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Staphylococcus gallinarum FCW1 was isolated from naturally fermented coconut-water and identified by biochemical and molecular methods. Probiotic characterization and safety assessment were conducted through a series of in vitro tests. A high survival rate was observed when the strain was tested for resistance to bile, lysozyme, simulated gastric and intestinal fluid, phenol, and different temperature and salt concentrations. The strain showed antagonism against some pathogens, was susceptible to all antibiotics tested except penicillin, and showed no hemolytic and DNase activity. Hydrophobicity, autoaggregation, biofilm formation, and antioxidation tests indicated that the strain possessed a high adhesive and antioxidant ability. Enzymatic activity was used to evaluate the metabolic capacities of the strain. In-vivo experiment on zebrafish was performed to check its safety status. The whole-genome sequencing indicated that the genome contained 2,880,305 bp with a GC content of 33.23%. The genome annotation confirmed the presence of probiotic-associated genes and genes for oxalate degradation, sulfate reduction, acetate metabolism, and ammonium transport in the FCW1 strain, adding to the theory that this strain may be helpful in treating kidney stones. This study revealed that the strain FCW1 might be an excellent potential probiotic in developing fermented coconut beverages and treating and preventing kidney stone disease.

Kidney stone formation is a global health problem with increasing prevalence. Stone formation is a physiochemical process involving crystallization of inorganic salts in the presence of biological constituents in the urinary system. To inhibit kidney stone formation, a better understanding of the underlying physicochemical mechanism of stone formation in the kidney is required. In this thesis, the solubility, nucleation and growth of calcium oxalate (CaOx), the most common inorganic constituent of kidney stones, were studied under different conditions such as ion concentration, pH value, and also the role of inhibitors in water or artificial urine was investigated. The first step towards this work was obtaining the solubility curve of calcium oxalate monohydrate (COM) in the solvent, such as ultrapure water and different buffers, to elucidate the physicochemical conditions which can cause the kidney stone formation (Chapter 2). Beside the solubility study, advanced technology to observe crystal formation in small scale and a very short time was needed. The volume, structure and flow properties inside the kidney inspired us to use microfluidic technology with comparable volume and flow rate. The developed microfluidic devices that mimic pathways in the human kidney were used to study the nucleation and growth of calcium oxalate crystals. The developed devices rendered an alternate perspective to the study of kidney stone formation and showed that microfluidics can provide precise, simple and fast detection of stone formation under various experimental conditions. Initially, the designed microfluidic device allowed us to build a testing platform for the study of nucleation kinetics of CaOx inside isolated environments provided by droplets. Preliminary experiments were performed by dissolving calcium chloride and sodium oxalate in ultrapure water. The aqueous solution, containing the ions, forms the droplet phase and oil were used as the continuous phase, Complex Fluid Processing

The increasing prevalence of urolithiasis in industrialized societies triggered considerable interest in how various species found in urine regulate the nucleation and growth of common kidney stone constituents such as calcium oxalate (CaOx). Yet, the role macromolecules play in kidney stone formation is often overlooked due to their low concentration in urine. In this study, we investigate the nucleation kinetics of CaOx in artificial urine with droplet-based microfluidic induction time measurements at varying concentrations of oxalate and hyaluronic acid (HA), a polysaccharide commonly found in urine. The formation of two pseudo-polymorphic forms of calcium oxalate crystals, calcium oxalate monohydrate (COM) and calcium oxalate dihydrate (COD), are carefully monitored using polarized light microscopy in induction time experiments. COM and COD nucleated concomitantly in artificial urine yet with distinct kinetics. Our results indicate that higher oxalate concentrations favor the formation of COD, the metastable form, over COM, the most stable form. Moreover, COD is also the fastest nucleating form in droplets under studied conditions. Furthermore, increasing the concentration of HA at fixed calcium and oxalate concentrations favored the nucleation of COM. We observed that in droplets where COM nucleated first, COD was not formed within the experimental time scale. However, in the droplets where COD appeared first, COM crystals were also observed later. We hope our findings shed light on the role macromolecules such as HA plays in dictating the pseudo-polymorphic form of CaOx and guide next generation treatments., QC 20220601

The increasing prevalence of urolithiasis in industrialized societies triggered considerable interest in how various species found in urine regulate the nucleation and growth of common kidney stone constituents such as calcium oxalate (CaOx). Yet, the role macromolecules play in kidney stone formation is often overlooked due to their low concentration in urine. In this study, we investigate the nucleation kinetics of CaOx in artificial urine with droplet-based microfluidic induction time measurements at varying concentrations of oxalate and hyaluronic acid (HA), a polysaccharide commonly found in urine. The formation of two pseudo-polymorphic forms of calcium oxalate crystals, calcium oxalate monohydrate (COM) and calcium oxalate dihydrate (COD), are carefully monitored using polarized light microscopy in induction time experiments. COM and COD nucleated concomitantly in artificial urine yet with distinct kinetics. Our results indicate that higher oxalate concentrations favor the formation of COD, the metastable form, over COM, the most stable form. Moreover, COD is also the fastest nucleating form in droplets under studied conditions. Furthermore, increasing the concentration of HA at fixed calcium and oxalate concentrations favored the nucleation of COM. We observed that in droplets where COM nucleated first, COD was not formed within the experimental time scale. However, in the droplets where COD appeared first, COM crystals were also observed later. We hope our findings shed light on the role macromolecules such as HA plays in dictating the pseudo-polymorphic form of CaOx and guide next generation treatments., QC 20220601

The increasing prevalence of urolithiasis in industrialized societies triggered considerable interest in how various species found in urine regulate the nucleation and growth of common kidney stone constituents such as calcium oxalate (CaOx). Yet, the role macromolecules play in kidney stone formation is often overlooked due to their low concentration in urine. In this study, we investigate the nucleation kinetics of CaOx in artificial urine with droplet-based microfluidic induction time measurements at varying concentrations of oxalate and hyaluronic acid (HA), a polysaccharide commonly found in urine. The formation of two pseudo-polymorphic forms of calcium oxalate crystals, calcium oxalate monohydrate (COM) and calcium oxalate dihydrate (COD), are carefully monitored using polarized light microscopy in induction time experiments. COM and COD nucleated concomitantly in artificial urine yet with distinct kinetics. Our results indicate that higher oxalate concentrations favor the formation of COD, the metastable form, over COM, the most stable form. Moreover, COD is also the fastest nucleating form in droplets under studied conditions. Furthermore, increasing the concentration of HA at fixed calcium and oxalate concentrations favored the nucleation of COM. We observed that in droplets where COM nucleated first, COD was not formed within the experimental time scale. However, in the droplets where COD appeared first, COM crystals were also observed later. We hope our findings shed light on the role macromolecules such as HA plays in dictating the pseudo-polymorphic form of CaOx and guide next generation treatments., QC 20220601

The increasing prevalence of urolithiasis in industrialized societies triggered considerable interest in how various species found in urine regulate the nucleation and growth of common kidney stone constituents such as calcium oxalate (CaOx). Yet, the role macromolecules play in kidney stone formation is often overlooked due to their low concentration in urine. In this study, we investigate the nucleation kinetics of CaOx in artificial urine with droplet-based microfluidic induction time measurements at varying concentrations of oxalate and hyaluronic acid (HA), a polysaccharide commonly found in urine. The formation of two pseudo-polymorphic forms of calcium oxalate crystals, calcium oxalate monohydrate (COM) and calcium oxalate dihydrate (COD), are carefully monitored using polarized light microscopy in induction time experiments. COM and COD nucleated concomitantly in artificial urine yet with distinct kinetics. Our results indicate that higher oxalate concentrations favor the formation of COD, the metastable form, over COM, the most stable form. Moreover, COD is also the fastest nucleating form in droplets under studied conditions. Furthermore, increasing the concentration of HA at fixed calcium and oxalate concentrations favored the nucleation of COM. We observed that in droplets where COM nucleated first, COD was not formed within the experimental time scale. However, in the droplets where COD appeared first, COM crystals were also observed later. We hope our findings shed light on the role macromolecules such as HA plays in dictating the pseudo-polymorphic form of CaOx and guide next generation treatments., QC 20220601

The increasing prevalence of urolithiasis in industrialized societies triggered considerable interest in how various species found in urine regulate the nucleation and growth of common kidney stone constituents such as calcium oxalate (CaOx). Yet, the role macromolecules play in kidney stone formation is often overlooked due to their low concentration in urine. In this study, we investigate the nucleation kinetics of CaOx in artificial urine with droplet-based microfluidic induction time measurements at varying concentrations of oxalate and hyaluronic acid (HA), a polysaccharide commonly found in urine. The formation of two pseudo-polymorphic forms of calcium oxalate crystals, calcium oxalate monohydrate (COM) and calcium oxalate dihydrate (COD), are carefully monitored using polarized light microscopy in induction time experiments. COM and COD nucleated concomitantly in artificial urine yet with distinct kinetics. Our results indicate that higher oxalate concentrations favor the formation of COD, the metastable form, over COM, the most stable form. Moreover, COD is also the fastest nucleating form in droplets under studied conditions. Furthermore, increasing the concentration of HA at fixed calcium and oxalate concentrations favored the nucleation of COM. We observed that in droplets where COM nucleated first, COD was not formed within the experimental time scale. However, in the droplets where COD appeared first, COM crystals were also observed later. We hope our findings shed light on the role macromolecules such as HA plays in dictating the pseudo-polymorphic form of CaOx and guide next generation treatments., QC 20220601

Kidney stone formation is a global health problem with increasing prevalence. Stone formation is a physiochemical process involving crystallization of inorganic salts in the presence of biological constituents in the urinary system. To inhibit kidney stone formation, a better understanding of the underlying physicochemical mechanism of stone formation in the kidney is required. In this thesis, the solubility, nucleation and growth of calcium oxalate (CaOx), the most common inorganic constituent of kidney stones, were studied under different conditions such as ion concentration, pH value, and also the role of inhibitors in water or artificial urine was investigated. The first step towards this work was obtaining the solubility curve of calcium oxalate monohydrate (COM) in the solvent, such as ultrapure water and different buffers, to elucidate the physicochemical conditions which can cause the kidney stone formation (Chapter 2). Beside the solubility study, advanced technology to observe crystal formation in small scale and a very short time was needed. The volume, structure and flow properties inside the kidney inspired us to use microfluidic technology with comparable volume and flow rate. The developed microfluidic devices that mimic pathways in the human kidney were used to study the nucleation and growth of calcium oxalate crystals. The developed devices rendered an alternate perspective to the study of kidney stone formation and showed that microfluidics can provide precise, simple and fast detection of stone formation under various experimental conditions. Initially, the designed microfluidic device allowed us to build a testing platform for the study of nucleation kinetics of CaOx inside isolated environments provided by droplets. Preliminary experiments were performed by dissolving calcium chloride and sodium oxalate in ultrapure water. The aqueous solution, containing the ions, forms the droplet phase and oil were used as the continuous phase, Complex Fluid Processing

Computed tomography (CT) is the mainstay imaging method for urinary stones. The aim of this thesis was to optimize the information obtained from the initial CT scan to allow a well-founded diagnosis and prognosis, and to guide the clinician as early and as far as possible in the further treatment of urinary stone disease. We examined CT scan parameters with regards to their importance for prediction of spontaneous ureteral stone passage, the impact of interreader variability of stone size estimates on this prediction, and the predictive accuracy of a semi-automated, three-dimensional (3D) segmentation algorithm. We also developed and tested the ability of a machine learning algorithm to classify pelvic calcifications into ureteral stones and phleboliths. Using single-energy CT, three quantitative methods for classification of stone composition into uric acid and non-uric acid stones in vivo were prospectively validated, using dual-energy CT as reference. Our results show that spontaneous ureteral stone passage can be predicted with high accuracy, with knowledge of stone size and position. The interreader variability in the size estimation has a large impact on the predicted outcome, but can be eliminated through a 3D segmentation algorithm. Which size estimate we use is of minor importance, but it is important that we use the chosen estimate consistently. A machine learning algorithm can differentiate distal ureteral stones from phleboliths, but more than local features are needed to reach optimal discrimination. A single-energy CT method can distinguish uric acid from non-uric acid stones in vivo with accuracy comparable to dual-energy CT. In conclusion, single-energy CT not only detects a urinary stone, but can also provide us with a prediction regarding spontaneous stone passage and a classification of stone type into uric acid and non-uric acid.

To determine whether functionally relevant questions associated with the urinary or gut microbiome and urinary stone disease (USD) can be answered from metagenome-wide association studies (MWAS), we performed the most comprehensive meta-analysis of published clinical MWAS in USD to date, using publicly available data published prior to April 2021. Six relevant studies met inclusion criteria. For alpha-diversity, significant differences were noted between USD status, stone composition, sample type, study location, age, diet, and sex. For beta-diversity, significant differences were noted by USD status, stone composition, sample type, study location, antibiotic use (30 days and 12 months before sampling), sex, hypertension, water intake, body habitus, and age. Prevotella and Lactobacillus in the gut and urinary tract, respectively, were associated with healthy individuals, while Enterobacteriaceae was associated with USD in the urine and stones. Paradoxically, other Prevotella strains were also strongly associated with USD in the gut microbiome. When data were analyzed together, USD status, stone composition, age group, and study location were the predominant factors associated with microbiome composition. Meta-analysis showed significant microbiome differences based on USD status, stone composition, age group or study location. However, analyses were limited by a lack of public data from published studies, metadata collected, and differing study protocols. Results highlight the need for field-specific standardization of experimental protocols in terms of sample collection procedures and the anatomical niches to assess, as well as in defining clinically relevant metadata and subphenotypes such as stone composition. IMPORTANCE Studies focused on the microbiome broadly support the hypothesis that the microbiome influences the onset of chronic diseases such as urinary stone disease. However, it is unclear what environmental factors shape the microbiome in ways that incre

To determine whether functionally relevant questions associated with the urinary or gut microbiome and urinary stone disease (USD) can be answered from metagenome-wide association studies (MWAS), we performed the most comprehensive meta-analysis of published clinical MWAS in USD to date, using publicly available data published prior to April 2021. Six relevant studies met inclusion criteria. For alpha-diversity, significant differences were noted between USD status, stone composition, sample type, study location, age, diet, and sex. For beta-diversity, significant differences were noted by USD status, stone composition, sample type, study location, antibiotic use (30 days and 12 months before sampling), sex, hypertension, water intake, body habitus, and age. Prevotella and Lactobacillus in the gut and urinary tract, respectively, were associated with healthy individuals, while Enterobacteriaceae was associated with USD in the urine and stones. Paradoxically, other Prevotella strains were also strongly associated with USD in the gut microbiome. When data were analyzed together, USD status, stone composition, age group, and study location were the predominant factors associated with microbiome composition. Meta-analysis showed significant microbiome differences based on USD status, stone composition, age group or study location. However, analyses were limited by a lack of public data from published studies, metadata collected, and differing study protocols. Results highlight the need for field-specific standardization of experimental protocols in terms of sample collection procedures and the anatomical niches to assess, as well as in defining clinically relevant metadata and subphenotypes such as stone composition. IMPORTANCE Studies focused on the microbiome broadly support the hypothesis that the microbiome influences the onset of chronic diseases such as urinary stone disease. However, it is unclear what environmental factors shape the microbiome in ways that incre

Computed tomography (CT) is the mainstay imaging method for urinary stones. The aim of this thesis was to optimize the information obtained from the initial CT scan to allow a well-founded diagnosis and prognosis, and to guide the clinician as early and as far as possible in the further treatment of urinary stone disease. We examined CT scan parameters with regards to their importance for prediction of spontaneous ureteral stone passage, the impact of interreader variability of stone size estimates on this prediction, and the predictive accuracy of a semi-automated, three-dimensional (3D) segmentation algorithm. We also developed and tested the ability of a machine learning algorithm to classify pelvic calcifications into ureteral stones and phleboliths. Using single-energy CT, three quantitative methods for classification of stone composition into uric acid and non-uric acid stones in vivo were prospectively validated, using dual-energy CT as reference. Our results show that spontaneous ureteral stone passage can be predicted with high accuracy, with knowledge of stone size and position. The interreader variability in the size estimation has a large impact on the predicted outcome, but can be eliminated through a 3D segmentation algorithm. Which size estimate we use is of minor importance, but it is important that we use the chosen estimate consistently. A machine learning algorithm can differentiate distal ureteral stones from phleboliths, but more than local features are needed to reach optimal discrimination. A single-energy CT method can distinguish uric acid from non-uric acid stones in vivo with accuracy comparable to dual-energy CT. In conclusion, single-energy CT not only detects a urinary stone, but can also provide us with a prediction regarding spontaneous stone passage and a classification of stone type into uric acid and non-uric acid.

To determine whether functionally relevant questions associated with the urinary or gut microbiome and urinary stone disease (USD) can be answered from metagenome-wide association studies (MWAS), we performed the most comprehensive meta-analysis of published clinical MWAS in USD to date, using publicly available data published prior to April 2021. Six relevant studies met inclusion criteria. For alpha-diversity, significant differences were noted between USD status, stone composition, sample type, study location, age, diet, and sex. For beta-diversity, significant differences were noted by USD status, stone composition, sample type, study location, antibiotic use (30 days and 12 months before sampling), sex, hypertension, water intake, body habitus, and age. Prevotella and Lactobacillus in the gut and urinary tract, respectively, were associated with healthy individuals, while Enterobacteriaceae was associated with USD in the urine and stones. Paradoxically, other Prevotella strains were also strongly associated with USD in the gut microbiome. When data were analyzed together, USD status, stone composition, age group, and study location were the predominant factors associated with microbiome composition. Meta-analysis showed significant microbiome differences based on USD status, stone composition, age group or study location. However, analyses were limited by a lack of public data from published studies, metadata collected, and differing study protocols. Results highlight the need for field-specific standardization of experimental protocols in terms of sample collection procedures and the anatomical niches to assess, as well as in defining clinically relevant metadata and subphenotypes such as stone composition. IMPORTANCE Studies focused on the microbiome broadly support the hypothesis that the microbiome influences the onset of chronic diseases such as urinary stone disease. However, it is unclear what environmental factors shape the microbiome in ways that incre

Computed tomography (CT) is the mainstay imaging method for urinary stones. The aim of this thesis was to optimize the information obtained from the initial CT scan to allow a well-founded diagnosis and prognosis, and to guide the clinician as early and as far as possible in the further treatment of urinary stone disease. We examined CT scan parameters with regards to their importance for prediction of spontaneous ureteral stone passage, the impact of interreader variability of stone size estimates on this prediction, and the predictive accuracy of a semi-automated, three-dimensional (3D) segmentation algorithm. We also developed and tested the ability of a machine learning algorithm to classify pelvic calcifications into ureteral stones and phleboliths. Using single-energy CT, three quantitative methods for classification of stone composition into uric acid and non-uric acid stones in vivo were prospectively validated, using dual-energy CT as reference. Our results show that spontaneous ureteral stone passage can be predicted with high accuracy, with knowledge of stone size and position. The interreader variability in the size estimation has a large impact on the predicted outcome, but can be eliminated through a 3D segmentation algorithm. Which size estimate we use is of minor importance, but it is important that we use the chosen estimate consistently. A machine learning algorithm can differentiate distal ureteral stones from phleboliths, but more than local features are needed to reach optimal discrimination. A single-energy CT method can distinguish uric acid from non-uric acid stones in vivo with accuracy comparable to dual-energy CT. In conclusion, single-energy CT not only detects a urinary stone, but can also provide us with a prediction regarding spontaneous stone passage and a classification of stone type into uric acid and non-uric acid.

FTIR spectroscopy is non-destructive and simple analytical technique that requires small sample amounts for providing information about functional groups in molecules. In certain cases, it is indispensable for structure elucidation of complex organic molecules such as triterpene derivatives1. Applying this technique, it is possible to monitor the change in the secondary structure of the protein.2. Combined with various statistical methods it is a powerful analytical tool in metabolomics. Thus, FTIR data based statistical models enabled propolis classification and floral origin determination3. In combination with biological tests such as cytotoxic activity), it can be used for biologically guided isolation of active compounds4. Nowadays FTIR spectroscopy is being routinely used for solving various practical analytical problems, e. g. quality analysis of bees products (beeswax and honey), quantitative determination of the major constituents in most types of food and agricultural products, straightforward identification of kidney and bladder stones etc.

Computed tomography (CT) is the mainstay imaging method for urinary stones. The aim of this thesis was to optimize the information obtained from the initial CT scan to allow a well-founded diagnosis and prognosis, and to guide the clinician as early and as far as possible in the further treatment of urinary stone disease. We examined CT scan parameters with regards to their importance for prediction of spontaneous ureteral stone passage, the impact of interreader variability of stone size estimates on this prediction, and the predictive accuracy of a semi-automated, three-dimensional (3D) segmentation algorithm. We also developed and tested the ability of a machine learning algorithm to classify pelvic calcifications into ureteral stones and phleboliths. Using single-energy CT, three quantitative methods for classification of stone composition into uric acid and non-uric acid stones in vivo were prospectively validated, using dual-energy CT as reference. Our results show that spontaneous ureteral stone passage can be predicted with high accuracy, with knowledge of stone size and position. The interreader variability in the size estimation has a large impact on the predicted outcome, but can be eliminated through a 3D segmentation algorithm. Which size estimate we use is of minor importance, but it is important that we use the chosen estimate consistently. A machine learning algorithm can differentiate distal ureteral stones from phleboliths, but more than local features are needed to reach optimal discrimination. A single-energy CT method can distinguish uric acid from non-uric acid stones in vivo with accuracy comparable to dual-energy CT. In conclusion, single-energy CT not only detects a urinary stone, but can also provide us with a prediction regarding spontaneous stone passage and a classification of stone type into uric acid and non-uric acid.

Computed tomography (CT) is the mainstay imaging method for urinary stones. The aim of this thesis was to optimize the information obtained from the initial CT scan to allow a well-founded diagnosis and prognosis, and to guide the clinician as early and as far as possible in the further treatment of urinary stone disease. We examined CT scan parameters with regards to their importance for prediction of spontaneous ureteral stone passage, the impact of interreader variability of stone size estimates on this prediction, and the predictive accuracy of a semi-automated, three-dimensional (3D) segmentation algorithm. We also developed and tested the ability of a machine learning algorithm to classify pelvic calcifications into ureteral stones and phleboliths. Using single-energy CT, three quantitative methods for classification of stone composition into uric acid and non-uric acid stones in vivo were prospectively validated, using dual-energy CT as reference. Our results show that spontaneous ureteral stone passage can be predicted with high accuracy, with knowledge of stone size and position. The interreader variability in the size estimation has a large impact on the predicted outcome, but can be eliminated through a 3D segmentation algorithm. Which size estimate we use is of minor importance, but it is important that we use the chosen estimate consistently. A machine learning algorithm can differentiate distal ureteral stones from phleboliths, but more than local features are needed to reach optimal discrimination. A single-energy CT method can distinguish uric acid from non-uric acid stones in vivo with accuracy comparable to dual-energy CT. In conclusion, single-energy CT not only detects a urinary stone, but can also provide us with a prediction regarding spontaneous stone passage and a classification of stone type into uric acid and non-uric acid.

Computed tomography (CT) is the mainstay imaging method for urinary stones. The aim of this thesis was to optimize the information obtained from the initial CT scan to allow a well-founded diagnosis and prognosis, and to guide the clinician as early and as far as possible in the further treatment of urinary stone disease. We examined CT scan parameters with regards to their importance for prediction of spontaneous ureteral stone passage, the impact of interreader variability of stone size estimates on this prediction, and the predictive accuracy of a semi-automated, three-dimensional (3D) segmentation algorithm. We also developed and tested the ability of a machine learning algorithm to classify pelvic calcifications into ureteral stones and phleboliths. Using single-energy CT, three quantitative methods for classification of stone composition into uric acid and non-uric acid stones in vivo were prospectively validated, using dual-energy CT as reference. Our results show that spontaneous ureteral stone passage can be predicted with high accuracy, with knowledge of stone size and position. The interreader variability in the size estimation has a large impact on the predicted outcome, but can be eliminated through a 3D segmentation algorithm. Which size estimate we use is of minor importance, but it is important that we use the chosen estimate consistently. A machine learning algorithm can differentiate distal ureteral stones from phleboliths, but more than local features are needed to reach optimal discrimination. A single-energy CT method can distinguish uric acid from non-uric acid stones in vivo with accuracy comparable to dual-energy CT. In conclusion, single-energy CT not only detects a urinary stone, but can also provide us with a prediction regarding spontaneous stone passage and a classification of stone type into uric acid and non-uric acid.

We present three medicolegal cases of medical negligence settled out of court. These cases all involved patients who presented to the emergency department (ED) with a suspected diagnosis of kidney stone. Highlighted are the importance of patient communication, addressing incidental findings found during a patient’s ED visit, anticipating complications, and the need for thorough documentation.

[EN] Exploratory Data Analysis (EDA): explore the database from an univariate perspective to analyse the distribution of the data. Shed light on the nephrolithiasis process by studying it from a multivariate, interdisciplinary perspective, analysing the properties and characteristics of the variables collectively together with their importance through PCA. Calculate and interpret the correlations and interactions between every variable and grouped in clusters. Use the correlations and interactions among variables to train an AI-based model for the clinical diagnosis and prevention of urolithiasis that can be implemented in hospitals and primary attention clinics. Make the AI-based model capable of predicting the probability that a problem patient has kidney stones and predict which type

Nephrolithiasis is a significant source of morbidity, and its incidence has increased significantly over the last decades. This rise has been attributed to concurrent increasing rates of obesity, associated with a 3-time risk of developing NL. To date, the mechanism by which obesity is linked to stone formation has not been elucidated. We aimed to utilize a transcriptomics approach to discover the missing link between these two epidemic diseases. We investigated gene expression profiling of nephrolithiasis patients by two RNA-sequencing approaches: comparison between renal papilla tissue with and without the presence of calcified Randall's plaques (RP), and comparison between the papilla, medulla, and cortex regions from within a single recurrent stone forming kidney. Results were overlaid between differently expressed genes found in the patient cohort and in the severely lithogenic kidney to identify common genes. Overlay of these two RNA-sequencing datasets demonstrated there is impairment of lipid metabolism in renal papilla tissue containing RP linked to downregulation of fatty acid binding protein (FABP) 4. Immunohistochemistry of human kidney specimens and microarray analysis of renal tissue from a nephrolithiasis mouse model confirmed that FABP4 downregulation is associated with renal stone formation. In a FABP4 knockout mouse model, FABP4 deficiency resulted in development of both renal and urinary crystals. Our study revealed that FABP4 plays an important, previously unrecognized role in kidney stone formation, providing a feasible mechanism to explain the link between nephrolithiasis and metabolic syndrome.

IntroductionNephrolithiasis is a major source of morbidity in the United States. In recent decades, there has been a notable increase in stone incidence in the pediatric population. We investigate whether recurrent stone formers who had their initial stone episode earlier in life are at risk for more frequent stone recurrences, compared to those with initial episodes later in life. We also examine possible risk factors that might change our approach to treatment of these patients.MethodsA review of prospectively collected data from the Registry for Stones of the Kidney and Ureter (ReSKU) from September 2015 to July 2018 was conducted to compare stone recurrence and other patient factors in patients who reported an initial stone episode prior to 20 years of age versus patients who reported an initial stone episode after age 20. Data on patient age, gender, BMI, family history, race, income, infectious symptoms, and number of prior stone episodes was analyzed. We excluded patients with a history of cystinuria stones. Univariate analysis was performed using Fisher's exact test and student's T test. Multivariate analysis was performed using logistic regression.ResultsOf the 1140 patients enrolled during this study period, 472 patients were recurrent stone formers, and of these, 66 had their first stone episode prior to the age of 20. On univariate analysis, early stone formers were more likely to be female, present at a younger age, and have more prior stone episodes on enrollment. Using multivariate modelling to control for age, gender, race, BMI, family history, and number of stone episodes, early stone formers were more likely to be female (CI 1.17 - 3.54) and have more than one prior stone episode (CI 1.13 - 3.78). Late stone formers were more likely to have BMI > 30 (CI 0.26 - 0.94).ConclusionRecurrent stone formers who have their first episodes prior to age 20 are more likely to present to stone clinics with multiple prior recurrences and hence more aggressive

Bakgrund: Stenar i njurar respektive urinvägar är ett växande problem både i Sverige samt i hela världen. Anledningen till den ökade incidensen av njursten anses vara oklar, däremot kan ändrade kostvanor förslagsvis vara bidragande orsak. Datortomografi (DT) anses vara förstahandsalternativet vid utredning av misstänkta njurstenar där DT har bra förmåga att kartlägga antalet stenar, bestämma storlek samt lokalisera stenarna. Tidigare forskning visar att ultra-lågdos samt lågdos har höga färdigheter i sensitivitet samt specificitet. Däremot avkastas jämförelser av detektering av stenar med standarddos DT. Syfte: Syftet med denna studie var att utforska om hur exponeringen skiljer sig med användandet av låg-dos protokoll i jämförelse med standardprotokoll. Utforska om hur mycket stråldosen kunde sänkas med lågdosprotokoll samt förmågan att detektera stenar. Fokus kommer att ligga på stråldosreducering samt specificitet och sensitivitet i utredning för njurstensmisstanke med datortomografi. Metod: Denna litteraturstudie använder sig av databaser som Pubmed för eftersökningen av vetenskapliga artiklar. Materialet samlades in och bearbetades i enlighet med Forsberg & Wengströms riktlinjer. Resultat: Resultatet till denna studie baseras på 10 valda artiklar från databasen Pubmed. Resultatet presenteras i tre underkategorier, storlek av sten, exponering samt sensitivitet/specificitet. Konklusion: Lågdosprotokoll kunde konkurrera med standardprotokoll gällande detektion av stenar, stenar under 3 mm kan vara svåra att detektera med lågdosprotokoll. Stråldosen reducerades med mer än hälften och bibehöll samtidigt tillräckligt bra kvalitet. Patienter bestrålas med mer än dubbelt så mycket i effektiv dos (ED) med användning av standardprotokoll än med låg-dos protokoll.

Accurate Calcium Oxalate Monohydrate (COM) solubility measurements are essential for elucidating the physiochemical mechanism behind the formation of kidney stones, nephrolithiasis. Yet the reported solubility values of COM in ultrapure water, arguably the simplest solvent relevant for nephrolithiasis, vary significantly depending on implemented method. To address this variation, we present an experimental study of the solubility of COM validated by a model based on the Debye–Hückel theory describing the solution chemistry and the complex formation. We also carefully monitor potential pseudopolymorphic/hydrate transitions during the solubility measurements with in-situ and ex-situ methods. Our results indicate that the solubility of COM in ultrapure water is a weak function of temperature. However, the measured solubility varies significantly in buffer solutions across physiologically relevant pH values at body temperature. The proposed model explains observed trends as a combined effect of ionic strength, protonation reactions, and soluble complex formation. Moreover, it predicts solubility of COM in buffer solutions remarkably well using our measurements in ultrapure water as input, demonstrating the consistency of presented approach. The presented study parleying experiments and modelling provides a solid stepping stone to extend the physiochemical understanding of nephrolithiasis to more realistic solutions laden with biological complexity., Intensified Reaction and Separation Systems

[EN] Exploratory Data Analysis (EDA): explore the database from an univariate perspective to analyse the distribution of the data. Shed light on the nephrolithiasis process by studying it from a multivariate, interdisciplinary perspective, analysing the properties and characteristics of the variables collectively together with their importance through PCA. Calculate and interpret the correlations and interactions between every variable and grouped in clusters. Use the correlations and interactions among variables to train an AI-based model for the clinical diagnosis and prevention of urolithiasis that can be implemented in hospitals and primary attention clinics. Make the AI-based model capable of predicting the probability that a problem patient has kidney stones and predict which type

We present three medicolegal cases of medical negligence settled out of court. These cases all involved patients who presented to the emergency department (ED) with a suspected diagnosis of kidney stone. Highlighted are the importance of patient communication, addressing incidental findings found during a patient’s ED visit, anticipating complications, and the need for thorough documentation.

IntroductionNephrolithiasis is a major source of morbidity in the United States. In recent decades, there has been a notable increase in stone incidence in the pediatric population. We investigate whether recurrent stone formers who had their initial stone episode earlier in life are at risk for more frequent stone recurrences, compared to those with initial episodes later in life. We also examine possible risk factors that might change our approach to treatment of these patients.MethodsA review of prospectively collected data from the Registry for Stones of the Kidney and Ureter (ReSKU) from September 2015 to July 2018 was conducted to compare stone recurrence and other patient factors in patients who reported an initial stone episode prior to 20 years of age versus patients who reported an initial stone episode after age 20. Data on patient age, gender, BMI, family history, race, income, infectious symptoms, and number of prior stone episodes was analyzed. We excluded patients with a history of cystinuria stones. Univariate analysis was performed using Fisher's exact test and student's T test. Multivariate analysis was performed using logistic regression.ResultsOf the 1140 patients enrolled during this study period, 472 patients were recurrent stone formers, and of these, 66 had their first stone episode prior to the age of 20. On univariate analysis, early stone formers were more likely to be female, present at a younger age, and have more prior stone episodes on enrollment. Using multivariate modelling to control for age, gender, race, BMI, family history, and number of stone episodes, early stone formers were more likely to be female (CI 1.17 - 3.54) and have more than one prior stone episode (CI 1.13 - 3.78). Late stone formers were more likely to have BMI > 30 (CI 0.26 - 0.94).ConclusionRecurrent stone formers who have their first episodes prior to age 20 are more likely to present to stone clinics with multiple prior recurrences and hence more aggressive

Nephrolithiasis is a significant source of morbidity, and its incidence has increased significantly over the last decades. This rise has been attributed to concurrent increasing rates of obesity, associated with a 3-time risk of developing NL. To date, the mechanism by which obesity is linked to stone formation has not been elucidated. We aimed to utilize a transcriptomics approach to discover the missing link between these two epidemic diseases. We investigated gene expression profiling of nephrolithiasis patients by two RNA-sequencing approaches: comparison between renal papilla tissue with and without the presence of calcified Randall's plaques (RP), and comparison between the papilla, medulla, and cortex regions from within a single recurrent stone forming kidney. Results were overlaid between differently expressed genes found in the patient cohort and in the severely lithogenic kidney to identify common genes. Overlay of these two RNA-sequencing datasets demonstrated there is impairment of lipid metabolism in renal papilla tissue containing RP linked to downregulation of fatty acid binding protein (FABP) 4. Immunohistochemistry of human kidney specimens and microarray analysis of renal tissue from a nephrolithiasis mouse model confirmed that FABP4 downregulation is associated with renal stone formation. In a FABP4 knockout mouse model, FABP4 deficiency resulted in development of both renal and urinary crystals. Our study revealed that FABP4 plays an important, previously unrecognized role in kidney stone formation, providing a feasible mechanism to explain the link between nephrolithiasis and metabolic syndrome.

Bakgrund: Stenar i njurar respektive urinvägar är ett växande problem både i Sverige samt i hela världen. Anledningen till den ökade incidensen av njursten anses vara oklar, däremot kan ändrade kostvanor förslagsvis vara bidragande orsak. Datortomografi (DT) anses vara förstahandsalternativet vid utredning av misstänkta njurstenar där DT har bra förmåga att kartlägga antalet stenar, bestämma storlek samt lokalisera stenarna. Tidigare forskning visar att ultra-lågdos samt lågdos har höga färdigheter i sensitivitet samt specificitet. Däremot avkastas jämförelser av detektering av stenar med standarddos DT. Syfte: Syftet med denna studie var att utforska om hur exponeringen skiljer sig med användandet av låg-dos protokoll i jämförelse med standardprotokoll. Utforska om hur mycket stråldosen kunde sänkas med lågdosprotokoll samt förmågan att detektera stenar. Fokus kommer att ligga på stråldosreducering samt specificitet och sensitivitet i utredning för njurstensmisstanke med datortomografi. Metod: Denna litteraturstudie använder sig av databaser som Pubmed för eftersökningen av vetenskapliga artiklar. Materialet samlades in och bearbetades i enlighet med Forsberg & Wengströms riktlinjer. Resultat: Resultatet till denna studie baseras på 10 valda artiklar från databasen Pubmed. Resultatet presenteras i tre underkategorier, storlek av sten, exponering samt sensitivitet/specificitet. Konklusion: Lågdosprotokoll kunde konkurrera med standardprotokoll gällande detektion av stenar, stenar under 3 mm kan vara svåra att detektera med lågdosprotokoll. Stråldosen reducerades med mer än hälften och bibehöll samtidigt tillräckligt bra kvalitet. Patienter bestrålas med mer än dubbelt så mycket i effektiv dos (ED) med användning av standardprotokoll än med låg-dos protokoll.

[EN] Exploratory Data Analysis (EDA): explore the database from an univariate perspective to analyse the distribution of the data. Shed light on the nephrolithiasis process by studying it from a multivariate, interdisciplinary perspective, analysing the properties and characteristics of the variables collectively together with their importance through PCA. Calculate and interpret the correlations and interactions between every variable and grouped in clusters. Use the correlations and interactions among variables to train an AI-based model for the clinical diagnosis and prevention of urolithiasis that can be implemented in hospitals and primary attention clinics. Make the AI-based model capable of predicting the probability that a problem patient has kidney stones and predict which type

Accurate Calcium Oxalate Monohydrate (COM) solubility measurements are essential for elucidating the physiochemical mechanism behind the formation of kidney stones, nephrolithiasis. Yet the reported solubility values of COM in ultrapure water, arguably the simplest solvent relevant for nephrolithiasis, vary significantly depending on implemented method. To address this variation, we present an experimental study of the solubility of COM validated by a model based on the Debye–Hückel theory describing the solution chemistry and the complex formation. We also carefully monitor potential pseudopolymorphic/hydrate transitions during the solubility measurements with in-situ and ex-situ methods. Our results indicate that the solubility of COM in ultrapure water is a weak function of temperature. However, the measured solubility varies significantly in buffer solutions across physiologically relevant pH values at body temperature. The proposed model explains observed trends as a combined effect of ionic strength, protonation reactions, and soluble complex formation. Moreover, it predicts solubility of COM in buffer solutions remarkably well using our measurements in ultrapure water as input, demonstrating the consistency of presented approach. The presented study parleying experiments and modelling provides a solid stepping stone to extend the physiochemical understanding of nephrolithiasis to more realistic solutions laden with biological complexity., Intensified Reaction and Separation Systems

INTRODUCTION: Nephrolithiasis is a major source of morbidity in the United States. In recent decades, there has been a notable increase in stone incidence in the pediatric population. We investigate whether recurrent stone formers who had their initial stone episode earlier in life are at risk for more frequent stone recurrences, compared to those with initial episodes later in life. We also examine possible risk factors that might change our approach to treatment of these patients. METHODS: A review of prospectively collected data from the Registry for Stones of the Kidney and Ureter (ReSKU) from September 2015 to July 2018 was conducted to compare stone recurrence and other patient factors in patients who reported an initial stone episode prior to 20 years of age versus patients who reported an initial stone episode after age 20. Data on patient age, gender, BMI, family history, race, income, infectious symptoms, and number of prior stone episodes was analyzed. We excluded patients with a history of cystinuria stones. Univariate analysis was performed using Fishers exact test and students T test. Multivariate analysis was performed using logistic regression. RESULTS: Of the 1140 patients enrolled during this study period, 472 patients were recurrent stone formers, and of these, 66 had their first stone episode prior to the age of 20. On univariate analysis, early stone formers were more likely to be female, present at a younger age, and have more prior stone episodes on enrollment. Using multivariate modelling to control for age, gender, race, BMI, family history, and number of stone episodes, early stone formers were more likely to be female (CI 1.17 - 3.54) and have more than one prior stone episode (CI 1.13 - 3.78). Late stone formers were more likely to have BMI > 30 (CI 0.26 - 0.94). CONCLUSION: Recurrent stone formers who have their first episodes prior to age 20 are more likely to present to stone clinics with multiple prior recurrences and hence more ag

This paper presents the findings of a clinical trial conducted in  the suburbs of Jammu ( Jammu & Kashmir State ) to assess the  efficacy of shwet parpati therapy – an Ayurvedic mineral  compound, on a random sample of ten mutrashmari patients. In  all there were 14 calculi sites, of which 8 (57 %) were in Kidney  and 6 (43 %) were in Ureter. There were 6 (43 %) calculi sites  which were uni-lateral and single, 2 sites (29 %) were multiple  (double) but unilateral while the remaining 2 (28 %) were bi lateral and single in each kidney. All the calculi cases were in  the size range of 4 – 8 mm. The shwet parpati therapy  completely cured 4 (28.6 %) of the cases. It markedly improved  5 (35.7 %) cases and improved 3 (21.4 %) of the cases. Only 2  (14.3 %) cases did not show significant response to therapy. The overall rating of the therapy was  1.8. In all there were 8 Kidney stones. Two stones (25.0 %) were completely cured, 3 (37.5 %)  were markedly improved. Two (25.0 %) were improved towards curing but 1 (12.5 %) did not  respond to the therapy. Overall rating of the therapy was 1.8. There were 6 Ureter stones. Two  (33.3 %) each, were cured and markedly improved. One (16.7 %) was improved and the remaining  1 (16.7 %) did not respond to therapy significantly. Overall rating of the therapy towards Ureter  Stones was 1.8. kaphaja was represented in 4 (40 % ) of the patients, followed by 3 (30 %) in  vataja and 3 (30 %) in pittaja ashmari. This shows the dominance of kaphaja type of ashmari in  the study area. There were 8 stones with kaphaja ashmari, out of which 3 (37,5 %) were completely  cured, 4 (50%) stones were markedly improved and 1 (12.5%) showed improvement in symptoms.  The therapy depicted good overall rating of 2.3. There were 3 stones of pittaja ashmari type  and no complete cure was noticed in this case. Two (66.7 %) cases were marked

Introduction: American Urological Association (AUA) guidelines recommend percutaneous nephrolithotomy (PCNL) for total stone burden greater than 20 mm, yet it is unclear if the number of stones affects adherence to this guideline. We aim to assess the impact of stone multiplicity on the choice of ureteroscopy (URS) vs PCNL as a first-line therapy for patients with high burden (>20 mm), and examine whether the AUA guideline-discordant care impacts patient outcomes. Materials and Methods: Data were collected from the Registry for Stones of the Kidney and Ureter (ReSKU) database, a prospectively collected registry of patients with stone disease. Multivariate logistic regression (MLR) was used to estimate the association between stone multiplicity and the decision to perform URS for high stone burden (>20 mm) patients. MLR was further used to estimate the association between performing URS and the following outcomes: stone-free rate, need for a second operation, and complications. Postoperative hospital stay was compared between patients receiving URS vs PCNL using Student's t-test. Results: One hundred twenty-five patients were included in this analysis. For patients with total stone burden exceeding 20 mm, those with more than three stones had roughly nine times the likelihood of undergoing URS over PCNL compared with patients with a single stone (adjusted odds ratio 9.21, confidence interval [95% CI] 2.55-40.58, p = 0.001). Stone-free rates, Clavien-Dindo scores, and frequency of second-look operations did not differ significantly between URS and PCNL patients. URS patients were discharged an average of 1.26 days earlier than patients who received PCNL (95% CI 0.72-1.81, p < 0.001). Discussion: Stone multiplicity strongly predicts which patients with stone burden >20 mm will undergo URS and who will undergo PCNL. These deviations from AUA guidelines do not appear to worsen patient outcomes. These results suggest that careful consideration of each patient

Introduction: American Urological Association (AUA) guidelines recommend percutaneous nephrolithotomy (PCNL) for total stone burden greater than 20 mm, yet it is unclear if the number of stones affects adherence to this guideline. We aim to assess the impact of stone multiplicity on the choice of ureteroscopy (URS) vs PCNL as a first-line therapy for patients with high burden (>20 mm), and examine whether the AUA guideline-discordant care impacts patient outcomes. Materials and Methods: Data were collected from the Registry for Stones of the Kidney and Ureter (ReSKU) database, a prospectively collected registry of patients with stone disease. Multivariate logistic regression (MLR) was used to estimate the association between stone multiplicity and the decision to perform URS for high stone burden (>20 mm) patients. MLR was further used to estimate the association between performing URS and the following outcomes: stone-free rate, need for a second operation, and complications. Postoperative hospital stay was compared between patients receiving URS vs PCNL using Student's t-test. Results: One hundred twenty-five patients were included in this analysis. For patients with total stone burden exceeding 20 mm, those with more than three stones had roughly nine times the likelihood of undergoing URS over PCNL compared with patients with a single stone (adjusted odds ratio 9.21, confidence interval [95% CI] 2.55-40.58, p = 0.001). Stone-free rates, Clavien-Dindo scores, and frequency of second-look operations did not differ significantly between URS and PCNL patients. URS patients were discharged an average of 1.26 days earlier than patients who received PCNL (95% CI 0.72-1.81, p < 0.001). Discussion: Stone multiplicity strongly predicts which patients with stone burden >20 mm will undergo URS and who will undergo PCNL. These deviations from AUA guidelines do not appear to worsen patient outcomes. These results suggest that careful consideration of each patient

Introduction: American Urological Association (AUA) guidelines recommend percutaneous nephrolithotomy (PCNL) for total stone burden greater than 20 mm, yet it is unclear if the number of stones affects adherence to this guideline. We aim to assess the impact of stone multiplicity on the choice of ureteroscopy (URS) vs PCNL as a first-line therapy for patients with high burden (>20 mm), and examine whether the AUA guideline-discordant care impacts patient outcomes. Materials and Methods: Data were collected from the Registry for Stones of the Kidney and Ureter (ReSKU) database, a prospectively collected registry of patients with stone disease. Multivariate logistic regression (MLR) was used to estimate the association between stone multiplicity and the decision to perform URS for high stone burden (>20 mm) patients. MLR was further used to estimate the association between performing URS and the following outcomes: stone-free rate, need for a second operation, and complications. Postoperative hospital stay was compared between patients receiving URS vs PCNL using Students t-test. Results: One hundred twenty-five patients were included in this analysis. For patients with total stone burden exceeding 20 mm, those with more than three stones had roughly nine times the likelihood of undergoing URS over PCNL compared with patients with a single stone (adjusted odds ratio 9.21, confidence interval [95% CI] 2.55-40.58, p = 0.001). Stone-free rates, Clavien-Dindo scores, and frequency of second-look operations did not differ significantly between URS and PCNL patients. URS patients were discharged an average of 1.26 days earlier than patients who received PCNL (95% CI 0.72-1.81, p < 0.001). Discussion: Stone multiplicity strongly predicts which patients with stone burden >20 mm will undergo URS and who will undergo PCNL. These deviations from AUA guidelines do not appear to worsen patient outcomes. These results suggest that careful consideration of each patient m

Rationale & Objective: The intestinal microbiome may affect urinary stone disease by modulating the amount of oxalate absorbed from the intestine and subsequently excreted in urine. This study sought to explore the association between antibiotics, which alter the intestinal microbiota, and risk for urinary stone disease. Study Design: Prospective cohort study. Setting & Participants: 5,010 women in the Nurses’ Health Study (NHS) I and II who had collected 24-hour urine samples. Exposures: Use of antibiotics during the age range of 40 to 49 (NHS II), 40 to 59 (NHS I), and 20 to 39 years (both cohorts). Outcomes: Incident symptomatic urinary stone disease; urine composition. Analytical Approach: Cause-specific hazards regression adjusted for age, body mass index, comorbid conditions, thiazide use, and dietary factors. Follow-up was censored at the time of asymptomatic kidney stones, cancer, or death. Results: Cumulative use of antibiotics for a total of 2 or more months during the age range of 40 to 49 years (NHS II) and 40 to 59 years (NHS II) was associated with significantly higher risk for developing incident stones compared with no use (pooled HR, 1.48; 95% CI, 1.12-1.96). Similar results were found for the period of 20 to 39 years (pooled HR, 1.36; 95% CI, 1.00-1.84). Results were unchanged after excluding participants who reported urinary tract infection with their stone event or as the most common reason for antibiotic use. Urine composition was generally similar across antibiotic groups except for marginally lower urine pH and citrate values among those taking antibiotics for 2 or more months. Limitations: Observational design; lack of information for type of antibiotic used; relatively large span of time between antibiotic use and urine collection. Conclusions: Use of antibiotics for more than 2 months in early adulthood and middle age is associated with higher risk for urinary stone disease in later life.

Kidney stone disease should be viewed as a systemic disorder, associated with or predictive of hypertension, insulin resistance, chronic kidney disease and cardiovascular damage. Dietary and lifestyle changes represent an important strategy for the prevention of kidney stone recurrences and cardiovascular damage. A full screening of risk factors for kidney stones and for cardiovascular damage should be recommended in all cases of calcium kidney stone disease, yet it is rarely performed outside of stone specialist clinics. Many patients have a history of kidney stone disease while lacking a satisfactory metabolic profile. Nonetheless, in a real-world clinical practice a rational management of kidney stone patients is still possible. Different scenarios, with different types of dietary approaches based on diagnosis accuracy level can be envisaged. The aim of this review is to give patient-tailored dietary suggestions whatever the level of clinical and biochemistry evaluation. This can help to deliver a useful recommendation, while avoiding excessive dietary restrictions especially when they are not based on a specific diagnosis, and therefore potentially useless or even harmful. We focused our attention on calcium stones and the different scenarios we may find in the daily clinical practice, including the case of patients who reported renal colic episodes and/or passed stones with no information on stone composition, urinary risk factors or metabolic cardiovascular risk factors; or the case of patients with partial and incomplete information; or the case of patients with full information on stone composition, urinary risk factors and metabolic cardiovascular profile.

OBJECTIVES: To compare the ability of different size estimates to predict spontaneous passage of ureteral stones using a 3D-segmentation and to investigate the impact of manual measurement variability on the prediction of stone passage. METHODS: We retrospectively included 391 consecutive patients with ureteral stones on non-contrast-enhanced CT (NECT). Three-dimensional segmentation size estimates were compared to the mean of three radiologists' measurements. Receiver-operating characteristic (ROC) analysis was performed for the prediction of spontaneous passage for each estimate. The difference in predicted passage probability between the manual estimates in upper and lower stones was compared. RESULTS: The area under the ROC curve (AUC) for the measurements ranged from 0.88 to 0.90. Between the automated 3D algorithm and the manual measurements the 95% limits of agreement were 0.2 ± 1.4 mm for the width. The manual bone window measurements resulted in a > 20 percentage point (ppt) difference between the readers in the predicted passage probability in 44% of the upper and 6% of the lower ureteral stones. CONCLUSIONS: All automated 3D algorithm size estimates independently predicted the spontaneous stone passage with similar high accuracy as the mean of three readers' manual linear measurements. Manual size estimation of upper stones showed large inter-reader variations for spontaneous passage prediction. KEY POINTS:• An automated 3D technique predicts spontaneous stone passage with high accuracy.• Linear, areal and volumetric measurements performed similarly in predicting stone passage.• Reader variability has a large impact on the predicted prognosis for stone passage., Funding AgencyResearch Committee of Region Orebro County

Urinary stones composed of uric acid can be treated medically. Prediction of uric acid stone type is, therefore, desirable when a urinary stone is diagnosed with unenhanced CT. The purpose of the present study was to describe single-energy thin slice quantitative CT parameters of urinary stones correlated to chemical stone type and to develop a method to distinguish pure uric acid stones (UA) from other stones (non-UA/Mix). Unenhanced thin slice single-energy CT images of 126 urinary stones (117 patients) with known chemical stone type were retrospectively included in the study. Among the included stones, 22 were UA and 104 were non-UA/Mix. The included CT images and Laplacian filtered images of the stones were quantitatively analyzed using operator-independent methods. A post hoc classification method for pure UA stones was created using a combination of cutoff values for the peak attenuation and peak point Laplacian. The stone types differed in most quantitative image characteristics including mean attenuation (p < 0.001), peak attenuation (p < 0.001), and peak point Laplacian (p < 0.001). The sensitivity for the post hoc-developed peak attenuation-peak point Laplacian method for classifying pure UA stones was 95% [21/22, 95% CI (77-100%)] and the specificity was 99% [103/104, 95% CI (95-100%)]. In conclusion, quantitative image analysis of thin slice routine single-energy CT images is promising for predicting pure UA content in urinary stones, with results comparable to double energy methods., Funding Agency:Universitetssjukhuset Örebro OLL-523931

BACKGROUND: Previous studies have shown that, compared with non-stone formers, stone formers have a higher papillary density measured with computer tomography (CT) scan. The effect of increased hydration on such papillary density in idiopathic calcium stone formers is not known. METHODS: Patients with recurrent calcium oxalate stones undergoing endourological procedures for renal stones at our Institution from June 2013 to June 2014 were considered eligible for enrolment. Enrolled patients underwent a baseline unenhanced CT scan before the urological procedure; after endoscopic removal of their stones, the patients were instructed to drink at least 2 L/day of a hypotonic, oligomineral water low in sodium and minerals (fixed residue at 180 °C < 200 mg/L) for at least 12 months. Finally, the patients underwent a follow-up unenhanced CT scan during hydration regimen. RESULTS: Twenty-five patients were prospectively enrolled and underwent baseline and follow-up CT scans. At baseline, mean papillary density was 43.2 ± 6.6 Hounsfield Units (HU) (43.2 ± 6.7 for the left kidney and 42.8 ± 7.1 HU for the right kidney). At follow-up and after at least 12 months of hydration regimen, mean papillary density was significantly reduced at 35.4 ± 4.2 HU (35.8 ± 5.0 for the left kidney and 35.1 ± 4.2 HU for the right kidney); the mean difference between baseline and follow-up was - 7.8 HU (95% confidence interval - 10.6 to - 5.1 HU, p < 0.001). CONCLUSIONS: Increased fluid intake in patients with recurrent calcium oxalate stones was associated with a significant reduction in renal papillary density. TRIAL REGISTRATION: NCT03343743 , 15/11/2017 (Retrospectively registered).

Renal stone is a most common clinical disorder affecting up to 5% of the general population in the USA. The prevalence of renal stone disease has been rising in both sexes, being estimated that about 5% of American women and 12% of men will develop a kidney stone at some time in their life, however, in certain areas of the world, as in the Middle East, the lifetime risk appears to be even higher, There has been heightened awareness of renal stone disease in children as well, Recurrence rates of 50% after 10 years and 75% after 20 years have been reported Epidemiological data on urolithiasis in sub-Saharan Africa are rare because research resources throughout most of the continent are poor. South Africa is an exception in this concern. Stone disease has been reported in several countries. Epidemiological factors in these regions are not unusual. However, in a few countries the disease is extremely rare. The absence of stones can be attributed to epidemiological factors in all regions except South Africa, where stone shortage arises because of racial differences between the white and black population groups. Routine urinary biochemical risk factors cannot account for this phenomenon. However, the protective capacity of urinary proteins may play a role in this regard The aim of this study were to investigate factors associated kidney stone and effectiveness and treatment outcome of ESWL as intervention method in shaafi hospital Mogadishu Somalia The specific objectives of this study were . To determine factors associated kidney stone at shaafi hospital. To asses availability and treatment outcome with renal calculi among adult patient in shaafi hospital in hodan district. Methodology used a descriptive cross-sectional design and the study area is shaafi hospital Mogadishu Somalia A total 40 respondents was purposively selected from 40 respondents The data were collected during 1-14 days may 2018 using structured questionnaire, . The data was compiled and analyzed by us

Renal stone is a most common clinical disorder affecting up to 5% of the general population in the USA. The prevalence of renal stone disease has been rising in both sexes, being estimated that about 5% of American women and 12% of men will develop a kidney stone at some time in their life, however, in certain areas of the world, as in the Middle East, the lifetime risk appears to be even higher, There has been heightened awareness of renal stone disease in children as well, Recurrence rates of 50% after 10 years and 75% after 20 years have been reported Epidemiological data on urolithiasis in sub-Saharan Africa are rare because research resources throughout most of the continent are poor. South Africa is an exception in this concern. Stone disease has been reported in several countries. Epidemiological factors in these regions are not unusual. However, in a few countries the disease is extremely rare. The absence of stones can be attributed to epidemiological factors in all regions except South Africa, where stone shortage arises because of racial differences between the white and black population groups. Routine urinary biochemical risk factors cannot account for this phenomenon. However, the protective capacity of urinary proteins may play a role in this regard The aim of this study were to investigate factors associated kidney stone and effectiveness and treatment outcome of ESWL as intervention method in shaafi hospital Mogadishu Somalia The specific objectives of this study were . To determine factors associated kidney stone at shaafi hospital. To asses availability and treatment outcome with renal calculi among adult patient in shaafi hospital in hodan district. Methodology used a descriptive cross-sectional design and the study area is shaafi hospital Mogadishu Somalia A total 40 respondents was purposively selected from 40 respondents The data were collected during 1-14 days may 2018 using structured questionnaire, . The data was compiled and analyzed by us

BackgroundTo compare head to head two end-engaging nitinol stone retrieval devices available to urologists, in terms of durability, versatility and efficacy.MethodsFor durability testing, 30 NGage and Dakota baskets were cycled 20 times between grasping and releasing synthetic stone models and evaluated for damage or device failure. For versatility and efficacy testing, baskets were assessed in their ability to capture and release stone models from 1 to 11 mm. Each stone was raised above the capture site and the basket was opened to passively release the stone. If the stone did not release, the basket handle was shaken and the OpenSure feature employed if needed. Manual release was used as a last resort.ResultsDurability-the Cook NGage demonstrated a statistically significant increased rate of visible device breakdown (P=0.0046) in 8 of 30 (26.7%) devices vs. 0 of 30 Dakota devices, with mean damage at 13.5 cycles. Versatility and efficacy-both 8 mm baskets successfully captured stones from 1-8 mm. The Dakota more effectively released 7-8 mm stones (P<0.0001). NGage required manual release of 8 mm stones in 13 cases compared to none with Dakota. For 11 mm baskets, the Dakota released all stones up to 10 mm with simple opening, while the NGage released 10 of 15 (67%) of 9 mm stones and 1 of 15 (7%) of 10 mm stones by simple opening. For 11 mm stones, the Dakota captured 100% whereas NGage could not capture any.ConclusionsBoth baskets showed similar durability characteristics. The Dakota basket more effectively captured and released stones over 7 mm, as compared to the NGage basket. The OpenSure aspect conferred an advantage in handling and release of larger stones. These in vitro results demonstrate potential versatility, durability and efficacy of the Dakota basket.

Introduction: Supporting an “ultrasound-first” approach to evaluating renal colic in the emergency department (ED) remains important for improving patient care and decreasing healthcare costs. Our primary objective was to compare emergency physician (EP) ultrasound to computed tomography (CT) detection of hydronephrosis severity in patients with suspected renal colic. We calculated test characteristics of hydronephrosis on EP-performed ultrasound for detecting ureteral stones or ureteral stone size >5mm. We then analyzed the association of hydronephrosis on EP-performed ultrasound, stone size >5mm, and proximal stone location with 30-day events.Methods: This was a prospective observational study of ED patients with suspected renal colic undergoing CT. Subjects had an EP-performed ultrasound evaluating for the severity of hydronephrosis. A chart review and follow-up phone call was performed.Results: We enrolled 302 subjects who had an EP-performed ultrasound. CT and EP ultrasound results were comparable in detecting severity of hydronephrosis (x2=51.7, p<0.001). Hydronephrosis on EP- performed ultrasound was predictive of a ureteral stone on CT (PPV 88%; LR+ 2.91), but lack of hydronephrosis did not rule it out (NPV 65%). Lack of hydronephrosis on EP-performed ultrasound makes larger stone size >5mm less likely (NPV 89%; LR-0.39). Larger stone size > 5mm was associated with 30-day events (OR 2.30, p=0.03).Conclusion: Using an ultrasound-first approach to detect hydronephrosis may help physicians identify patients with renal colic. The lack of hydronephrosis on ultrasound makes the presence of a larger ureteral stone less likely. Stone size >5mm may be a useful predictor of 30-day events.

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a genetic disorder affecting approximately 2.5 million people worldwide. It is the number one, life-threatening monogenic disorder known, caused by mutations in either the Pkd1 or Pkd2 genes resulting in numerous fluid-filled cysts within the kidneys. ADPKD presents in the 2nd decade of life and presents with progressive renal decline and eventually to end stage renal disease (ESRD) in the 5th to 6th decade of life for half of all patients. Currently no treatments exist to ameliorate or cure ADPKD, creating a large financial burden on both the health care system, the patient, and their care-givers. Treatment options once patients reach ESRD are limited to dialysis and kidney transplant. Since the discovery of the genetic link to ADPKD, there has been intense research to understand what role the Pkd1/2 genes play in the formation of cysts and the progression of ADPKD. The slow progression of ADPKD and the difference in disease severity between individuals implies that there may be environmental factors acting as causative agents in promoting cyst formation. Animal models of ADPKD appear to be more susceptible to cyst formation following injury with nephrotoxic chemicals, ischemia, and partial or total unilateral nephrectomy. These data demonstrate that the injured state is a driver of cyst formation once Pkd1/2 have been mutated, but these experimental approaches are not representative of normal environmental injuries to the kidney. The focus of my research is to elucidate an environmental agent that can promote cystogenesis in an otherwise healthy individual. The kidney is responsible for filtering solutes from the blood which include ions and molecules that under the right circumstances can form precipitates in the urinary filtrate. It is our hypothesis that the endogenous kidney injury in ADPKD patients results via the precipitation of microcrystals and the inappropriate response to crystal clearance. The kid

Introduction: Supporting an “ultrasound-first” approach to evaluating renal colic in the emergency department (ED) remains important for improving patient care and decreasing healthcare costs. Our primary objective was to compare emergency physician (EP) ultrasound to computed tomography (CT) detection of hydronephrosis severity in patients with suspected renal colic. We calculated test characteristics of hydronephrosis on EP-performed ultrasound for detecting ureteral stones or ureteral stone size >5mm. We then analyzed the association of hydronephrosis on EP-performed ultrasound, stone size >5mm, and proximal stone location with 30-day events.Methods: This was a prospective observational study of ED patients with suspected renal colic undergoing CT. Subjects had an EP-performed ultrasound evaluating for the severity of hydronephrosis. A chart review and follow-up phone call was performed.Results: We enrolled 302 subjects who had an EP-performed ultrasound. CT and EP ultrasound results were comparable in detecting severity of hydronephrosis (x2=51.7, p<0.001). Hydronephrosis on EP- performed ultrasound was predictive of a ureteral stone on CT (PPV 88%; LR+ 2.91), but lack of hydronephrosis did not rule it out (NPV 65%). Lack of hydronephrosis on EP-performed ultrasound makes larger stone size >5mm less likely (NPV 89%; LR-0.39). Larger stone size > 5mm was associated with 30-day events (OR 2.30, p=0.03).Conclusion: Using an ultrasound-first approach to detect hydronephrosis may help physicians identify patients with renal colic. The lack of hydronephrosis on ultrasound makes the presence of a larger ureteral stone less likely. Stone size >5mm may be a useful predictor of 30-day events.

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a genetic disorder affecting approximately 2.5 million people worldwide. It is the number one, life-threatening monogenic disorder known, caused by mutations in either the Pkd1 or Pkd2 genes resulting in numerous fluid-filled cysts within the kidneys. ADPKD presents in the 2nd decade of life and presents with progressive renal decline and eventually to end stage renal disease (ESRD) in the 5th to 6th decade of life for half of all patients. Currently no treatments exist to ameliorate or cure ADPKD, creating a large financial burden on both the health care system, the patient, and their care-givers. Treatment options once patients reach ESRD are limited to dialysis and kidney transplant. Since the discovery of the genetic link to ADPKD, there has been intense research to understand what role the Pkd1/2 genes play in the formation of cysts and the progression of ADPKD. The slow progression of ADPKD and the difference in disease severity between individuals implies that there may be environmental factors acting as causative agents in promoting cyst formation. Animal models of ADPKD appear to be more susceptible to cyst formation following injury with nephrotoxic chemicals, ischemia, and partial or total unilateral nephrectomy. These data demonstrate that the injured state is a driver of cyst formation once Pkd1/2 have been mutated, but these experimental approaches are not representative of normal environmental injuries to the kidney. The focus of my research is to elucidate an environmental agent that can promote cystogenesis in an otherwise healthy individual. The kidney is responsible for filtering solutes from the blood which include ions and molecules that under the right circumstances can form precipitates in the urinary filtrate. It is our hypothesis that the endogenous kidney injury in ADPKD patients results via the precipitation of microcrystals and the inappropriate response to crystal clearance. The kid

Uvod: Perkutana nefrolitolapaksija (PCNL) predstavlja metodu izbora u lečenju kamena (kalkulusa) u bubregu većeg od 2 cm. Metoda pripada grupi endoskopskih minimalno invazivnih procedura. Uprkos manjoj invazivnosti u odnosu na otvorene hirurške tehnike, metoda ima i svoje specifičnosti, na polju bezbednosti i potencijalnih komplikacija. Pristup kamenu se obavlja širenjem kanala kroz parenhim bubrega, nakon ulaska iglom do željenog dela sabirnog sistema bubrega i kamena. Kao i ostale tehnike fragmentisanja kamena u bubregu i PCNL može da ima uticaj na bubrežnu funkciju. Cilj: Analiza (1) uspešnosti PCNL u lečenju kamena u bubregu u odnosu na veličinu, anatomske odnose i lokalizaciju, (2) učestalosti komplikacija kod bolesnika lečenih ovom metodom, u odnosu na veličinu, anatomske odnose i lokalizaciju, (3) uticaja metode na bubrežnu funkciju i eventualnog stepena oštećenja bubrega i (4) učestalosti recidiva. Materijal i metode: Kohortnom studijom su obuhvaćeni pacijenati Klinike za urologiju KCS koji su u periodu od 2010. do 2014. godine operisani PCNL metodom, od strane jednog hirurga. Selekcija pacijenata obavljena je prema preporukama za tretman kalkuloze bubrega Evropske asocijacije urologa i svi su imali kamen veći od 2 cm. Nakon sprovedenih radiografskih procedura karakteristike kalkulusa, veličina, broj i položaj, kao i anatomska građa sabirnog sistema bubrega i samog bubrega sagledavani su korišćenjem „Guy’s Stone Score“ klasifikacije (GSS) i bolesnici su svrstavani u jednu od četiri ponuđene kategorije. Klasifikacija komplikacija izvršena je prema modifikovanom Clavien-Dindo sistemu. Uspeh procedure je definisan kao izostanak rezidualnih fragmenata > 3 mm. Bubrežna funkcija je praćena određivanjem β2-mikroglobulina i mikroalbuminurije. Tri meseca nakon operacije vršena je procena učestalosti recidiva. Rezultati: Ispitivanu populaciju činilo je 111 bolesnika. Medijana starosti bolesnika je iznosila 48 godina. Medijana veličine kamena iznosila je 51 mm. Najmanj, INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is considered today as a treatment of choice for kidney stones bigger than 2 cm. PCNL is endoscopic, minimally invasive procedure. Beside its low aggressiveness it is accompanied with few specific, critical steps and possible complications. The crucial step to perform successful and safe procedure is renal access. Precise access to the planed and desired part of the kidney collecting system is followed with careful dilatation of the working tract. As all other techniques of kidney stones disintegration, PCNL can possibly impact renal function. OBJECTIVE: The aim of the present study was to investigate 1) PCNL efficacy and 2) PCNL safety, overall and dependent on stone complexity, respectively, 3) possible mechanism of impact on renal function and 4) the frequency of stone recurrence. MATERIAL AND METHODS: The study cohort evaluated all patients of Clinic of urology in Belgrade who underwent PCNL by a single surgeon, between August 2010 and December 2014. The patients were selected according to the Guideline of the European Association of Urology and all stones were bigger than 2 cm. After the appropriate radiological and laboratory investigation the complexity of the stones, but also of kidney anatomy was determined by Guy’s Stone Score classification. Stones were classified to one of the four offered groups. Complications were evaluated using modified Clavien-Dindo classification. For detection of possible impact of PCNL on renal function the micro albumin and β2-microglobulin levels in urine were evaluated. Three months following PCNL the frequency of recurrence was determined. RESULTS: Study cohort gained 111 patients. The median age of the patients was 48 years, while the median stone diameter was 51 mm. The smallest stone was 21 mm and the biggest 91 mm. According to Guy’s Stone Score (GSS) 16,2% of the patients were classified in GSS 1 group, 18,9% in GSS 2, 26,2% in GSS 3 and 38,7% in GSS 4 groups, respectivel

BACKGROUND AND OBJECTIVES: Protein and potassium intake and the resulting diet-dependent net acid load may affect kidney stone formation. It is not known whether protein type or net acid load is associated with risk of kidney stones. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We prospectively examined intakes of protein (dairy, nondairy animal, and vegetable), potassium, and animal protein-to-potassium ratio (an estimate of net acid load) and risk of incident kidney stones in the Health Professionals Follow-Up Study (n=42,919), the Nurses' Health Study I (n=60,128), and the Nurses' Health Study II (n=90,629). Multivariable models were adjusted for age, body mass index, diet, and other factors. We also analyzed cross-sectional associations with 24-hour urine (n=6129). RESULTS: During 3,108,264 person-years of follow-up, there were 6308 incident kidney stones. Dairy protein was associated with lower risk in the Nurses' Health Study II (hazard ratio for highest versus lowest quintile, 0.84; 95% confidence interval, 0.73 to 0.96; P value for trend <0.01). The hazard ratios for nondairy animal protein were 1.15 (95% confidence interval, 0.97 to 1.36; P value for trend =0.04) in the Health Professionals Follow-Up Study and 1.20 (95% confidence interval, 0.99 to 1.46; P value for trend =0.06) in the Nurses' Health Study I. Potassium intake was associated with lower risk in all three cohorts (hazard ratios from 0.44 [95% confidence interval, 0.36 to 0.53] to 0.67 [95% confidence interval, 0.57 to 0.78]; P values for trend <0.001). Animal protein-to-potassium ratio was associated with higher risk (P value for trend =0.004), even after adjustment for animal protein and potassium. Higher dietary potassium was associated with higher urine citrate, pH, and volume (P values for trend <0.002). CONCLUSIONS: Kidney stone risk may vary by protein type. Diets high in potassium or with a relative abundance of potassium compared with animal protein could represent a means of stone p