Urolithiasis in ferrets (Mustela putorius).

Urinary calculi was observed frequently in ferrets which were from a group used for influenza research. They were submitted for necropsy with various clinical signs. The calculi were composed of magnesium ammonium phosphate hexahydrate and were found in the pelvis of the kidney, urinary bladder and urethra. Crystals of undetermined nature occasionally were observed in the kidneys.     

侧卧位经皮肾微造瘘输尿管镜下取石治疗上尿路结石56例报道

目的:探讨侧卧位施行经皮肾微造瘘输尿管镜下取石(MPCNL)治疗上尿路结石方法及疗效。方法:回顾分析56例上尿路结石侧卧位施行PCNL治疗的临床资料,其中肾铸形结石33例,输尿管上段结石23例。结果:56例均手术成功,无穿刺失败或中转开放手术。一次结石取净率80%,两次手术合计达96%。术中均无输血,无肠道损伤等并发症。结论:侧卧位施行MPCNL手术患者易耐受,手术更安全,术中碎石易排出。效果良好。     

Plasma levels and urinary excretion of amino acids by subjects with renal calculi

Plasma levels and urinary amino acid excretions were estimated by high-performance liquid chromatography in 15 control subjects and 36 stone formers (SFs) classified according to the stone type: (1) 22 cases with calcium oxalate stones; (2) four cases with pure uric acid stones; (3) 10 cases with magnesium-ammonium phosphate stones, either pure or mixed with apatite. Some types of stones (namely oxalate and uric acid calculi) are mainly formed as a result of a metabolic deficiency that may affect the amino acid metabolism, and thus may be reflected in the urinary amino acid pattern. Data demonstrated clearly that there is a general tendency towards decreased amino acid excretions in all SFs with all types of stones. As a whole, one can observe a higher percentage of patients with calcium oxalate and phosphate calculosis, who have low urine excretions of amino acids; about 50% are the SFs with lower urine excretion of serine, glycine, taurine and i-leucine; the high percentage of patients with CaOX calculi shows lower urine excretions of tyrosine and ornithine.     

Struvite Urolithiasis in Long–Evans Rats

Struvite urinary calculi, which are composed of magnesium, ammonium, and phosphate, can cause complications including sepsis and renal failure. Struvite calculi were identified within the urinary bladder and renal pelvis of 2 Long-Evans rats that died within days after arrival from a commercial vendor. The remaining rats in the shipment were screened by physical examination, radiography, and ultrasonography, revealing an additional 2 animals that were clinically affected. These rats were euthanized, necropsied, and yielded similar findings to those from the first 2 rats. In addition, urine samples had an alkaline pH and contained numerous bacteria (predominantly Proteus mirabilis), leukocytes, and crystals. All calculi were composed completely of struvite. Another 7 rats in the shipment had alkaline urine with the presence of blood cells; 6 of these rats also had abundant struvite crystals, and P. mirabilis was cultured from the urine of 3 rats. Further investigation by the vendor identified 2 of 100 rats with struvite calculi from the same colony. Although no specific cause could be implicated, the fact that all the affected rats came from the same breeding area suggests a genetic or environmental triggering event; a contribution due to diet cannot be ruled out. Our findings suggest that the affected rats had metabolic disturbances coupled with bacterial infection that predisposed them to develop struvite calculi. During sudden increases of struvite urinary calculi cases in rats, urine cultures followed by appropriate surgical intervention and antibiotic therapy is warranted. Additional factors, including diet, merit attention as well.Struvite, also known as triple phosphate, is a crystalline substance composed of magnesium ammonium phosphate (MgNH₄PO₄• 6 H₂0)¹⁰ that was first identified in the 18th century. This mineral is what consolidates into urinary calculi, or stones, both in humans and animals. Other frequently encountered types of urinary stones include calcium oxalate, calcium phosphate, uric acid, and cysteine.¹⁷ Although only 2% to 3% of stones from humans are composed of struvite,⁴³ struvite calculi are important clinically because they can lead to sepsis and renal failure.⁴³In both humans and animals, stones in the urinary tract can obstruct the urine outflow, with subsequent extreme pain, hydronephrosis, and (possibly) rupture of the urinary bladder. In addition, disruption of kidney function can lead to metabolic imbalances, such as uremia, seizures, depression, anorexia, dehydration, even coma and death.^1,8 Here we present a case study describing the spontaneous presentation of struvite urolithiasis in a recently imported cohort of rats and related significant clinical findings.     

80例血液透析患者上尿路结石患病率及危险因素分析

摘要 目的：分析血液透析患者上尿路结石的患病率及其危险因素,为早期干预提供依据。方法：回顾性分析2017年1月至2018年12月我院肾内科收治的CKD 5期持续性血液透析患者（血液透析组）上尿路结石的患病情况,并与健康体检者80名（对照组,n=80）、CKD1~3期患者（非血液透析组,n=80）进行比较。比较血液透析患者中结石和非结石者人口学资料、血清白蛋白、血糖、血脂、肾功能等生化指标,并记录二者透析时间及24 h尿量。采用多因素logistic回归分析上尿路结石的患病情况的危险因素。结果：血液透析组上尿路结石患病率为25.0%,显著高于非血液透析组13.8%、对照组10.0%(P<0.05);非血液透析组、对照组上尿路结石患病率比较,差异无统计学意义(P>0.05)。结石与非结石患者在性别、透析时间、TG、TC、UA、ALB、24 h尿量方面比较,差异均有统计学意义（P<0.05）。多因素logistic回归分析显示,透析时间、UA、TC是血液透析患者发生上尿路结石的独立危险因素,而ALB则是保护性因素（P<0.05）。结论：血液透析患者上尿路结石的患病率较高,对血脂代谢异常、高血UA、低血清ALB及长期透析者应早期筛查,并纠正脂代谢紊乱和低蛋白血症。     

Asian small-clawed otter (Aonyx cinerea) urolithiasis prevalence in North America

The prevalence of urolithiasis in the North American Asian small-clawed otter (Aonyx cinerea) population was determined through a retrospective survey. A questionnaire regarding diet and radiographic or necropsy evidence of urolithiasis was sent to the 16 North American institutions or individuals listed in the Asian Small-Clawed Otter North American Regional Studbook. Completed forms were returned by 75% of questionnaire recipients. Individual surveys or necropsy reports were received for 79.8% of the living or dead animals listed as comprising the North American population. Renal calculi were detected in 66.1%, and cystic calculi in 23.2%, of the captive adult population that had been radiographed or necropsied. All otters with cystic calculi also had renal calculi. Bilateral renal calculi occurred in 83.8% of affected otters. Both males (61.2%) and females (72%) were frequently affected. The prevalence of urolithiasis in wild-born otters was 76.7%, and in adult (≥1 year) captive-born otters it was 53.8%. The higher prevalence in wild-born otters may be a reflection of the older mean age at which they were first evaluated. In the overwhelming majority of otters with renal calculi, the calculi were multiple and diffusely distributed throughout the renal parenchyma. Renal and cystic calculi analyzed were primarily composed of calcium oxalate or urates. Glucosuria was infrequently reported. Necropsies of dependent neonates (≤ 2 months old) that died revealed cystic calculi in one animal. Renal disease was the cause of, or a contributing factor in, the deaths of all older animals whose necropsy reports were reviewed. The captive diet may be a contributing factor to urolith formation and progression.     

Application of Ureteroscope in Emergency Treatment with Persistent Renal Colic Patients during Pregnancy

Background

Although the application of ureteroscopy in the treatment of ureteral calculi during pregnancy has been on the rise, for persistent renal colic patients without ultrasound-detected ureteral calculi, it may represent a clinical dilemma due to the potential risks for both mother and fetus.

Objective

The aim of the present study is to present our experience with the application of the ureteroscope in the emergency treatment of persistent renal colic patients during pregnancy.

Methods

From March 2009 to September 2014, a total of 117 pregnant women who received ureteroscopy for persistent renal colic were retrospectively analyzed. Patients were divided into three groups according to duration of the persistent renal colic: Group A (within 12 hours; 24 cases); Group B (12 to 24 hours; 76 cases); and Group C (more than 24 hours; 17 cases). The stone-free rate, complications, and other qualitative data were analyzed.

Results

Of the 117 patients, 31 patients who were found not to have renal or ureteral calculi received ureteroscopic double-J (DJ) stent insertion, whereas 86 patients who were found with ureteral calculi received ureteroscopic lithotripsy (URSL) and DJ stent insertion. Among them, 24 patients (27.9%) were found with ureteral calculi by ureteroscopy rather than ultrasound. In addition, 73 patients (84.9%) had complete fragmentation of calculi; 12 patients (10.3%) had a threatened abortion (the rates of threatened abortion in Groups A, B and C were 8.3% vs. 6.5% vs. 29.4%; Group C compared with Groups A and B, p<0.05), and one patient (1.2%) had urosepsis (in Group C). However, these complications were cured with conservative treatment, without postpartum infant and maternal complications.

Conclusion

For pregnant patients with persistent renal colic/ureteral calculi and hydronephrosis, ureteroscopic DJ stent insertion and URSL are effective and safe options when conservative treatment fails, even if no urinary calculi were found by ultrasound. At the same time, for patients with persistent renal colic during pregnancy, early application of ureteroscopy may reduce the risk of preterm birth.     

Experimental oxalate urolith formation in rats.

Urinary calculi composed of calcium oxalate were produced in male hooded Wistar rats fed a vitamin B6 deficient diet over 16 weeks. This basic diet was modified by doubling the phosphate content or loading with vitamin C or D3 in three treatment groups. The number of rats developing oxalate stones was not altered by the addition of vitamin D3 or phosphate, but there was a significant increase in total weight of stone formed and histological evidence of extensive renal damage in rats on the high vitamin D3 diet. The addition of vitamin C to the vitamin B6 deficient rats resulted in a reduction in the number of rats with uroliths and a fall in urinary oxalate excretion, while similarly loaded vitamin B6 supplemented controls were free of oxalate calculi. It is concluded that the oxalate urolithiasis induced by vitamin B6 deficiency was exacerbated by added vitamin D3 and reduced by vitamin C.     

Analysis of purines in urinary calculi by high-performance liquid chromatography

A high-pressure liquid chromatography method has been developed for the analysis in urinary calculi of six purines: uric acid, 2, 8-dihydroxyadenine, xanthine, hypoxanthine, allopurinol, and oxypurinol. Separation was conducted isocratically on a reversed-phase column, using 50 mM phosphate buffer (pH 5.5) / methanol (97/3, v/v) as mobile phase. Limits of detection, depending on compound, ranged from 7 to 28 microg/g stone weight. Hitherto, no reports have appeared on other purines present with uric acid in stones, due to lack of a sensitive and specific analytical method. We have now found that all calculi with more than 4% uric acid also contained 1-methyluric and 7-methyluric acids and trace amounts of hypoxanthine, xanthine, and 2,8-dihydroxyadenine. Accurate identification and quantitation of purines in urinary calculi are important for the diagnosis of rare metabolic diseases leading to urolithiasis (xanthinuria, dihydroxyadeninuria), as well as for prevention of iatrogenic complications during treatment with allopurinol of uric acid urolithiasis. The method may be used for reference purposes in clinical laboratories and for research on the pathogenesis of urolithiasis in disorders of purine metabolism.     

Urinary Pyrophosphate in Normal Subjects and in Stone Formers

The urinary excretion of inorganic pyrophosphate was determined in nine normal subjects and also in eight patients with recurrent calcium-containing renal stones during varied levels of phosphate intake. The excretion of pyrophosphate and orthophosphate is virtually the same in the two groups at all levels of phosphate intake. It appears unlikely that a consistently reduced urinary excretion of pyrophosphate is a factor in the formation of urinary calculi. Pyrophosphate excretion rose and calcium excretion fell with increasing phosphate intake; this might be expected to have a beneficial effect in patients with recurrent calcium stones.     

酪酸梭菌活菌胶囊对胆道结石患者术后肠功能紊乱的治疗作用

目的观察酪酸梭菌活菌胶囊(商品名:阿泰宁)对胆道结石患者术后肠功能紊乱的疗效及对术后消化吸收功能的改善作用。方法选取40例行胆总管切开探查术且术后出现腹泻、腹胀、消化不良等肠功能紊乱的胆总管结石患者。随机分为观察组和对照组,每组20例。两组患者均予以生理盐水补液、止泻药止泻和低脂饮食等常规治疗,观察组患者加服酪酸梭菌活菌胶囊,3粒/次,2次/d,连用28d。观察两组患者用药后的临床疗效及不良反应。结果观察组患者临床总有效率(100.0%)显著高于对照组(80.0%)(P0.05);腹泻和腹胀的时间显著短于对照组(P0.01);同时治疗后观察组患者总胆固醇、甘油三酯、球蛋白水平显著高于对照组(P0.05),电解质紊乱发生率低于对照组(P0.05)。治疗期间所有患者未见不良反应。结论酪酸梭菌活菌胶囊治疗胆道结石患者术后肠功能紊乱疗效显著,能够显著改善患者对脂质的消化吸收能力,对患者术后消化吸收功能的改善具有积极的作用,值得临床推广应用。     

Physical, X-ray diffraction and scanning electron microscopic studies of uroliths

Identification of chemical constituents of calculus is important in the diagnosis and management of urolithiasis. The compositional variability of uroliths has different etiologies and requires various modes of treatment and prophylaxis. In the present study, we report the chemical compositional analyses of calculi recovered from buck and bullock by X-ray diffraction (XRD) and energy dispersive X-ray (EDX) techniques and ultra-structure examination by scanning electron microscopy (SEM). XRD and EDX investigations conclusively established the chemical compositions of urinary calculi under investigation. The calculus from buck (sample I) had calcium oxalate monohydrate, a dominant salt phase and magnesium compound in significant amount. The calculus from bullock (sample II) had magnesium ammonium phosphate phase, with significant amount of calcium in apatite form and K+ ions. SEM study at higher magnification (X 1000) showed bipyramidal crystals in external zones of urolith (sample I). The struvite apatite calculus showed that basic unit of structure was lamination and the laminitis appeared to be made up of fine granules and high porosity. The bio-mineralization process of calculus formation was also studied, with a view to take preventive and therapeutic measures for amelioration of urinary stone diseases in animals and humans.     

Pediatric urolithiasis in Croatia

A retrospective review was performed of the records of 148 Croatian children with urolithiasis treated between 1989 and 2003. The study evaluated age, gender, family history, clinical symptoms, location of stone, laboratory findings, stone composition, mode of treatment and compared our results with data from higher and lower socio-economic countries. The mean age of our patients was 9.38 years (10 months to 18 years). Thirty-seven children (25%) were less than 5 years (group 1), 44 (29.7%) were between 5 and 10 years (group 2) and 67 (45.3%) were older than 10 years of age (group 3). There were 60 girls and 88 boys with overall male to female ratio of 1.47. Abdominal pain (83%) and haematuria (59.5%) were the main symptoms in the groups 2 and 3. Urinary tract infection was predominant symptom in the group 1 (62.1%). Calculi were located in the kidney in 90 children (60.8%), in the ureter in 39 (26.4%), in the bladder in 8 (5.4%). Urinary tract anomalies with or without infection were associate with a greater frequency of urolithiasis in the youngest age group and hypercalciuria was predominant cause in children over 5. Stone analysis was performed in 80 children. Predominant constituent of stones was calcium oxalate (48.7%), followed by struvite (25%), calcium phosphate (13.7%), cystine (10%) and uric acid (1.2%). Calcium oxalate stones were most common in all age groups. Struvite stones were most prevalent in the children younger than 5 years of age. Most patients (33.1%) underwent surgery for removal of their calculi. In 31.8% of children stones were passed spontaneously and the highest spontaneous passage rate was in the group 3 (37.3%). Stone composition, location and etiology in Croatian children are similar to those in developed Western countries.     

Association between Schizophrenia and Urinary Calculi: A Population-Based Case-Control Study

Background

People with schizophrenia have been demonstrated to have higher overall morbidity and all-cause mortality rates from general medical conditions. However, little attention has been given to the urinary system of people with schizophrenia. As no direct evidence has been reported demonstrating a link between schizophrenia and urinary calculi, this study utilized a population-based case-control study design to investigate the possibility of an association between schizophrenia and the occurrence of urinary calculi.

Method

This study used data from the Taiwan Longitudinal Health Insurance Database. Cases consisted of 53,965 urinary calculi patients newly diagnosed between 2002 and 2008. In total, 269,825 controls were randomly selected and matched with the cases in terms of age and sex. Each person was traced to discern whether he had previously received a diagnosis of schizophrenia. Conditional logistic regression models were performed for the analysis.

Results

A total of 3,119 (1.0%) subjects had been diagnosed with schizophrenia prior to the index date. This included 0.7% of the patients with urinary calculi, and 1.0% of the controls. A prior diagnosis of schizophrenia was independently associated with a 30% decrease (95% CI = 0.62–0.76) in the occurrence of urinary calculi. The reduction was even more remarkable in males (38%, 95% CI = 0.55–0.71) and in elder individuals independent of gender (48% in those aged >69, 95% CI = 0.36–0.77).

Conclusion

Our findings suggest that there is an inverse association between schizophrenia and urinary calculi. Future studies are needed to elucidate the mechanisms by which schizophrenia negatively associates with urinary calculi.     

Hydrogen bonds between protein side chains and phosphates and their role in biological calcification

Poly(L-histidine)-phosphate (H2PO4-, HPO4(2-)) and poly(L-glutamate)-phosphate systems (residue/phosphate, 1:1) in the presence of Ca2+ are studied by infrared spectroscopy. In the poly(L-histidine)-phosphate systems N...HOP in equilibrium NH+...O-P hydrogen bonds are formed where most phosphate protons are found at the histidine ring. With an increase in the degree of hydration the proportion of the proton limiting structure NH+...O-P increases. In the poly(L-glutamate)-dihydrogen phosphate system most phosphate protons are found at the carboxylate groups. Different behavior is observed for poly(L-glutamate)-hydrogen phosphate mixtures, where the residence time of the phosphate proton at the hydrogen acceptor carboxylate group is very short. This residence time increases, however, with increasing humidity. All these results support the triphasic theory of biological calcification involving a tripartite protein-calcium-phosphate complex where these hydrogen bonds can be present. The behavior of these hydrogen bonds can also explain the formation of a nidus of calcium phosphate salts in calcium oxalate-containing urinary calculi.     

Prevalence of renal urolithiasis in a large, captive white-tailed deer herd

Prevalence of renal urolithiasis in a large, captive white-tailed deer (Odocoileus virginianus) herd was examined over a two-year period of time. In 1973, 1.3% of 225 deer examined had calculi in the renal pelvis and 4.4% had kidney lesions, either independent or in combination with the calculi. In 1974, prevalence increased and 5.9% of 354 deer had calculi and 6.5% had kidney lesions. Calculi and lesions affected all sex and age-classes. Involvement was both unilateral and bilateral with 23.8% having stones in both kidneys and 30.4% having lesions in both kidneys. Lesions and calculi occurred together in 42.8% of cases. Etiology is unknown, but possible relationships are discussed.     

SOME ASPECTS OF THE MANAGEMENT OF BILATERAL CALCULUS DISEASE OF THE KIDNEY

In the diagnosis of bilateral calculus disease of the kidneys, it is important to differentiate between cystine, uric acid, calcium oxalate and phosphate renal lithiasis. Methods for distinguishing one from another are described.Dietary therapy is the method of choice for cystine and uric acid lithiasis.In calcium and phosphate urolithiasis, dietary therapy is a very useful adjunct. It must be regulated by careful studies of its effect on urinary calcium precipitability, a new test for which is described based upon the demonstration of the existence of two forms of calcium in the urine.Irrigation therapy for calcium phosphate and phosphate lithiasis is briefly discussed.Surgical therapy for large renal phosphatic calculi is discussed to show how considerations of renal counterbalance and urinary calcium, magnesium and phosphate excretion through damaged kidney substances influence the surgical plan in each case.     

钙敏感受体(CaSR)基因986、990多态性与尿石症的相关性研究

目的:探讨钙敏感受体(Ca SR)基因单核昔酸多态性与泌尿系结石的关系。方法:选取90例黑龙江地区的泌尿系结石患者及90例健康对照者外周血标本中的基因组DNA,采用PCR(聚合酶链反应)结合DNA测序,检测并分析Ca SR基因的单核苷酸多态性位点的分布。结果:泌尿系结石组和对照组Ca SR基因第986位、990位频率分布符合Hardy-Weinberg定律,其基因型分布频率在泌尿系结石患者和健康对照者中差异无统计学意义(P0.05),但在泌尿系结石患者组内Ca SR第990位GG纯合子和RG杂合子出现频率明显偏高,差异有统计学意义(P0.05)。结论:Ca SR基因第7外显子第986、990多态性位点与泌尿系结石的形成无直接相关性,但第7外显子第990位A/G单核苷酸多态性可能与泌尿系结石的形成密切相关。     

A new method of urinary stone analysis by batik histochemical staining of thin sections.

Thin sections of urinary calculi are prepared by petrographic methods using Araldite as the mounting medium. By covering the remaining part of the section with wax, an exposed segment of the section is stained by a histochemical technique. By the process of dewaxing and rewaxing, successive adjacent segments are stained by GBHA, Von Kossa, Schultz, and titan yellow methods for calcium oxalate, apatite, uric acid and urates, and magnesium in magnesium ammonium phosphate, respectively. If desired, matrix in additional segments is stained with PAS and aqueous toluidine blue. Microscopic examination of each layer through all the stained segments of a stone section reveals its chemical nature. Thus the chemical composition, morphology, and spatial distribution of the crystalline and matrix constituents of thin sections of urinary calculi are simultaneously revealed in situ.     

应用管路封堵器处理输尿管上段结石的随机对照研究

目的:研究辅助使用管路封堵器后,采用输尿管镜下碎石术处理输尿管上段结石的效果及安全性。方法:选取自2012年6月至2013年2月需输尿管镜处理输尿管上段结石的病例198例,随机分为应用管路封堵器组98例和对照组100例。封堵器组术中输尿管镜发现结石后,封堵器组患者使用英诺伟IVX-SC10型管路封堵器超越结石远端封堵结石,再予钬激光碎石,对照组术中输尿管镜发现结石后,直接予钬激光碎石,术后留置双J管2至4周。记录并随访患者输尿管镜术后结石清除率及肾脏出血相关并发症。结果:管路封堵器组碎石成功率95.9%(94/98),对照组碎石成功率81.0%(81/100),两组有统计学差异(P=0.0011)。碎石成功后管路封堵器组出现3例(3.2%)肾脏破裂出血,而对照组无肾脏破裂出血,两组无统计学差异(P=0.1048)。结论:辅助应用管路封堵器能提高输尿管镜对于输尿管上段结石的碎石成功率;其使用并没有增加术后肾脏出血并发症的发生。