uUAEx), phosphate (uPiEx), calcium (uCaEx), magnesium (uMgEx) and sodium (uNaEx). The creatinine clearance (CrCl) was calculated. Calcium deposits in kidney sections were examined using hematoxylin and eosin (HE) and von Kossa stains. The rats on F10 and F60, as compared to the RD diet, showed a tendency for lower CrCl, higher HCS level and some features of MS as higher Ins and TG levels. Interestingly, F10 (fluid) versus F60 (solid) diet led to higher serum Ins levels. F10 and F60 versus RD demonstrated higher urinary excretion of MCP-1 and NAG which were suggestive for inflammatory injury of the proximal tubule. F10 and F60 as compared to RD showed significantly lower uUAEx, although there were no differences in clearance and fractional excretion of UA. F60 versus RD induced severe phosphaturia (>30×) and natriuria (4×) and mild calciuria. F10 versus RD induced calciuria (3×), phosphaturia (2×) and mild natriuria. Calcium phosphate stones within the tubules and interstitium were found only in rats on FR diet, respectively, in two rats from the F10 group and another two in the F60 group. The rats which developed stones were characterized by significantly higher serum insulin concentration and urinary excretion of calcium and magnesium. A fructose-rich diet may promote development of calcium stones due to proximal tubule injury and metabolic syndrome.

Effect of Fat-Soluble Vitamins A, D, E and K on Vitamin Status and Metabolic Profile in Patients with Fat Malabsorption with and without Urolithiasis

Patients with intestinal fat malabsorption and urolithiasis are particularly at risk of acquiring fat-soluble vitamin deficiencies. The aim of the study was to evaluate the vitamin status and metabolic profile before and after the supplementation of fat-soluble vitamins A, D, E and K (ADEK) in 51 patients with fat malabsorption due to different intestinal diseases both with and without urolithiasis. Anthropometric, clinical, blood and 24-h urinary parameters and dietary intake were assessed at baseline and after ADEK supplementation for two weeks. At baseline, serum aspartate aminotransferase (AST) activity was higher in stone formers (SF; n = 10) than in non-stone formers (NSF; n = 41) but decreased significantly in SF patients after supplementation. Plasma vitamin D and E concentrations increased significantly and to a similar extent in both groups during intervention. While plasma vitamin D concentrations did not differ between the groups, vitamin E concentrations were significantly lower in the SF group than the NSF group before and after ADEK supplementation. Although vitamin D concentration increased significantly in both groups, urinary calcium excretion was not affected by ADEK supplementation. The decline in plasma AST activity in patients with urolithiasis might be attributed to the supplementation of ADEK. Patients with fat malabsorption may benefit from the supplementation of fat-soluble vitamins ADEK.

[Application of serum amino acid profile in urolithiasis based on gas chromatography-mass spectrometry]

An overall workflow based on gas chromatography-mass spectrometry (GC-MS) was established for the analysis of the serum amino acid profile between urolithiasis patients (n=80, age (46.82±13.39) years) and healthy controls (n=37, age (43.46±12.79) years). The raw data from GC-MS analysis were processed by multivariate statistical methods to build the model. Following this, student's t-test and logistic regression were performed and receiver operator characteristic (ROC) curve was plotted to identify the potential biomarkers. Good linearities were observed for the target amino acids, with correlation coefficients (R²) greater than 0.9985. The limits of detection (LODs) were 0.1-4.0 μmol/L. The results indicated a significant discrimination between the urolithiasis and control groups. Five significantly differentially expressed amino acids (variable importance in projection (VIP)>1 and p<0.05) were found to provide the scientific evidence for the early diagnosis of urolithiasis, while the sensitivity of the integrated five differential amino acids was up to 97.3%. In particular, the area under the curve (AUC) of serine reached 0.819, which suggested a great clinical screening value.

[Specific features of the immune status and blebbing of the plasmatic membrane of lymphocytes patients with urolithiasis complicated by the pyelonephritis]

INTRODUCTION

According to the epidemiological studies, prevalence of urolithiasis is nearly 10% worldwide. The course of the disease is often complicated by the development of pyelonephritis, the pathogenesis of which is rather multifactorial. Along with urinary tract obstruction, increasing virulence of microorganisms and immune insufficiency in patients also plays a major role.

AIM

To define specific features of immune insufficiency in patients who develop pyelonephritis as a complication of urolithiasis.

MATERIALS AND METHODS

A total of 150 patients with urolithiasis complicated by pyelonephritis were prospectively enrolled into our study in order to develop a novel method. All patients were divided into two clinical groups. Group I consisted of 75 patients with urolithiasis complicated by serous pyelonephritis and Group II included 75 patients with urolithiasis complicated by purulent pyelonephritis. In all patients an evaluation of the immune status with a determination of CD3, CD4, CD8, CD16, CD19 level and phagocyte activity of immune system was carried out. The state of lymphocytes plasmatic membrane was evaluated by phase contrast microscopy.

RESULTS

It is established that development of pyelonephritis in patients with urolithiasis is accompanied by a lymphopenia, the decrease in relative contents T-helpers, natural killers, as well as a decrease in the immuno-regulatory index and an increase in indicators of terminal and total lymphocytes blebbing. The most pronounced changes were noted in purulent pyelonephritis, where suppressed immune status was confirmed by the high level of lymphocyte with terminal blebbing state.

The association between a non-invasive hepatic fibrosis score and urolithiasis among non-alcoholic fatty liver disease (NAFLD) patients in China: a cross-sectional study

OBJECTIVE

Mounting data now support a strong link between the presence of non-alcoholic fatty liver disease (NAFLD) and an increased risk of urolithiasis. However, little is known on the association between hepatic fibrosis and the risk of urolithiasis among NAFLD patients. Therefore, this study aimed to investigate the prevalence of urolithiasis among NAFLD patients and determine whether the Fibrosis-4 (FIB-4) score, a surrogate marker of hepatic fibrosis, is associated with urolithiasis among NAFLD patients.

DESIGN

Cross-sectional studies.

SETTING

China.

METHODS

A total of 2058 adult patients with NAFLD were included in this study. Logistic regression analysis was used to detect the association between FIB-4 score and urolithiasis. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic value of FIB-4 score for the detection of urolithiasis among NAFLD patients.

RESULTS

200 (9.7%) individuals had ultrasonography-diagnosed urolithiasis among 2058 NAFLD patients. FIB-4 score (OR=1.58; 95% CI 1.06 to 2.31), age (OR=1.11; 95% CI 1.08 to 1.13), obesity (OR=3.16; 95% CI 2.29 to 4.39) and hyperuricemia (OR=3.79; 95% CI 2.67 to 5.36) were independent factors associated with urolithiasis among NAFLD patients. Moreover, a novel algorithm including multiple variables (FIB-4 score, age, obesity and hyperuricemia) showed an area under a ROC curve of 0.813 (95% CI 0.795 to 0.829) for identifying urolithiasis among NAFLD patients. The optimal cut-off value of > -2.23 for the multivariate model provides a sensitivity of 76% and a specificity of 74% for predicting urolithiasis among NAFLD patients.

CONCLUSION

Urolithiasis among NAFLD patients is associated with FIB-4 score. Further, a novel algorithm based on FIB-4 score could serve as a useful tool for identifying individuals with a higher risk of urolithiasis among NAFLD patients, although prospective cohort studies are still needed in the future.

Heavy Metal Components in Blood and Urinary Stones of Urolithiasis Patients

Lifestyle, food intake, and exposure to chemicals are potential risk factors for the development of calcium urolithiasis. Pb, Cd, and Hg have been proved to cause renal illness, and urinary tract stones might be caused by exposure to metals. Therefore, this study aimed to measure the concentration of metals in urinary tract stones and blood simultaneously in urolithiasis patients. Moreover, we intended to determine whether urinary tract stones can be regarded as a biomarker of exposure or an effect marker in a population with environmental exposure to metals. Thirty-five urolithiasis patients (case) and 34 healthy inhabitants (control) were recruited in this study. The contents of Pb, Cd, Cr, Cu, Ni, As, Zn, and Hg were determined in urinary stones and blood in the case and control groups. The most abundant metals were Zn and Cu in blood and Zn and Ni in urinary stones. Significantly higher levels of Zn, Ni, and As were found in calcium phosphate stones than in calcium oxalate or uric acid stones. The majority of metals were not present at consistent levels in both blood and urinary stones, except for Zn. Urinary stones might be explained as providing another metabolic pathway for metal contamination. Moreover, as the metals with the highest content in urinary stones were Ni and Zn, and Ni content was very much higher than in other countries, contamination by Ni should be further taken into consideration if there is any serious contamination in Taiwan.

In vitro and ex vivo approach for anti-urolithiatic potential of bioactive fractions of gokhru with simultaneous HPLC analysis of six major metabolites and their exploration in rat plasma

CONTEXT

Tribulus terrestris L. (Zygophyllaceae) fruits have long been used in traditional systems of medicine for the treatment of various urinary diseases including urolithiasis.

OBJECTIVE

To explore the anti-urolithiatic potential of gokhru and to develop an analytical method for quantitative estimation of metabolites for its quality control.

MATERIALS AND METHODS

Aqueous extract of gokhru fruit was prepared through maceration followed by decoction to produce a mother extract, which was further used for polarity-based fractionations. In vitro and ex vivo anti-urolithiatic activity of mother extract and fractions at different concentration (100-1000 μg/mL) were carried out using aggregation assay in synthetic urine and in rat plasma, however, nucleation assay for 30 min was done using confocal microscopy. A simultaneous HPLC method has been developed for quantification of diosgenin, catechin, rutin, gallic acid, tannic acid and quercetin in mother extract and in fractions.

RESULTS

The extraction resulted in 14.5% of w/w mother extract, however, polarity-based fractionation yielded 2.1, 2.6, 1.5, 1.3 and 6.1% w/w of hexane, toluene, dichloromethane (DCM), n-butanol and water fractions, respectively. In vitro and ex vivo studies showed a significant anti-urolithiatic potential of n-butanol fraction. Further, HPLC analysis revealed significantly (p < 0.01) higher content of quercetin (1.95 ± 0.41% w/w), diosgenin (12.75 ± 0.18% w/w) and tannic acid (9.81 ± 0.47% w/w) in n-butanol fraction as compared to others fractions.

DISCUSSION AND CONCLUSION

In vitro and ex vivo studies demonstrated potent anti-urolithiatic activity of n-butanol fraction which can be developed as new phytopharmaceuticals for urolithiasis. HPLC method can be used for quality control and pharmacokinetic studies of gokhru.

[Clinical and biochemical aspects of pathogenesis of urolithiasis]

AIM

To investigate the role of infection in the pathogenesis of urolithiasis using chromatography mass spectrometry analysis.

MATERIALS AND METHODS

The study analyzed clinical and laboratory data of 316 urolithiasis patients hospitalized between February 2005 and January 2015. All patients underwent a comprehensive clinical examination, including laboratory tests (hematological and biochemical blood tests, clinical and bacteriological tests of urine) and chromatography mass spectrometry analysis urine and blood. The laboratory testing was carried out both during the patients hospital stay and outpatient follow-up.

RESULTS

We analyzed the biological material for the presence of characteristic ions. Urine samples of 316 urolithiasis patients were found to contain activators of "cooperative sensitivity." Moreover, there was a significant increase in the concentration of signaling compounds of the "cooperative sensitivity" of microorganisms in patients with complicated urolithiasis in comparison with the control indices (lactones-0.006 plus/minus 0.0004 mmol/L, normal values less than 0.002, quinolones 0.004 plus/minus 0.0003 mmol/l, normal values - less than 0.002 and furan esters - 0.005 plus/minus 0.0004, normal values less than 0.002). Threshold values of the activators of "cooperative sensitivity" demonstrated the readiness of the microbial community to initiate an inflammatory process. The presence of activators such as lactones, quinolones and furan esters in the samples of urolithiasis patients predisposes to the activation of pathogenic genes in a large group of microorganisms, including gram positive and gram negative species.

DISCUSSION

In our opinion, to improve the quality of diagnostic, treatment and preventive measures in patients with different types of stone formation, it is advisable to use chromatography mass spectrometry analysis, which allows determination of priority clinical and laboratory indicators.

CONCLUSION

The data on the role of infection in the pathogenesis of urolithiasis obtained by chromatographic methods suggest the possibility of using the indicators of the activators of the "cooperative sensitivity" of microbes in patients with various forms of urolithiasis to assess the disease severity.

Association between Circulating Vitamin D Level and Urolithiasis: A Systematic Review and Meta-Analysis

Many studies compared the serum/plasma 1,25 dihydroxyvitamin D₃ (1,25(OH)₂D) and 25 hydroxyvitamin D₃ (25(OH)D) between people with and without nephrolithiasis, and their results were conflicting. After systematically searching PubMed, Web of Science, The Cochrane Library, CNKI, and the Wanfang Database, we conducted a meta-analysis. Thirty-two observational studies involving 23,228 participants were included. Meta-analysis of these studies showed that of stone formers (SFs), calcium SFs had significantly higher concentrations of 1,25(OH)₂D (weighted mean difference (WMD), 10.19 pg/mL; 95% confidence interval (CI), 4.31-16.07; p = 0.0007 and WMD, 11.28 pg/mL; 95% CI, 4.07-18.50; p = 0.002, respectively) than non-stone formers, while the levels of 25(OH)D (WMD, 0.88 ng/mL; 95% CI, -1.04-2.80; p = 0.37 and WMD, -0.63 ng/mL; 95% CI, -2.72-1.47; p = 0.56, respectively) are similar. Compared with controls and normocalciuria SFs, hypercalciuria SFs had increased circulating 1,25(OH)₂D (WMD, 9.41 pg/mL; 95% CI, 0.15-18.67; p = 0.05 and WMD, 2.75 pg/mL; 95% CI, -0.20-5.69; p = 0.07, respectively) and markedly higher 25(OH)D (WMD, 5.02 ng/mL; 95% CI, 0.99-9.06; p = 0.01 and WMD, 5.02 ng/mL; 95% CI, 2.14-7.90; p = 0.0006, respectively). Normocalciuria SFs had elevated 1,25(OH)₂D level (WMD, 6.85 pg/mL; 95% CI, -5.00-18.71; p = 0.26) and comparable 25(OH)D (WMD, 0.94 ng/mL; 95% CI, -3.55-5.43; p = 0.68). Sensitivity analysis generated similar results. Current evidence suggests that increased circulating 1,25(OH)₂D is associated with urinary stones and a higher level of circulating 25(OH)D is significantly associated with hypercalciuria urolithiasis. Further studies are still needed to reconfirm and clarify the role of vitamin D in the pathogenesis of stones.

Chenopodium album Linn. leaves prevent ethylene glycol-induced urolithiasis in rats

ETHNOPHARMACOLOGICAL RELEVANCE

The leaves of Chenopodium album Linn. are traditionally used for correction of kidney diseases and urinary stones. The present work investigated the effect of methanolic and aqueous extracts of leaves of Chenopodium album on experimentally-induced urolithiasis in rats to substantiate its traditional use as antilithiatic agent.

MATERIALS AND METHODS

The leaf extract was standardized by HPLC. Urolithiasis was induced in rats by administration of 0.75% v/v of ethylene glycol (EG) in distilled water and in addition, vehicle or methanol (CAME) or aqueous (CAAE) extract of the leaves of Chenopodium album each in the dose 100, 200 and 400mg/kg or Cystone (750mg/kg) were administered daily orally for 28 days. Urolithiasis was assessed by estimating the calcium, phosphorus, urea, uric acid, and creatinine in both urine and plasma. The volume, pH and oxalate levels were also estimated in urine. The renal oxalate content was estimated in kidney while calcium oxalate deposits were observed histologically.

RESULTS

The treatment with CAME or CAAE for 28 days significantly attenuated the EG-induced elevations in the urine and plasma levels of calcium, phosphorus, urea, uric acid and creatinine along with decrease in urine volume, pH and oxalates. The treatments also decreased renal tissue oxalate and deposition of oxalate crystals in kidney due to EG treatment. The effects of CAME and CAAE were comparable to standard antilithiatic agent, cystone. The findings indicate the preventive effect of CAME and CAAE which can be due to inhibitory effect on crystallization and stone dissolution. The effect was attributed to the presence of phytochemicals like flavonoids and saponins.

CONCLUSION

In conclusion, Chenopodium album leaves exhibited antilithiatic effect and validates its ethnomedicinal use in urinary disorders and kidney stones.

Antilithiatic effect of Peucedanum grande C. B. Clarke in chemically induced urolithiasis in rats

ETHNOPHARMACOLOGICAL RELEVANCE

Duqu (Peucedanum grande C. B. Clarke) has been used by Unani physicians since ancient times in retention of urine, renal and bladder calculi, nephritis and other associated disorders in different dosage forms.

AIM OF THE STUDY

The aim of the study was to evaluate the antiurolithiatic activity of Peucedanum grande C. B. Clarke in experimental model.

MATERIALS AND METHODS

The experiment was carried out in male Sprague Dawley rats divided into 5 groups of 8 animals each. Animals of negative control received 1ml of 5% Gum acacia throughout the study. Remaining four groups received Ethylene glycol 0.75% and Ammonium chloride 1% by adding in their drinking water for first seven days to induce urolithiasis. From 8th day, positive control received 1ml of 5% Gum acacia, standard control received Cystone in the dose of 750mg/kg while test groups A and B were treated with hydroalcoholic extract of test drug in the dose of 56mg/kg and 97mg/kg respectively up to 21 days, thereafter the animals were sacrificed. Number of CaOx crystals in urine, levels of serum calcium, phosphorus, creatinine, urea, urinary calcium and sodium were observed. Kidney homogenate analysis and histopathology were also carried out.

RESULTS

Test drug reduced number of CaOx crystals in urine (p<0.001); levels of serum calcium, phosphorus, creatinine, (p<0.001) urea, (p<0.05); urinary calcium (p<0.001) and sodium decreased significantly in standard and test groups. The urine volume increased significantly (p<0.05, 0.01) in both the test groups. Histopathology of kidney showed no CaOx crystal deposition in both the test groups.

CONCLUSION

On the basis of above findings, it can be concluded that the test drug possesses significant antiurolithiatic activity.

Metabolic risk factors in pediatric stone formers: a report from an emerging economy

The goal of this study was to investigate metabolic risk factors in pediatric stone formers in an emerging economy. A prospective, data collection enrolled 250 children age <1-15 years at our center. Risk factors were evaluated by gender and in age groups <1-5, 6-10 and 11-15 years. Patients were evaluated for demographics, blood and 24 h urine for calcium, magnesium, phosphate, uric acid, electrolytes and additional protein, citrate, ammonia and oxalate in urine. All reported values were two sided and statistical significance was considered at p value ≤0.05. The mean age at diagnosis was 7.50 ± 3.56 years with a male to female ratio of 1.84:1. A family history of urolithiasis was found in 41 (16.4 %), urinary tract infection in 18 (7 %) and chronic diarrhea in 75 (30 %). Hypercalcemia was seen in 37 (14.8 %), hyperuricemia in 23 (9.2 %) and hyperphosphatemia in 6 (2.4 %). Urinary metabolic abnormalities were identified in 248 (98 %) of the cases. Hypocitraturia was found in 207 (82.8 %), hyperoxaluria in 62 (26.4 %), hyperuricosuria in 82 (32.8 %), hypercalciuria in 51 (20.4 %), hyperphosphaturia in 46 (18.4 %), hyperammonuria in 10 (4 %), hypocalciuria in 82 (32.8 %), and hypovolemia in 73 (29.2 %). Risk factors were similar between genders except higher rates of hyponatriuria, hypophosphaturia, and hypocalciuria in females. Hyperuricosuria, hyponatriuria, and hypovolemia were highest in 1-5 years (52, 49, 49 %) as compared to (18, 21, 12 %) those in 11-15 years (p < 0.001), respectively. This study shows that careful metabolic analysis can identify risk factors in 98 % of the children where appropriate metaphylaxis can be undertaken both for treatment and prevention of recurrence.

Polyacrylic acid attenuates ethylene glycol induced hyperoxaluric damage and prevents crystal aggregation in vitro and in vivo

The study explores calcium oxalate crystal inhibiting characteristic of polyacrylic acid (pAA), an anionic polymer in in vitro and in vivo. Animals were divided into 5 groups where group 1 served as control, group 2 were made hyperoxaluric by supplementing with Ethylene glycol (EG) 0.75% (v/v) for 30 days. Group 3, 4 & 5 were also given with EG and treated simultaneously with 2.5, 5 & 10 mg of pAA/kg of body weight, respectively. Urine, serum and tissue analyses along with histological studies were performed at the end of the 30 days study. In vitro crystallization was significantly inhibited by pAA and further it was supported by particle size analyses, XRD and FT-IR studies. Toxicological analyses showed that pAA was safe to use in animals at concentrations below 100 mg/kg BW. In vivo anti-urolithic study showed significant improvement in urinary lithogenic factors (calcium, oxalate, phosphate, citrate & magnesium) and renal function parameters (creatinine, urea and protein). Tissue analyses on anti-oxidant enzyme activity and lipid peroxides showed maintenance of tissue antioxidant status in the pAA supplemented rats and histological studies demonstrated the nephroprotection offered by pAA and were concurrent to the biochemical analyses. Supplementation of pAA not only reduces the crystal aggregation but also regulates the expression and localization of crystal inhibiting proteins and gene expression of inflammatory cytokines in experimental animals. In summary, pAA is a potent anti-urolithic agent in rats and we can propose that 10 mg/kg body weight is the effective dosage of pAA and this concentration can be used for further studies.

[THE SEARCH AFTER PROGNOSTIC TESTS OF DEVELOPMENT OF UROLITHIASIS OF PATIENTS WITH VERTEBRO-CEREBROSPINAL TRAUMA]

The article presents analysis of alterations of biochemical indicators in blood serum and day urine of 22 patients in acute and early periods after vertebro-cerebrospinal trauma. Out of total number of patients in 10 (main group) in post-traumatic period urolithiasis developed In 12 patients no signs of urolithiasis were detected These examinedpatients were included into comparative group. The reference group was composed with 20 healthy individuals. The concentration of urea, creatinine, uric acid, calcium and inorganic phosphate in blood serum and day urine were detected In patients of main group statistically significant increasing of levels of urea and creatinine was detected in blood serum relative to patients of comparative group. In examined patients of main group clearance of urea was reliably lower than both values of comparative group (up to 2.55 times; p < 0.05) and indicators of reference group (up to 3.75 times; p < 0.05). In patients of this group, clearance of uric acid also had reliable differences from indicators both in comparative group and reference group. Therefore, in patients in acute and early periods of vertebro- cerebrospinal trauma expressed disorders of biochemical indicators of blood serum and urine that can be referred to predictors of risk of development of urolithiasis in the following. The most informative tests were increasing of concentration of urea in blood serum more than 5.30 mmol/l (ratio of likelihood ofpositive test--4.26) and decreasing of clearance of uric acid and urea.

[PERSISTENCE OF MYCOPLASMA DURING UROLITHIASIS]

AIM

Study the frequency of detection of mycoplasma and ureaplasma in clinical material from urolithiasis patients.

MATERIALS AND METHODS

Clinical material samples (blood sera, urine, uroliths) from 31 urolithiasis patients were obtained during operations of urolith-removal. Cultural method, LAR and PCR were used in the study.

RESULTS

The study of clinical material from 31 patients by PCR has shown, that in 25 individuals. (80.6%) DNA of mycoplasma and ureaplasma was detected, and mycoplasma DNA was more frequently detected in uroliths and less--in-blood sera. Mycoplasma hominis DNA was detected in clinical material of a significantly largerninmber of patients. 23 cultures were isolated from 8 patients by a cultural method, that were identified by PCR as M. hominis. All the isolates have grown as "mini colonies". Even after multiple passages in agar medium, reversion of "mini-colonies" into colonies with a classic morphology was not obtained.

CONCLUSION

A high frequency of detection of mycoplasma and ureaplasma in clinical material of patients with urolithiasis was established. The isolated M. hominis cultures have only grown as "mini-colonies". The phenomenon discovered could give evidence on high variability of mycoplasma and a possibility of existence of previously unknown form of their persistence in human organism.

[THE MODERN PROSPECT FOR CITRATE MIXTURES IN THE TREATMENT OF UROLITHIASIS]

The authors present a review of literature on the use of litholytic citrate medications for conservative management of urolithiasis. Urate urolithiasis is the most common clinical condition encountered by urologists. Citrate agents, in particular Blemaren, not only may be employed in a conservative therapy of uric acid stones, but can also be successfully used in the treatment of the calcium urolithiasis, i.e. mixed composition stones, which is supported by current international urology guidelines.

[The use of NefroDoz in patients with urolithiasis who underwent extracorporeal shock wave lithotripsy]

The article presents the results of the multicenter clinical comparative open-label trial in three parallel groups, which was aimed to the evaluation of the efficacy and safety ofbiologically active food supplement NefroDoz after extracorporeal shock wave lithotripsy (ESWL) in patients with urolithiasis. NefroDoz was prescribed for the lithokinetic purpose. The study involved 114 patients from different regions of the Russian Federation aged from 18 to 75 years (mean age 45.56 +/- 12.49 years) with a diagnosis of urolithiasis who underwent ESWL. Patients were divided into 3 groups according to the type oftreatment. Evaluation of the effectiveness was performed using data from a blood test, urine analysis, and biochemical blood assay, ultrasound and KUB X-ray. The results showed that NefroDoz has diuretic, anti-inflammatory, and lithokinetic effects, and is effective and safe drug for the patients with urolithiasis who underwent ESWL.

[Potential biochemical factors for the development of urolithiasis in patients with spinal cord injuries]

A comparative analysis of biochemical parameters of blood serum and daily urine in patients with urolithiasis developed after spinal cord injury (study group--35 patients) and patients without development of the disease (comparison group--20 patients) was performed. It was found that patients after spinal cord injury have developed productive azotemia, which led to the disruption of renal excretory function (accumulation of urea and creatinine in blood, and lowering their clearance). Against this background, there is violation of excretion of uric acid, magnesium, decreased sensitivity of the renal tubules to aldosterone (in patients with nephrolithiasis K/Na ratio in urine was lower). As a result, patients have decreased reabsorption of sodium and water retention, increased urine osmolality; against the background of electrolyte imbalance in urine, this leads to the formation of stones. In patients with spinal cord injuries, main trigger mechanism of formation of urinary stones was excessive posttraumatic azotemia. The high concentration of the products of protein-nitrogen catabolism in the serum of patients in the acute and early periods of spinal cord injury may be unfavorable criterion determining the significant risk of developing of kidney stones.

[Clinical and laboratory parameters in patients with urolithiasis in the presence and absence of primary hyperparathyroidism]

The clinical and laboratory findings in 78 patients with various forms of urolithiasis depending on the presence of primary hyperparathyroidism (PHPT) were analyzed. PHPT was diagnosed in 17 patients. Group "without PHPT" and group "with PHPT" differed significantly in terms of parathyroid hormone (PTH) level, serum calcium, phosphorus, chloride, alkaline phosphatase, calciuria and kaliuria. In patients with staghorn calculi, PHPT was diagnosed in 12.5%, and staghorn calculi in the presence of PHPT were identified in 17.7% of cases. Hypercalciuria in the group "with PHPT" was detected in 82.4% of patients (all 3 patients with staghorn calculi), and in the group "without PHPT"--in 18% of patients (2 of 21 patients with staghorn calculi). Hyperoxaluria was observed in 42.3% of patients "without PHPT" and in 35.3% of patients "with PHPT", in 36.8% of patients with simple stones and in 57.2%--with staghorn calculi. In 39% of patients "without PHPT", secondary hyperparathyroidism (SHPT) was diagnosed. SHPT prevalence was 28% in patients with staghorn calculi, and 45% in patients with simple stones. In 87.5% of patients with hypomagnesemia, staghorn calculi were observed. Significant relationship between magnesium and triglycerides (r(s) = -0.296; P = 0.041), and magnesium and high-density lipoproteins (r(s) = 0.339; P = 0.032) in all patients with urolithiasis were revealed. Thus, the study found no association between staghorn nephrolithiasis and PHPT. Elevated PTH levels usually indicate SHPT rather than PHPT. In hypocalcemia, there was more strong association between PTH and calcium, in normocalcaemia--between PTH and magnesium.

Monosodium glutamate (MSG) consumption is associated with urolithiasis and urinary tract obstruction in rats

BACKGROUND

The peritoneal injection of monosodium glutamate (MSG) can induce kidney injury in adult rats but the effects of long-term oral intake have not been determined.

METHODS

We investigated the kidney histology and function in adult male Wistar rats that were fed ad libitum with a standard rat chow pellet and water with or without the addition of 2 mg/g body weight MSG/day in drinking water (n=10 per group). Both MSG-treated and control animals were sacrificed after 9 months when renal function parameters, blood and urine electrolytes, and tissue histopathology were determined.

RESULTS

MSG-treated rats were more prone to kidney stone formation, as represented by the alkaline urine and significantly higher activity product of calcium phosphate. Accordingly, 3/10 MSG-treated rats developed kidney stones over 9 months versus none of the control animals. Further, 2/10 MSG-treated rats but none (0/10) of the controls manifested hydronephrosis. MSG-treated rats had significantly higher levels of serum creatinine and potassium including urine output volume, urinary excretion sodium and citrate compared to controls. In contrast, MSG-treated rats had significantly lower ammonium and magnesium urinary excretion.

CONCLUSION

Oral MSG consumption appears to cause alkaline urine and may increase the risks of kidney stones with hydronephrosis in rats. Similar effects in humans must be verified by dedicated studies.

Determinants of urolithiasis in patients with intestinal fat malabsorption

OBJECTIVE

To investigate the determinants of urinary stone formation in patients with fat malabsorption, because, although the prevalence of urolithiasis is greater in patients with intestinal diseases, the pathogenetic mechanisms and risk factors associated with urolithiasis in this population remain partially unsolved.

MATERIALS AND METHODS

The present study retrospectively analyzed the determinants of urolithiasis in 51 patients with fat malabsorption due to different intestinal diseases. Anthropometric, clinical, blood, 24-hour urinary parameters, and dietary intake were assessed.

RESULTS

The resection rate (ie, pancreatic and/or bowel resection) differed significantly between stone formers (SF; n=10) and nonstone formers (NSF; n=41; 70% vs 29%; P=.027). Urinary citrate was lower (1.606±1.824 vs 3.156±1.968 mmol/24 h; P=.027), while oxalate excretion (0.659±0.292 vs 0.378±0.168 mmol/24 h; P=.002) and the relative supersaturation of calcium oxalate were greater in SF than NSF (8.16±4.61 vs 3.94±2.93; P=.003). Total cholesterol and low-density lipoprotein cholesterol, but also high-density lipoprotein cholesterol, plasma β-carotene, and vitamin E concentrations, were significantly diminished, whereas serum aspartate aminotransferase activity was significantly greater in SF compared with NSF. Binary logistic regression analysis revealed resection status as a major extrarenal risk factor for stone formation (odds ratio 5.639).

CONCLUSION

Increased urinary oxalate and decreased citrate excretion, probably resulting from pancreatic and/or bowel resection with mainly preserved colon, were identified as the most crucial urinary risk factors for stone formation in patients with fat malabsorption. The findings suggest that hyperoxaluria predominantly results from increased colonic permeability for oxalate due to disturbed bile acid metabolism. The impaired status of fat-soluble antioxidants β-carotene and vitamin E indicates severe malabsorptive states associated with an enhanced stone-forming propensity.

[Treatment and metaphylaxis of gout complicated by nephropathy and urolithiasis]

The evaluation of clinical efficacy of combined treatment and metaphylaxis in 58 patients with gout complicated by nephropathy and urolithiasis was performed. The study included 41 (71%) men and 27 (29%) women aged 44 to 88 years (mean age - 58 +/- 7 years). All patients received parenteral therapy with trometamol H, 5 -10 infusion for the course, an average of 7 infusions. For the metaphylaxis, all patients received biologically active supplement urisan 2 tablets 2 times a day during next three months against the background of drug therapy. Findings indicate a high clinical efficacy of the trometamol H in the combined treatment of patients with gout, complicated by nephropathy and urolithiasis, considering that improvement of renal function, microcirculation in the renal parenchyma, increased glomerular filtration rate, normalization of nitrogenous wastes levels, partial or complete dissolution of concretions of the kidneys, a significant decrease in the tophs size, an increase in motor activity were observed, which ultimately improves the quality of life for these patients. Metaphylaxis using urisan for 3 months on a background of traditional therapy contributed to a stable normalization of blood uric acid levels, which prevented the exacerbation of underlying disease and recurrent stone formation. These data allow to recommend reducing the dose of traditional anti-gout drugs and conducting repeated course of metaphylaxis with the urisan after 5-6 months during 3 months.

Helichrysum plicatum DC. subsp. plicatum extract as a preventive agent in experimentally induced urolithiasis model

ETHNOPHARMACOLOGICAL RELEVANCE

Since ancient times, various herbal preparations have been used in treatment of urolithiasis, which is basically formation of calcium oxalate stones in kidney. The aim of our study is to assess the effects of Helichrysum plicatum DC. subsp. plicatum (HP) as a preventive agent in experimentally induced urolithiasis model in rats.

MATERIALS AND METHODS

The efficacy of 125, 250, and 500 mg/kg HP extract was studied in 1% ethylene glycol and 1% ammonium chloride-induced urolithiasis for 21 days in rats. The weight difference and the levels of calcium, magnesium, phosphorus, urea nitrogen, creatinine and uric acid in both serum and 24h-urine were measured. The calcium oxalate (CaOx) and pH were defined in urine. Histo-pathological analyses in kidneys were also performed.

RESULTS

The rats' weights were higher in HP groups than urolithiasis group. Urolithiasis caused a significant increase in both serum and urine biochemical parameters compared to healthy rats. HP extract decreased levels of these parameters. Urine CaOx level was high in urolithiasis rats, whereas it was decreased by HP extract. Histopathological examinations revealed extensive intratubular crystal depositions and degenerative tubular structures in urolithiasis group, but not in HP treatment groups.

CONCLUSION

More studies will be necessary to elucidate the antiurolithiatic activity of HP. Nonetheless, having a beneficial effect in preventing and eliminating CaOx deposition into kidneys, HP extract may be a potential drug for urolithiasis treatment.

[Choice of urinary tract drainage in different age groups of patients with urolithiasis]

Retro- and prospective analyses of 802 case histories of patients with nephrostomic drainage (n=272), ureteral catheter (n=27) and ureteral stent (n=503) treated for urolithiasis in the urological department of M.F. Vladimirsky Moscow Region Research Clinical Institute and Zhukovsky city hospital hospitalized in 1995 to 2009 made it possible to develop algorithms of choice of upper urinary tract drainage depending on clinical and laboratory indices. Nephrostomic drainage is preferable in a single functioning kidney, acute obstructive pyelonephritis, anuria, hyperthermia above 38 degrees C, marked supravesical urodynamic disorder, in renal failure, serum creatinine over 200 mcmol/l, urea over 10 mmol/l, blood potassium over 5 mmol/l, uric acid over 380 mcmol/l and leukocytosis over 8 x 10(9) l. Draining with ureteral stent was used primarily in elective surgery--extracorporeal shock-wave lithotripsy and transurethral operations. Stenting was better tolerated and entailed less frequent complications. In the rest cases choice of drain method should be made by the urologist. In active inflammation, before getting antibioticogram, the drain should be followed by antibiotic treatment with fluoroquinolones, cephalosporines of the third or forth generation, aminoglycosides, carbapenems in standard doses.

[Role of an infectious factor in the pathogenesis of urolithiasis]

The paper gives the data of complex clinical and biochemical examination in 122 urolithiasis (ULT) inpatients treated at the Urology Unit, Moscow City Clinical Hospital Seven, in February 2004 to January 2008. The levels of lithogenic substances and compounds, inhibitors and activators of lithogenesis have been determined. The authors show it possible to use the level of hydrolytic enzymes and activators of cooperative microbial sensitivity as diagnostic and prognostic criteria in diferent forms of ULT, which is in turn of no small importance in developing the science-based methods for the treatment and prevention of recurrent lithogenesis.

[Endothelial dysfunction in urolithiasis patients]

To characterize endothelial dysfunction in operated nephrolithiasis patients, we studied NO, VEGF, ET-1, IL-6 concentration in the blood serum and NO in the urine of nephrolithiasis patients divided into three groups by the type of surgical treatment before operation, 7-10 days and 1 month after it. We used beta-2 microglobulin as an indicator of tubular dysfunction. We found a significant rise of a concentration of the endothelial dysfunction markers ET-1, IL-6 and VEGF in the blood serum (p < 0.05), showing endothelial dysfunction in nephrolithiasis patients, especially in early postoperative period after multiple exposure to short-wave lithotripsy. One month after open surgery or lithotripsy a complete recovery of endothelial function was not recorded.

[Choice of an upper urinary tract drainage method in urolithiasis]

We made a retrospective (290) and a prospective (131) analysis of the evidence obtained on 421 patients with nephrostomic drainage (251) and an ureteral stent (170) treated for urolithiasis in the urological department of the Moscow Regional Research Clinical Institute from 1995 to 2008. Assessment of clinical and laboratory characteristics of the patients with nephrostomic drainage and an ureteral stent allowed the following conclusions: puncture nephrostomy (p < 0.05) for upper urinary tract drainage is preferable in a solitary functioning kidney, acute obstructive pyelonephritis, anuria, hyperthermia 380 and higher, marked supravesical urodynamic disorder, renal failure, plasmic creatinine level over 200 mcmol/l, azotemia over 10 mmol/l, blood potassium over 5.0 mmol/l, uric acid over 380 mcmol/l and leukocytosis over 8.0 x 10(9)/l. In the other cases a drainage method can be chosen by a physician. Cephalosporines, aminoglycosides, fluoroquinolones and carbapenems in standard doses are recommended in active inflammation when antibioticograms are not obtained yet. Significant differences are seen in drainage with nephrostoma and ureteral stent. Recommendations on nephrostomic drain and ureteral stent installation depending on clinical and laboratory findings are presented.

Primary hyperparathyroidism in Taiwan: clinical features and prevalence in a single-center experience

In Taiwan, urolithiasis remains a common manifestation of primary hyperparathyroidism (PHPT). We designed this study to estimate the prevalence of PHPT in asymptomatic adults and to assess the complications already present when the disease was diagnosed. In the first phase of the study, we retrospectively reviewed 50 patients diagnosed with surgically or biochemically proven PHPT between April 1995 and April 2007. In the second phase, we reviewed the records of 4,359 asymptomatic subjects who had undergone a health examination between August 2002 and January 2007. Of the 50 patients reviewed in the first phase, hypercalcemia was the presenting complication in 33 patients (64%) followed by symptomatic recurrent solitary urolithiasis in 10 patients (20%). Of the 43 patients who underwent urologic imaging, 29 (67%) had urolithiasis and 7 (16%) had nephrocalcinosis, indicating that urinary stone disease is common. In the second phase, 28 of the 4,359 asymptomatic adults (0.64%) were found to have hypercalcemia; of these 28, 4 (0.092%) were diagnosed with PHPT. In Taiwan, PHPT remains underdiagnosed, and complications manifest in most patients upon admission. Although still relatively uncommon, screening serum calcium levels helps diagnose PHPT at an asymptomatic stage.

Twenty four hours urine and serum biochemical parameters in patients with urolithiasis

From the analysis of various urinary constituents and the estimation of serum parameters, it is now possible to identify the risk factors responsible for or contributing for stone formation metabolic factor included calcium, oxalate, uric acid, citrate and pH. Environmental factors where total volume, sodium, phosphate and magnesium. Urinary citrate and magnesium found to be lower in stone formers. The levels of serum parameters like calcium, sodium and intact parathyroid hormone (IPTH) is higher than normal. Where as potassium and magnesium is found to be lower than normal. Higher level of IPTH is associated with primary hyperparathyroidism and is related with stone formation in-patient with urolithiasis. Serum levels of phosphorus, uric acid and Creatinine found to be normal.

[Clinical characteristics and risk of urolithiasis in metallurgists]

A complex investigation of the urogenital system in 200 metallurgists and 190 workers (a control group) has shown that 35.0% metallurgists and 15.7% controls had urogenital pathology. Urolithiasis was detected more often in metallurgists (72.8 and 14.9%, respectively, p < 0.001). An elevated level of blood uric acid, aciduria, decreased diuresis were also more frequent in metallurgists than in the control group. Metallurgists had a higher relative risk and an etiologic factor of urolithiasis (RR = 7.0-7.9; EF = 85.5-87%). Incidence of urolithiasis in metallurgists can be reduced after prophylactic programs. Therefore, urologic examination and ultrasonic scanning should be included in regular medical check-ups of metallurgists.

[Immunological indices in urolithiasis patients with secondary pyelonephritis]

The immunological status was studied in 335 patients with urolithiasis and pyelonephritis. The techniques used for assessment of the immunological status provided a multifactorial control over immune system function in inflammation and urolithiasis: registered a significant rise of the level of proinflammatory and anti-inflammatory mediators of the immune response (IL-1beta, IL-4, IL-6, TNF), of neutrophil metabolic activity with parallel suppression of neutrophil phagocytic and absorbing functions, inhibition of bactericidal activity of the serum, a significant fall in the number of mature T-lymphocytes (CD3+) and T-helpers (CD4+). The immune status indices in urolithiasis patients with secondary pyelonephritis are closely linked with clinico-laboratory manifestations of the inflammatory process and renal function. Thus, the results of the study give grounds for developing indications for use of immunomodulating drugs in patients with secondary pyelonephritis associated with urolithiasis.

Effects of epidural ketamine-xylazine combination on the clinicophysiological and haematobiochemical parameters of uraemic and healthy goats

Xylazine-ketamine combination was evaluated for its efficacy and safety after epidural administration in uraemic and healthy goats. The combination (xylazine 0.025 mg/kg and ketamine 2.5 mg/kg) was administered to uraemic (n = 6) and healthy (n = 6) animals in the lumbosacral epidural space. The combination was evaluated in terms of clinical, physiological, haematological and biochemical parameters. The onset of analgesia was faster in healthy animals than in uraemic animals. Xylazine and ketamine produced complete analgesia of tail, perineum, inguinal and thigh regions in all animals of both groups. However, healthy animals showed longer duration of complete analgesia than did uraemic animals. Greater ataxia was recorded in healthy animals than in uraemic animals. The heart rate showed a significant decrease in both groups; however, respiratory rate and rectal temperature did not show any significant changes. Haemoglobin, packed cell volume and total leukocyte count decreased non-significantly in both groups. Total leukocyte count was significantly higher in uraemic animals. A significantly higher value of urea nitrogen and creatinine was recorded in uraemic animals. The blood electrolytes (Na+, K+ and Cl-) and blood gases (PO2 and PCO2) did not show any significant changes in both groups; however, base excess was significantly higher in uraemic animals. The effects produced by the combination on different systems were transient and values normal as the effect of the drugs wore off. The results suggest that the combination when used epidurally in uraemic goats produced effective and safe surgical analgesia.

Serum biochemical abnormalities in goats with uroliths: 107 cases (1992–2003)

OBJECTIVE

To characterize serum biochemical abnormalities in goats with uroliths.

DESIGN

Retrospective case-control series.

ANIMALS

107 male goats with uroliths and 94 male goats with various nonrenal diseases (controls).

PROCEDURES

For male goats, results of serum biochemical analyses collected from 1992 through 2003 were retrieved from computerized records, as were signalment, clinical diagnoses, and discharge status. Results of analyses for BUN, creatinine, phosphorus, calcium, Na, K, Cl, total CO2, anion gap, and glucose were compared between goats with uroliths and control goats.

RESULTS

Goats with uroliths had higher mean BUN, creatinine, total CO2, K, and glucose concentrations and lower mean phosphorus, Na, and Cl concentrations than control goats, with no difference in mean calcium concentration and anion gap. Goats with uroliths had higher frequency of azotemia, hypophosphatemia, hypochloridemia, and increased total CO2 and lower frequency of decreased total CO2 than control goats. Urolithiasis occurred more frequently in castrated males than in sexually intact males and in dwarf African breeds than in other breeds.

CONCLUSIONS AND CLINICAL RELEVANCE

Goats with uroliths often had hypophosphatemia at admission. Hypochloridemic metabolic alkalosis was the most common acid-base disorder. Rupture in the urinary tract system was associated with increased prevalence of hyponatremia and hyperkalemia. Clinicians should be aware of these abnormalities when determining fluid therapy.