Search

Context: Renal calculus disease has a lifetime recurrence rate of 80%. Protocol-based metabolic evaluation in high-risk subjects for recurrent renal stones reveals abnormalities in a large subset of subjects. However, such information is not available in Indian subjects. Aims: To evaluate the abnormalities by a protocol-based metabolic evaluation in patients at a high risk for recurrent renal stones. Settings and Design: Prospective, academic tertiary care center. Materials and Methods: Fifty North Indian patients (38 males and 12 females; mean age 38 ± 10.2 years) with recurrent or bilateral renal stones were evaluated. All subjects underwent a protocol-based evaluation involving estimation of serum total calcium, phosphorus, creatinine, albumin, iPTH, 25(OH)D 3 , 1,25(OH) 2 D 3 , and a calcium load test. Estimation of daily urinary excretion of volume, oxalate, calcium, uric acid, and citrate, and urinary acidification studies were performed. Statistical Analysis Used: Descriptive statistics and t-test. Results: An underlying disorder was detected in 48 (96%) patients. Almost half had two or more metabolic abnormalities. The metabolic abnormalities detected were: Hypercalciuria 26 (52%) patients, renal hypercalciuria 16 (32%), absorptive hypercalciuria 6 (12%), unclassified hypercalciuria 4 (8%), hyperoxaluria 27 (54%), hyperuricosuria 9 (18%), distal renal tubular acidosis 4 (8%; 2 complete and 2 partial), primary hyperparathyroidism 3 (6%), and hypocitraturia 14 (n=18, 77%). In two patients, the etiology could not be detected. Conclusions: Protocol-based metabolic evaluation reveals metabolic abnormalities in majority of patients with nephrolithiasis. The spectrums of metabolic abnormalities are different in Indian subjects as compared to the western population.

PUSPOSE: To evaluate food intake of patients with urinary lithiasis and idiopathic hypercalciuria (IH). MATERIALS AND METHODS: Between August 2007 and June 2008, 105 patients with lithiasis were distributed into 2 groups: Group 1 (n = 55) - patients with IH (urinary calcium excretion > 250 mg in women and 300 mg in men with normal serum calcium); Group 2 (n = 50) - normocalciuria (NC) patients . Inclusion criteria were: age over 18, normal renal function (creatinine clearance = 60 mL/min), absent proteinuria and negative urinary culture. Pregnant women, patients with some intestinal pathology, chronic diarrhea or using corticoids were excluded. The protocol of metabolic investigation was based on non-consecutive collection of two 24-hour samples for dosages of: calcium, sodium, uric acid, citrate, oxalate, magnesium and urinary volume. Food intake was evaluated through the quantitative method of Dietary Register of three days. RESULTS: Urinary excretion of calcium (433.33 ± 141.92 vs. 188.93 ± 53.09), sodium (280.08 ± 100.94 vs. 200.44.93 ± 65.81), uric acid (880.63 ± 281.50 vs. 646.74 ± 182.76) and magnesium (88.78 ± 37.53 vs. 64.34 ± 31.84) was significantly higher in the IH group in comparison to the NC group (p < 0.05). As regards the nutritional composition of food intake of IH and NC groups, there was no statistical significant difference in any nutrient evaluated. CONCLUSION: In our study, no difference was observed in the food intake of patients with urinary lithiasis and IH or NC.

The incidence of urolithiasis (UL) in children has been increasing. Although the pathogenesis of pediatric UL is controversial and remains unclear, multiple monogenic causes of UL have been identified. We aim to investigate the prevalence of inherited UL causes and explore the genotype-phenotype correlation in a Chinese pediatric group. In this study, we analyzed the DNA of 82 pediatric UL patients using exome sequencing (ES). The data of metabolic evaluation and genomic sequencing were subsequently analyzed together. We detected 54 genetic mutations in 12 of 30 UL-related genes. A total of 15 detected variants were described as pathogenic mutations, and 12 mutations were considered likely pathogenic. Molecular diagnoses were made in 21 patients with pathogenic or likely pathogenic variants. Six novel mutations that were not previously reported were identified in this cohort. Calcium oxalate stones were detected in 88.9% cases (8/9) with hyperoxaluria-related mutations, while 80% of individuals (4/5) with cystinuria-causing defects were diagnosed with cystine stones. Our study highlights the significant genetic abnormalities in pediatric UL and demonstrates the diagnostic power of ES for screening patients with UL., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wang, He, liu, Tong, Li, Zhao and Li.)

Fifty-four patients with infected renal lithiasis underwent complete metabolic evaluation searching for underlying factors contributing to stone formation including urine analysis and culture. Metabolic abnormalities were significantly more present in patients with mixed infected stones (struvite+/-apatite and calcium oxalate) than in patients with pure infected stones (struvite+/-carbonate apatite): hypercalciuria in 40%, hyperoxaluria in 34% and hyperuricosuria in 28% (p < 0.05). Urinary excretion of citrate was low in both groups without statistically significant difference (238+/-117 mg/24 h vs 214+/-104 mg/24/h, t = 0.72, p = 0.5). The few metabolic abnormalities present in patients with pure infected stones should suggest that urinary tract infection could change the urine chemistry in a lithogenic direction and be only cause of stone formation. [ABSTRACT FROM AUTHOR]

Pediatric patients with limited lower extremity mobility may be at increased risk of developing nephrolithiasis due to bone mineral metabolic derangements. This study sought to assess whether nephrolithiasis management and related outcomes differ between ambulatory versus non-ambulatory pediatric patients. This was a retrospective review of ambulatory and non-ambulatory pediatric patients with nephrolithiasis from 2010 to 2021 from a single tertiary care center. Demographics, surgical history, stone compositions, and 24-h urine data were reviewed. Adjusted logistic and linear regression models were utilized to assess whether mobility status was associated with nephrolithiasis-related management and outcomes, including: age at first stone; requiring surgical intervention for stones; number of surgeries; stone compositions; urine culture results; and completion of 24-h urine studies. Among 339 pediatric patients with nephrolithiasis, 67 (19.8%) were non-ambulatory. In adjusted analyses, non-ambulatory patients had 3.24 times greater odds of requiring surgical intervention for stones (95% CI: 1.93–6.84; p < 0.0001); among those who required surgery, non-ambulatory patients required an average of 0.82 more surgical interventions (95% CI: 0.35–1.30; p = 0.0008) than ambulatory patients. Additionally, non-ambulatory patients had 5.28 times greater odds of having a positive urine culture at the time of surgery (95% CI: 2.35–14.08; p = 0.0001) and were significantly less likely to undergo 24-h urine studies (OR: 0.35; 95% CI: 0.15–0.83; p = 0.02). Stone composition significantly varied by mobility status, with non-ambulatory patients being significantly more likely to form calcium apatite (OR: 5.1; 95% CI: 2.18–11.93; p = 0.0002) or struvite (OR 3.72; 95% CI: 1.18–11.74; p = 0.03) stones, and significantly less likely to form calcium oxalate stones (OR: 0.19; 95 CI: 0.08–0.47; p = 0.0003). Among all patients, age at first stone occurred at a median age of 13.4 years (IQR: 8.2–16.4) and did not significantly differ by mobility status (p = 0.92). Patients with limited mobility required surgery for nephrolithiasis at significantly higher rates and had different stone compositions than ambulatory patients. Obtaining a 24-h urine study in patients with comorbidities affecting ambulation was uncommon, compared to ambulatory patients. Similarly to ambulatory patients, pediatric patients with limited mobility who develop nephrolithiasis tend to first present with stones in early adolescence. [ABSTRACT FROM AUTHOR]

Context An optimum metabolic evaluation strategy for urinary stone patients has not been clearly defined. Objective To evaluate the optimum strategy for metabolic stone evaluation and management to prevent recurrent urinary stones. Evidence acquisition Several databases were searched to identify studies on the metabolic evaluation and prevention of stone recurrence in urolithiasis patients. Special interest was given to the level of evidence in the existing literature. Evidence synthesis Reliable stone analysis and basic metabolic evaluation are highly recommended in all patients after stone passage (grade A). Every patient should be assigned to a low- or high-risk group for stone formation. It is highly recommended that low-risk stone formers follow general fluid and nutritional intake guidelines, as well as lifestyle-related preventative measures to reduce stone recurrences (grade A). High-risk stone formers should undergo specific metabolic evaluation with 24-h urine collection (grade A). More specifically, there is strong evidence to recommend pharmacological treatment of calcium oxalate stones in patients with specific abnormalities in urine composition (grades A and B). Treatment of calcium phosphate stones using thiazides is only highly recommended when hypercalciuria is present (grade A). In the presence of renal tubular acidosis (RTA), potassium citrate and/or thiazide are highly recommended based on the relative urinary risk factor (grade A or B). Recommendations for therapeutic measures for the remaining stone types are based on low evidence (grade C or B following panel consensus). Diagnostic and therapeutic algorithms are presented for all stone types based on the best level of existing evidence. Conclusion Metabolic stone evaluation is highly recommended to prevent stone recurrences. Patient summary In this report, we looked at how patients with urolithiasis should be evaluated and treated in order to prevent new stone formation. Stone type determination and specific blood and urine analysis are needed to guide patient treatment. [ABSTRACT FROM AUTHOR]

The aim of this study was to construct the fourth in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis (IAU) that by providing a clinical framework for the metabolic evaluation, prevention, and follow-up of patients with urolithiasis based on the best available published literature. All recommendations were summarized following a systematic review and assessment of the literature in the PubMed database from January 1976 to June 2022. Each generated recommendation was graded using a modified GRADE methodology. Guideline recommendations were developed that addressed the following topics: initial evaluation, metabolic testing, dietary measures, medical management, and follow-up of recurrent stone formers. It was emphasized by the Panel that prevention of new stone formation is as important as the surgical removal of the stones. Although general preventive measures may be effective in reducing stone recurrence rates in some patients, specific medical and dietary management should be well considered and eventually applied in an individualized manner based on the outcomes of metabolic work-up, stone analysis and some certain patient related factors. A detailed follow-up of each case is essential depending on the metabolic activity of each individual patient., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To determine the metabolic risk factors in children and adults with urinary system stone disease. Materials and methods: Between September 2008 and February 2011, 257 patients who underwent 24-h urine analysis because of urinary system stone disease were included in the present study. Group I and II include only adult patients. The first-time stone formers were named as Group I ( n = 106), and recurrent stone formers were named as Group II ( n = 107). Group III was occurred by pediatric patients ( n = 44). Control group includes 105 people was called as Group IV. This group was divided into two subgroups. Group IVa includes 70 adult people, and Group IVb includes 35 children. The metabolic evaluation results of patients and control groups were compared. Results: Hypercalciuria (35.8, 44.9, and 47.7 % for Group I, II, and III, respectively) and hypocitraturia (42.5, 40.2, and 50 % for Group I, II, and III, respectively) were most common risk factors for stone formation. However, unlike the literature, we have seen that hypomagnesiuria is also an important risk factor in adults and children. Hypomagnesiuria was defined at 36.4 % in Group I, 29 % in Group II, and 56.8 % in Group III ( p < 0.05 for each group). These three parameters were significantly different between patient and control groups. Conclusions: Hypomagnesiuria, hypocitraturia, and hypercalciuria are the most important risk factors for stone formation in adults and pediatric patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of metabolic abnormalities in the serum and urine of patients with urinary stones disease. Methods: Two hundred patients with either multiple or recurrent urolithiasis diagnosed on ultrasonography and intravenous urography were included in this study. 24 hour urine sample were collected from each patient and sent for PH, specific gravity, Creatinine, uric acid, calcium, phosphate, oxalate, citrate and magnesium. In addition, blood sample of each patient was also sent for serum levels of urea, creatinine, uric acid, phosphate and calcium. Results: Mean age of patients was 38 ± 7.75 years with male to female ratio of 2:1. The main presenting complaint was lumber pain and 82.5% patients were found to have calcium oxalate stones on chemical analysis. Metabolic abnormalities were found in 90.5% patients, whereas there were no metabolic abnormalities in 19 (9.5%) patients. Forty patients (21.5%) only had one metabolic abnormality and 157 (78.5%) patients had multiple metabolic abnormalities. Hyperoxaluria was the most commonly observed metabolic abnormality and was found in 64.5% patients. Other significant metabolic abnormalities were hypercalciuria, Hypercalcemia, hypocitraturia and hyperuricemia. Conclusion: This study concludes that frequency of metabolic abnormalities is very high in patients with urolithiasis and hyperoxaluria, hypercalciuria and hypocitraturia are the most important metabolic abnormalities observed in these patients. [ABSTRACT FROM AUTHOR]

Context: Renal calculus disease has a lifetime recurrence rate of 80%. Protocol-based metabolic evaluation in high-risk subjects for recurrent renal stones reveals abnormalities in a large subset of subjects. However, such information is not available in Indian subjects. Aims: To evaluate the abnormalities by a protocol-based metabolic evaluation in patients at a high risk for recurrent renal stones. Settings and Design: Prospective, academic tertiary care center. Materials and Methods: Fifty North Indian patients (38 males and 12 females; mean age 38 ± 10.2 years) with recurrent or bilateral renal stones were evaluated. All subjects underwent a protocol-based evaluation involving estimation of serum total calcium, phosphorus, creatinine, albumin, iPTH, 25(OH)D3, 1,25(OH)2D3, and a calcium load test. Estimation of daily urinary excretion of volume, oxalate, calcium, uric acid, and citrate, and urinary acidification studies were performed. Statistical Analysis Used: Descriptive statistics and t-test. Results: An underlying disorder was detected in 48 (96%) patients. Almost half had two or more metabolic abnormalities. The metabolic abnormalities detected were: Hypercalciuria 26 (52%) patients, renal hypercalciuria 16 (32%), absorptive hypercalciuria 6 (12%), unclassified hypercalciuria 4 (8%), hyperoxaluria 27 (54%), hyperuricosuria 9 (18%), distal renal tubular acidosis 4 (8%; 2 complete and 2 partial), primary hyperparathyroidism 3 (6%), and hypocitraturia 14 (n=18, 77%). In two patients, the etiology could not be detected. Conclusions: Protocol-based metabolic evaluation reveals metabolic abnormalities in majority of patients with nephrolithiasis. The spectrums of metabolic abnormalities are different in Indian subjects as compared to the western population. [ABSTRACT FROM AUTHOR]

Copyright of La Radiologia Medica is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Background: Diagnosis of urolithiasis in infancy is uncommon. It imposes rational exploration resting on medical history, clinical features, radiologic assessment, metabolic investigation and stone analysis. Aim: The aim of this study is to evaluate epidemiologic and etiologic features of the urolithiasis in infancy. Methods: It''s a retrospective study including 14 cases of urolithiasis in infants, enrolled in pediatric department of Charles-Nicolle Hospital during fourteen years (1995–2008). Results: The median age was 13 months. Thirty five percent of the patients had a positive family history of urolithiasis. The main presenting symptoms were urinary tract infection (four cases) and macroscopic hematuria (three cases). Radio-opaque urolithiasis were diagnosed in nine patients (64%), multiple stones in four patients (28%). Six of patients were diagnosed as having metabolic urolithiasis, four anatomic, two infectious and two idiopathic. Conclusion: In our study, metabolic causes remain the first cause of urolithiasis in infancy. [Copyright &y& Elsevier]

Nephrolithiasis is a highly prevalent condition with a high recurrence rate that has a large impact on the quality of life of those affected. It also poses a great financial burden on society. There have been great advancements in the surgical treatment of stone disease over the past several decades. The evolution of surgical technique appears to have overshadowed the importance of prevention of stone disease despite evidence showing medical therapies significantly decreasing stone recurrence rates. Herein we review the metabolic evaluation of stone formers with the use of specific blood and urine tests. We complete our discussion with a review of the medical management of stone formers providing both general recommendations as well as reviewing focused therapies for specific metabolic abnormalities and medical conditions. [ABSTRACT FROM PUBLISHER]

Data on urolithiasis (UL) in infancy are limited. The objective of this study was to increase awareness of infant UL and to investigate the influence of possible risk factors in this very specific age group. Nonfasting, second-voiding urine samples were obtained to test for urinary excretions of calcium, oxalate, citrate, magnesium, uric acid, and creatinine. Blood analysis included calcium, phosphate, magnesium, uric acid, creatinine, sodium, potassium, chloride, and alkaline phosphatase. Patients received follow-up testing every 1–2 months; serial ultrasonography was used to track UL status. Fifty infants with a median age of 5 months were enrolled in the study. Hypercalciuria was detected in 9/47, hyperoxaluria in 5/39, hypocitraturia in 4/31, and cystinuria in 2/50 infants. We identified at least one metabolic abnormality in 46% of our patients; no metabolic abnormality was identified in 27 infants. Within a mean follow-up period of 14 months, 17 infants became stone free, stones increased in number in ten patients and decreased in number in 16, and recurrence was detected in seven. This study showed that UL could be detected in very early life, even in the newborn period, and could be the source of late childhood/adulthood UL. Infants with nonspecific symptoms such as restlessness may have UL and should undergo ultrasonographic examination. Metabolic evaluation of UL in this specific age group carries some diagnostic challenges, e.g. unsatisfactory data regarding normal ranges of urinary mineral excretion, and collection of 24-h urine samples. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the clinical outcome in children with urinary calculi, to detect risk factors for nephrolithiasis in childhood. This retrospective study comprised 62 pediatric nephrolithiasis patients who have come for routine follow-up visits between the dates of January 2002–August 2006 (48% girls and 52% boys). The mean age of the patients was 8.8 ± 4.5 years (1–16 years). Hypercalciuria was found in 25 (40%) patients. The mean urinary calcium excretion for hypercalciuric patients was 5.7 ± 1.2 mg/kg (4.8 mg/kg per day). In our hypercalciuric patients 15 (60%) children had abdominal or flank pain, seven (28%) patients macroscopic hematuria and three (12%) dysuria. Hypocitraturia is the second important risk factor for nephrolithiasis. Urinary calcium excretion showed a positive correlation with the stone size ( r = 0.482, P = 0.043). A positive correlation was found between recurrent urinary tract infection (UTI) and hypercalciuria ( r = 0.528, P = 0.017). Urinary citrate excretion showed a negative correlation with recurrent UTI ( r = −0.503, P = 0.024). Hyperuricaciduria, hyperoxaluria were found to have no effect on the stone size and UTI of the patients. Stones were disintegrated with ESWL in two patients, endoscopic interventions were used in one patient and two underwent an open surgical procedure. All children with nephrolithiasis should have a metabolic screen. Children with a positive family history and consanguinity should be followed carefully with respect to metabolic abnormalities. [ABSTRACT FROM AUTHOR]

Metabolic evaluation of stone-forming (SF) patients is based on the determination of calcium, oxalate, citrate, uric acid and other parameters in 24-h urine samples under a random diet. A reliable measurement of urinary oxalate requires the collection of urine in a receptacle containing acid preservative. However, urinary uric acid cannot be determined in the same sample under this condition. Therefore, we tested the hypothesis that the addition of preservatives (acid or alkali) after urine collection would not modify the results of those lithogenic parameters. Thirty-four healthy subjects (HS) were submitted to two non-consecutive collections of 24-h urine. The first sample was collected in a receptacle containing hydrochloric acid (HCl 6 N) and the second in a dry plastic container, with HCl being added as soon as the urine sample was received at the laboratory. Additionally, 34 HS and 34 SF patients collected a spot urine sample that was divided into four aliquots, one containing HCl, another containing sodium bicarbonate (NaHCO35 g/l), and two others in which these two preservative agents were added 24 h later. Urinary oxalate, calcium, magnesium, citrate, creatinine and uric acid were determined. Urinary parameters were also evaluated in the presence of calcium oxalate or uric acid crystals. Mean values of all urinary parameters obtained from previously acidified 24-h urine samples did not differ from those where acid was added after urine collection. The same was true for spot urine samples, with the exception of urinary citrate that presented a slight albeit significant change of 5.9% between samples in HS and 3.1% in SF. Uric acid was also not different between pre- and post-alkalinized spot urine samples. The presence of crystals did not alter these results. We concluded that post-delivery acidification or alkalinization of urine samples does not modify the measured levels of urinary oxalate, calcium, magnesium, creatinine and uric acid, and that the change on citrate was not relevant, hence allowing all parameters to be determined in a single urine sample, thus avoiding the inconvenience and cost of multiple 24-h urine sample collections. [ABSTRACT FROM AUTHOR]

Aims: The goal of clinical and metabolic evaluation of patients with urinary stones is to identify patients at high risk for recurrent stone formation and as such, to allow the practitioner to suggest preventive therapies. However, knowledge about risk factors for active stone formation in patients with urolithiasis is limited. This study was initiated to assess the significance of several metabolic and clinical parameters for the determination of the risk of active stone formation. Methods: Study in 320 consecutive outpatients referred to our clinic for metabolic analysis. Clinical and metabolic parameters were determined by standardized procedures of questionnaires, serum biochemical profiles and urinalysis. Results: In 21.5% of 284 patients with complete data stone formation was active. Hypercalciuria, hypocitraturia and urinary tract infections had odds ratios for active stone formation above 2.5, whereas the odds ratio of a positive family history was 0.38. Hyperuricosuria, hyperoxaluria and a low urinary volume did not influence the risk for active stone formation. Conclusion: The risk profile for active stone formation differs from the risk profile for urolithiasis in general. Metabolic evaluation and determination of those risk factors in patients with urolithiasis might improve the estimation of the risk of future stone formation. [ABSTRACT FROM AUTHOR]

Cystinuria, an autosomal-recessive disorder of a renal tubular amino acid transporter, is the cause of about 10% of all kidney stones observed in children. Different genetic characteristics are not represented by different phenotypes. The stones are formed of cystine, which is relatively insoluble at the physiological pH of urine. Without any preventive measures, the patients will suffer from recurrent stone formation throughout their life. Even with medical management, long-term outcome is poor due to insufficient efficacy and low patient compliance. Many patients suffer from renal insufficiency as a result of recurrent stone formation and repeated interventions. However, regular follow-up and optimal pharmacotherapy significantly increase stone-free intervals. Medical management is mainly based on hyperhydration and urine alkalinization. Sulfhydryl agents such as tiopronin can be added. Recurrent stone formation necessitates repeated urological interventions. These mostly minimally invasive procedures carry the risk of impairment of renal function. In adults, extracorporeal shockwave lithotripsy (SWL) as well as intracorporeal lithotripsy is often unsuccessful. However, in children SWL shows excellent results for cystine stones. In cases with large stone burden, percutaneous nephrolithotripsy (PNL) or even open surgical nephrolithotomy are preferred. This review discusses the underlying pathogenetic mechanisms and provides guidance for the diagnosis, therapy, and management of cystinuria following the recommendations of the International Cystinuria Consortium and the European Association of Urology. [ABSTRACT FROM AUTHOR]

The aetiology of stones in children differs from that in adults. Young children, especially boys, are prone to infective stones, although this type of calculi is decreasing in frequency over time in prosperous countries. Two monogenic causes, cystinuria and hyperoxaluria, each account for 5-15% of paediatric stones. Increased factors for stone formation in children include prematurity, neurological problems, ketogenic diet and reconstructed or augmented bladders. Hypercalciuria is commonly found in paediatric stone formers, is usually idiopathic and is only rarely associated with hypercalcaemia. All children with stones should undergo a metabolic evaluation. [ABSTRACT FROM AUTHOR]

Objective: The implementation of preventive clinical actions in Primary Care would allow to act on the high incidence of urolithiasis and the correctable risk factors. This pilot study compared a systematic follow-up (SFU) versus a regular follow-up (RFU) in terms of feasibility, safety and clinical outcomes., Materials and Methods: We conducted a multicentric and controlled pilot study in 30 patients comparing SFU versus RFU. Patients followed allocation concealment by an independent blocked computer-generated list. We defined "success" if feasibility objectives were matched including recruitment rate, follow-up compliance, completion and staff resources. Clinic variables (pain and fever), analytics (blood and urine) and image techniques (echography and radiography) were recorded at 10, 45 and 90 days in SFU and at 3 months in RFU. The SFU group received nutritional and analgesic recommendations. Preliminary clinical outcomes were compared and complications were recorded in each group., Results: The feasibility objectives were matched as follows: 94.1% of recruitment rate, 5.9% refused to participate, 10 patients/month were recruited, 93.1% of follow-up compliance and 90% of completion. No clinical differences were found between groups. There was a recurrence in the RFU group., Conclusions: The feasibility objectives were matched except those related to human resources. Clinical outcomes did not favour any group or contraindicate the development of a future clinical trial., (Copyright © 2022 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Despite being recommended by most guidelines, the metabolic evaluation of patients with nephrolithiasis has limited diffusion due to difficulties relating both to the access to laboratory investigations and to urine collection modalities. Consequently, in addition to the classical 24-h collection, alternative and simplified collection modes have been proposed. We report here on the comparison between metabolic evaluation carried out on 24-h double collection (Lithotest) and overnight spot urines (RF test). Fifty-four patients with stone disease were enrolled, excluding patients with infection or cystine stones. For Lithotest, we measured all analytes necessary to calculate state of saturation (ß) with calcium oxalate, brushite and uric acid, by means of Lithorisk.com. For RF, we measured calcium, magnesium, oxalate, citrate, sulphate, phosphate, pH and creatinine. The comparison was made with creatinine ratios. An estimate of ßCaOx, ßbrushite and ßAU was obtained also on RF urines by using simplified algorithms. We found highly significant correlations between all parameters, despite quite different means. There was a nice correspondence between the two sets of measurements, assessed by the Bland-Altmann test, for calcium, oxalate, citrate, sulphate, urate and pH. Overnight urine had higher saturations compared to 24-h one owing to higher concentration of the former. In conclusion, RF test on overnight urine cannot completely replace Lithotest on 24-hr urine. However, it can represent a simplified tool for either preliminary evaluation or follow-up of patients with stone disease., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Most human urinary stones are calcium-based and are often associated with hypercalciuria. A simple test described in 1975 by Pak et al allows for pathogenic classification of hypercalciuria: the calcium load test (CLT). The CLT explores calcium homeostasis after a low-calcium diet and then a calcium load (typically oral administration of 1 g of elemental calcium). Only simple laboratory equipment is required. Inadequate calcium excretion after a calcium-free diet or a calcium load is suggestive of resorptive or absorptive hypercalciuria, respectively. The CLT is particularly valuable in diagnosing primary hyperparathyroidism, even in most early stages of this disease. PATIENT SUMMARY: Kidney stone formation can be linked to calcium metabolism. When high calcium levels are found in urine despite adequate diet changes, a calcium load test may help to understand the underlying mechanisms. Urine and blood levels are explored during a low-calcium diet phase, and after a calcium load phase in the test. The calcium load test is particularly advantageous for revealing abnormally high function of the parathyroid gland, which is called hyperparathyroidism., (Copyright © 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Objective: To establish the metabolic evaluation database of urolithiasis, perform metabolic evaluation, and provide instructions for treatment and prevention of urolithiasis. Methods: This metabolic evaluation database was developed by JAVA and was established by Oracle11g database and Browser/Server framework. We extracted the clinical data of all patients who had complete information, and analyzed their risk factors of stone formation, stone-related medical history, blood and urine tests results and 24-hour urine analysis. Results: A total of 360 patients diagnosed as urolithiasis were included in this research. Male to female ratio was 1.9∶1, and the urolithiasis was first diagnosed at (35.5±13.5) years old. Family history was positive in 39.7% of patients. Metabolic syndrome occurred in 35.0% of patients. Overweight or obesity occurred in 73.2% and 50.0% of male patients, respectively. Abdominal obesity in 62.3% and 56.1% of male and female patients, respectively. Among all patients, 67.5% had high urine sodium, 53.6% had hypercalciuria, 41.1% had hypocitraturia, 29.7% had hyperuricosuria, 22.5% had hypomagnesuria, 15.8% had hyperoxaluria, 11.7% had hyperphosphoraturia, and 36.4% had low urinary volume. Conclusions: The prevalence of overweight or obesity, abdominal obesity, hypertension, diabetes, and metabolic syndrome in stone patients were significantly higher than those in general population. The number of 24-hour urinary abnormalities was positively associated with body mass index. The interventions on high urinary sodium, low urinary volume, obesity and metabolic syndrome were important to the treatment of urolithiasis. This database would facilitate the metabolic evaluation, provide evidence for the treatment and prevention of urolithiasis, and lay foundation for finding important controllable risk factors of urinary stone.

Staghorn renal calculi are large renal calculi that occupy nearly the entirety of the renal collecting system. They may be composed of metabolic or infection stone types. They are often associated with specific metabolic defects. Infection stones are associated with urease-producing bacterial urinary tract infections. The ideal treatment for staghorn calculi is maximal surgical removal. However, some patients are either unwilling or unable to proceed with that modality of treatment, and therefore other management must be used. One such technique is the metabolic evaluation with directed medical management. Based on contemporary evidence that the majority of staghorn stones are metabolic in etiology, and furthermore that even infection stones are usually associated with metabolic abnormalities, metabolic evaluation with directed medical management is recommended for all staghorn stone formers. The scientific basis of this recommendation is reviewed in the present work., Competing Interests: The authors declare no conflict of interest., (© 2020 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V.)

Introduction: Metabolic abnormalities are one of the most important risk factors for urinary stone disease. Our objective was to determine the prevalence of metabolic abnormalities in patients referred to the urolithiasis outpatient clinic of a tertiary centre., Material and Methods: We performed a cross-sectional study evaluating 67 patients referred to the urolithiasis outpatient clinic. Metabolic evaluation was performed, including one 24-hour urine sample., Results: Metabolic abnormalities could be identified in 92.5% patients. Almost a quarter of the patients had only one metabolic abnormality and 67.6% had more than one abnormality. The most prevalent metabolic abnormalities were hypercalciuria (54.5%), hyperoxaluria (34.7%) and hyperuricosuria (32.3%). Patients with hypercalciuria were older (54.7 vs. 47.8 years, p = 0.018) and family history of stone disease was significantly more frequent among patients with hyperoxaluria (71.4% vs. 28.6%, p = 0.013). There was a positive linear relationship between body mass index (BMI) and urinary calcium (r = 0.247, p = 0.048) and a negative linear relationship between BMI and urinary pH (r = -0.254, p = 0.046)., Conclusions: Given the high prevalence of metabolic abnormalities, metabolic evaluation should be performed in every patient with urolithiasis evaluated in a tertiary setting., Competing Interests: The authors declare no conflicts of interest., (Copyright by Polish Urological Association.)

Considering the variation in metabolic evaluation and medical management of kidney stone disease, this consensus review was created to discuss the metabolic activity of nephrolithiasis, define the difference between single and recurrent stone formers, and develop a schema for metabolic and radiologic follow-up. A systematic review of the literature was performed to identify studies of metabolic evaluation and follow-up of patients with nephrolithiasis. Both single and recurrent stone formers share many similarities in metabolic profiles. The study group determined that based on an assessment of risk for stone recurrence and metabolic activity, single and recurrent stone formers should be evaluated comprehensively, including two 24 h urine studies on a random diet. Targeted medication and dietary recommendations are effective for many patients in reducing the risk of stone recurrence. Follow-up of those with stone disease should be obtained depending on the level of metabolic activity of the patient, the risk of chronic kidney disease and the risk of osteoporosis/osteopenia. A standard scheme includes a baseline metabolic profile, a repeat study 3-6 months after initiation of treatment, and then yearly when stable, with abdominal imaging obtained every 1-2 years.

Background: Pancreaticoduodenectomy represents the major treatment for pancreatic and periampullary neoplasms. Complications related to pancreaticojejunostomy are still the leading cause of morbidity and mortality. A solution proposed by some surgeons is the occlusion of main pancreatic duct by acrylic glue, avoiding pancreaticojejunostomy. Nevertheless, the consequences of this procedure on glucose metabolism are not well-defined., Methods: We retrospectively analyzed a cohort of 50 patients who underwent pancreaticoduodenectomy and had metabolic assessments available. The metabolic evaluation included the following: body composition and clinical evaluation, an oral glucose tolerance test, and an hyperinsulinemic euglycemic clamp procedure., Results: Twenty-three patients underwent pancreatic duct occlusion and were compared with 27 patients, well-matched controls, who underwent pancreaticojejunostomy. Pancreatic duct occlusion leads to a greater impairment in insulin secretion compared with classic pancreaticojeunostomy., Conclusion: Pancreatic duct occlusion is associated with a greater reduction in insulin secretion but does not lead to meaningful differences in the management of patients with diabetes., (Copyright © 2015 Elsevier Inc. All rights reserved.)

This text summarizes the CLAFU first-line screening guidelines for renal stone disease patients. We have focused on the useful information provided by renal stone analysis and also the identification of relevant stone risk factors detected in a 24-hour urine collection. Indeed, evaluation of water, sodium and protein intake may be easily achieved in a current clinical setting and allows a useful pedagogic tool for patients' advices and follow-up: daily diuresis above 2000 mL, calcium intake between 800 mg and 1 g/day, a moderate daily sodium and proteins restricted diet (<9 g and <1.2 g/kg per day respectively). General therapeutical principles are reviewed, including circumstances requiring specialized management., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Metabolic abnormalities are identified in over 90% of stone formers and the institution of preventative dietary and medical measures has resulted in substantial reduction in stone recurrence rates. We review the contemporary approach to metabolic evaluation of urolithiasis. A careful medical and dietary history, stone analysis, serologic tests, and urinalysis constitute the initial screening regimen in patients who have been diagnosed with stones. Risk stratification of patients, based on the outcome of the initial screening tests, determines the need for and extent of urinary evaluation in individual stone formers. Conservative dietary measures or a simple metabolic evaluation and treatment has been described for first-time or low-risk stone formers, although the number of 24-h urine collections needed is debatable. A more extensive metabolic evaluation is recommended for recurrent or high-risk stone formers or for those in whom empiric treatment or medical therapy based on simplified evaluation is unsuccessful. Regardless of etiology, all stone formers should be counseled on dietary measures for stone prevention. The need for medication is determined by the results of 24-h urine analysis and the risk level of the patient. Cost effectiveness of the metabolic evaluation and treatment is strongly influenced by recurrence rate and efficacy of therapy. Metabolic evaluation and treatment has clearly been shown in randomized trials to reduce stone recurrence rates. Further study will determine the extent of evaluation necessary and the need for selective vs. empiric medical therapy for first-time and recurrent stone formers.