Search

Although metabolic syndrome and its individual components have been associated with kidney stone disease, whether the clustering of metabolic syndrome traits increases the severity of kidney stone disease has not been examined in a large-scale study.Cross-sectional analysis.Data were obtained from 30,448 patients enrolled in the 6th Nationwide Survey on Urolithiasis in Japan conducted in 2005. Patients with lower urinary tract stones, struvite stones, cystine stones, or hyperparathyroidism and those younger than 15 years were excluded.Number of metabolic syndrome traits (obesity [body mass index ≥25 kg/m(2)], diabetes, hypertension, and dyslipidemia).Severe form of kidney stone disease, defined as recurrent and/or multiple stones, and abnormalities in urine constituents (hypercalciuria, hyperuricosuria, hyperoxaluria, and hypocitraturia).11,555 patients were included in the final analyses. Proportions of patients with recurrent and/or multiple stones were 57.7%, 61.7%, 65.2%, 69.3%, and 73.3% with 0, 1, 2, 3, and 4 metabolic syndrome traits, respectively (P0.001). There was a significant and stepwise increase in the odds of recurrent and/or multiple stones after adjustment for age and sex. In patients with 4 metabolic syndrome traits, the odds was 1.8-fold greater compared with patients with 0 traits (OR, 1.78; 95% CI, 1.22-2.66). In addition, the presence of metabolic syndrome traits was associated with significantly increased odds of having hypercalciuria, hyperuricosuria, hyperoxaluria, and hypocitraturia after adjustment for age and sex.Cross-sectional design, absence of dietary data, ill-defined diagnostic criteria for metabolic syndrome traits, and missing data for the majority of participants.Metabolic syndrome trait clustering is associated with greater severity of kidney stone disease; increased urinary calcium, uric acid, and oxalate excretion; and decreased urinary citrate excretion. These results suggest that kidney stone disease should be regarded as a systemic disorder linked to metabolic syndrome.

OBJECTIVE To examine the responses of renal fibroblasts to high oxalate (Ox) and calcium Ox (CaOx) crystals, as the latter are found in the renal interstitium of patients with primary or enteric hyperoxaluria, and in animals with experimental CaOx nephrolithiasis, and are associated with tubulointerstitial inflammation (TI). TI might begin with the production of chemoattractants by the renal epithelial cells exposed to high Ox and/or CaOx crystals; as Ox levels are also high in the renal interstitium and crystal deposition in nephrolithiasis might start in the interstitium, we hypothesized that renal fibroblasts might also be involved in the development of TI. MATERIALS AND METHODS We exposed renal fibroblast cells of line NRK 49F in vitro to Ox ions (500 µmol/L) or CaOx monohydrate crystals (67 µg/cm2). We assessed the production of osteopontin and monocyte chemoattractant protein-1 (MCP-1), and expression of their mRNA, in the cells. We also determined the cellular malondialdehyde content as a marker of reactive oxygen species (ROS)-induced lipid peroxidation, and Trypan blue staining and the release of lactate dehydrogenase as markers of injury. RESULTS Similar to renal epithelial cells, renal fibroblasts were stimulated by exposure to Ox and CaOx crystals. They showed signs of injury and ROS-induced lipid peroxidation. The mRNA expression and production of osteopontin and MCP-1 increased significantly. CONCLUSIONS These results indicate that fibroblasts respond to high Ox and CaOx crystals by up-regulating specific pathways producing pro-inflammatory conditions. Migration of monocytes/macrophages to sites of interstitial crystal deposits can lead to localized interstitial inflammation and fibrosis.

Maxacalcitol, the 22-oxa-derivative of 1α,25-dihydroxyvitamin D3 and used currently as an antihyperparathyroidism and antipsoriatic drug, has been synthesized in seven chemical steps from 1α-hydroxydehydroepiandrosterone on the basis of our previously developed route. The present synthesis allows the production of the protected form of the penultimate intermediate in 26% overall yield in a kilogram scale reaction employing neither difficult reaction conditions nor chromatographic purification, having overcome all the difficulties involved in the previous route.

PURPOSE We examined whether there would be any inhibitive effect to the crystal formation in ethylene glycol treated rat kidney by angiotensin II type I receptor blocker (candesartan). METHODS We divided 10-weeks-old male Sprague-Dawley rats into 4 groups. In these groups, rats were given tap water (group A), 1.0% ethylene glycol (group B), 1.0% ethylene glycol and 20 microg/ml candesartan (group C), 20 microg/ml candesartan (group D) for 4 weeks. Immunohistochemical studies of a renal tissue was performed by ED1 antibody and the osteopontin antibody, the transcription of renin, angiotensin converting enzyme, angiotensin II and osteopontin mRNA in whole kidney was determined using real time PCR and malondialdehyde level was measured. Renal tissue was evaluated using H.E. stain for counting the calcium deposit in the renal tubules. Calcium concentrations in whole kidney were measured with an atomic absorption spectrophotometer. RESULTS Although there is no significant difference urinary oxalate and calcium levels compared with group B and C, group C showed fewer the numbers of calcium deposit in the tubules and decreased the amount of calcium contained in the whole kidney, ED1 positive cells, osteopontine mRNA expression and malondialdehyde level. CONCLUSION These results suggest that candesartan inhibited superfluously induced osteopontin in the whole kidney by ethylene glycol and crystal formation was also related decreased.

Objective: We evaluated whether osteopontin (OPN) and other proteins with the RGD sequence as in OPN (RGD family proteins) that are present in renal tubular cells (fibronectin [FN], Tamm–Horsfall glycoprotein [THP], vitronectin [VN], and laminin [LN]) inhibit the aggregation and growth of calcium oxalate (CaOx) crystals by a novel seed crystal method using collagen granules (CG) with and without OPN adhered on the surface. We also evaluated the effect of solid phase OPN, FN and THP in which the relationship between their proteins and CaOx crystallization was reported. Moreover, the state and time-course changes in CaOx crystals adhered to CG were observed under scanning electron microscopy (SEM). Methods: The inhibitory activity (IA) on the aggregation and growth of CaOx crystals was measured in vitro by the conventional seed crystal method using isotopes. In this study, the following nine samples were used: OPN alone; FN alone; THP alone; VN alone; LN alone; CG alone; and CG with OPN, FN, or THP adhered on the surface (OPN/FN/THP-immobilized CG). In addition, the state and time-course changes in CaOx crystals adhered to CG were evaluated by SEM. Results: Using the conventional seed crystal method, the following values of IA were obtained: 91.7% (37.5μg/ml) for OPN, 5.0% (100μg/ml) for FN, 2.0% (100μg/ml) for THP, 3.0% (100μg/ml) for VN, and 1.0% (100μg/ml) for LN. However, the value of IA obtained by our seed crystal method using CG was 92.1% (180cm 2 /5ml PBS) when CG alone was used. Although the value of IA was decreased by 33.6% when OPN-immobilized CG was used, it did not significantly change when FN/THP-immobilized CG was used. When CG alone was used, the evaluation of CaOx crystallization by SEM demonstrated mild adherence and aggregation of CaOx crystal suspension (seed crystals) on the CG surface, although newly formed crystals only slightly adhered to the CG surface. When OPN-immobilized CG was used, marked adherence and aggregation of seed crystals were observed, in addition to the relatively increased adherence of newly formed crystals. When FN/THP-immobilized CG was used, newly formed crystals only slightly adhered to the CG surface, although the degree of seed crystal adherence and aggregation did not significantly change. Conclusions: These findings suggest that the immobilization of OPN to the CG surface enhances the adherence and aggregation of seed crystals, as well as enhancing the adherence of newly formed crystals, resulting in decreased IA of CG (overall promotion of crystal deposition). Therefore, the results of this study clarified that OPN enhances the formation and aggregation of CaOx crystals in this experimental system.

We report three cases of proliferative cystitis causing hydronephrosis. Three patients presented with a complaint of miction pain, gross hematuria or pollikisuria. Cystoscopic findings revealed papillary sessile tumor from neck to orifice. Transurethral resection of the bladder tumor (TURBT) was performed because the tumor was not responsive to medical treatment. The pathological diagnosis was intestinal type or typical type of cystitis glandularis and no malignant cells were observed. After the operation, although hydronephrosis improved in two cases, the left hydronephrosis did not improve in one case and ureteralileostomy was performed. Five year after the last operation, there is no evidence of recurrence of the tumor. Tumor formation arising from proliferative cystitis is relatively rare. Pathogenesis and management of this rare condition are discussed.

The low incidence of atherosclerosis and other degenerative disease, including urolithiasis, in the Greenland Eskimo has been attributed to their high consumption of oily fish with its high concentration of eicosapentaenoic acid (EPA). With a westernized diet, the oxygenated products of renal prostaglandin synthesis are metabolites of the n-6 series and these are known to play important roles in several pathophysiological processes involved in calcium stone formation. Buck's group presented a hypothesis that the initiating factor for lithiasis triggers prostaglandin synthesis, and showed that this influenced by EPA treatment.In order to ascertain the effects of EPA on plasma lipids and urinary parameters, we undertook a clinical study whereby a highly purified preparation was administrated (1,800 mg/day) to 88 patients with urinary stones for 3 months (short term) and 18 months (long term).Hyperlipemia improved the affected individuals and urinary calcium was significantly reduced in the hypercalciuric but not in the normocalciuric group.The results suggest that EPA by reducing urinary calcium might favorably affect urine composition in a way that possibly reduces the risk of calcium stone formation.

We recently reported that osteopontin (OPN) and calprotectin (CPT) are present in the matrix of urinary calcium stones, and that OPN mRNA is expressed in the renal distal tubular cells. In the present study, we examined the immunohistochemical distributions of OPN and CPT in urinary stones. The stones used in this study were passed spontaneously from the upper urinary tract. One half of each of the stones was analyzed with an infrared spectrophotometer, and were shown to be comprised of calcium oxalate, calcium phosphate, uric acid and cystine. The other half of each stone was immersed in tetrasodium ethylenediamine-tetraacetate (EDTA) solution. The half-stones were embedded in paraffin and cut into 5-microm sections. The avidin-biotin-peroxidase complex technique was employed. A monoclonal antibody to human milk-derived OPN and a monoclonal antibody to human granulocyte-derived CPT were used as primary antibodies. The immunochemical study using the OPN and CPT antibodies showed positive staining of the matrix of the urinary calcium stones. The stones showed staining in two distinct zones: a core area was stained with randomly aggregated OPN and CPT, and peripheral layers were stained in concentric circles. On the basis of our observations, it is reasonable to presume that OPN and CPT play roles as the matrix in the structure of urinary calcium stones.

Inhibitory effects of female sex hormones on urinary stone formation in rats. Background The effects of female sex hormones on urinary stone formation are not known. This study was conducted to investigate the effects of these hormones on stone formation by using an ethylene glycol (EG) and vitamin D-induced rat urolithiasis model. Methods Adult female Wistar rats were fed the same diet for four weeks and were then divided into four groups ( N = 10 each). One group was administered 0.5 ml of olive oil three times per week for four weeks as a control. The other three groups were administered 0.5 μg of vitamin D 3 and 0.5 ml of 5% EG three times per week for four weeks. The rats in two of these three groups were oophorectomized, and the rats of the remaining group underwent a sham operation on the day before the start of the four-week treatment period. One of the two oophorectomized groups was then administered a supplementation of female sex hormones (0.1 mg of estrogen and 2.5 mg of progesterone 3 times per week for 4 weeks). On the first day of the fifth week of the experimental period, the degree of crystal deposition was determined histologically, and the calcium content in renal tissue was measured. We also investigated the level of osteopontin (OPN) mRNA in renal tissues by Northern blot analysis. OPN is a matrix protein thought to be a promoter of stone formation. Results The urinary oxalate excretion, crystal deposition and calcium content in renal tissue and the expression of OPN-mRNA were greater in the oophorectomized rats compared with the controls, and the same parameters were inhibited by the female sex hormone supplementation. Conclusions These results suggest that female sex hormones can inhibit renal crystal deposition in EG-treated rats by suppressing the urinary oxalate excretion and the expression of OPN.

The canine renal distal tubular cell line Madin-Darby canine kidney (MDCK) forms calcium phosphate microliths during a long-term culture in vitro. We identified osteopontin (OPN) and calprotectin (CPT) from a urinary stone matrix. We recently also detected the expression of OPN and CPT in MDCK cells. The relationship between the mechanism of the stone formation and these stone matrix proteins is not yet known. Here, MDCK cells were cultured and inoculated in the subcutis of nude mice. After 4, 8 and 12 weeks, the inoculated tissues were resected, fixed and immunostained with polyclonal anti-human OPN and polyclonal anti-human CPT antibodies. Some serial specimens were stained with von Kossa's procedure. MDCK cells formed some follicular formations in the subcutis of nude mice at least at 12 weeks after transplantation. At 8 weeks after the inoculation, we detected small calcium phosphate stones with MDCK cells trapped in the follicles. The cells forming the stones also expressed both OPN and CPT. The CPT expression sites coincided with the stone formation sites. We confirmed that MDCK cells inoculated in nude mice had stone-forming potential, and we speculate that OPN and CPT play important roles in stone formation by MDCK cells.

Kampo medicine is a traditional Japanese therapeutic system which originated in China and was used to treat various diseases for hundreds of years. Kampo medicine had been also used for the cure and the prevention of urinary calculi for many years, but the effect and the mechanism of this use of kampo medicine are unclear. We examined the inhibitory effect of the kampo medicine takusha on the formation of calcium oxalate renal stones induced by ethylene glycol (EG) and vitamin D3 in rats. We also investigated the effect of takusha on osteopontin (OPN) expression, which we previously identified as an important stone matrix protein. The control group rats were non-treated; the stone group rats were administered EG and vitamin D3, and the takusha group was administered takusha in addition to EG and vitamin D3. The rate of renal stone formation was lower in the takusha group than in the stone group; thus, the OPN expression in the takusha group was smaller than in the stone group. Takusha was effective in preventing oxalate calculi formation and OPN expression in rats. These findings suggest that takusha prevents stone formation including not only calcium oxalate aggregation but also proliferation.

We recently reported that the addition of the protein osteopontin (OPN) resulted in an increase in the deposition of calcium oxalate (CaOx) crystals on the surface of Madin Darby canine kidney (MDCK) cells. To determine the degree to which this increased deposition is caused by OPN, we investigated the extent to which the CaOx crystal deposition produced by the expression of OPN at the cell surface was suppressed by 4 different methods prior to the determination of the level of CaOx crystal binding. MDCK cells (2 × 106 cells/well) were cultured to a confluent state, and the binding of OPN to the cellular surface was then inhibited by adding one of the following 4 substances: human OPN polyclonal antibody, thrombin, cyclic Arg-Gly-Asp (RGD) peptides and tunicamycin. The cells were cultured for 24 h. We then used a fluorescent antibody technique with an OPN polyclonal antibody to determined whether the expression of OPN at the cell surface was inhibited, and we measured the degree of CaOx crystal deposition using the isotope 45Ca. The degree of CaOx crystal deposition was inhibited by 80% or more in the antibody-treated group, by 50–80% in the thrombin-treated group, by 60–80% in the cyclic RGD-treated group, and by 50–60% in the tunicamycin-treated group. These results suggest that OPN in the extracellular matrix is the main cause of CaOx crystal deposition on the surface of MDCK cells.

Background This study investigated the feasibility and long term results of retrograde endopyelotomy with the Acucise ureteral cutting balloon device in the management of ureteropelvic junction (UPJ) obstruction. Methods Thirteen patients (primary: 12, secondary: 1, male: 7, female: 6, mean age: 36) with UPJ obstruction were treated by the Acucise under fluoroscopic guidance. After cutting the stenotic area electrically using cutting wire and dilatation by the balloon, ureteral catheter (7-14 Fr) was inserted for 6-8 weeks. Results The mean operative time was 43 minutes, the median postoperative hospital stay was 4 days. The subjective success rate (disappearance of the abdominal pain) was 92% (11/12) and the objective success rate evaluated by radiographic studies was 62% (8/13). One patient needed a transfusion but no other major complication occurred in the treatment. The failure 5 patients were now under conservative follow up. Conclusion Our limited data suggest that endopyelotomy with the Acucise device offer lower morbidity with slightly lower success rate compared other endopyelotomies. We believe that Acucise endopyelotomy can be an appropriate one of the first-line therapy for UPJO.

It has been reported that osteopontin (OPN) plays an important role during urolithiasis as well as bone formation. Generation of stones in the urinary tract may be associated with osteoporosis and bisphosphonates are potent inhibitors of bone resorption, being used with effect in the management of bone disease. We therefore investigated the relationship between alendronate, a bisphosphonate derivative, and OPN expression in the kidney. Alendronate was administered to rats made hypercalcemic by treatment with parathyroid hormone-related peptide (PTHrP). The renal expression of OPN was then evaluated at both protein and mRNA levels. OPN expression was enhanced in the distal tubular cells of hypercalcemic rats and was decreased by alendronate. The observed inhibition of OPN expression suggests an ability of alendronate and other bisphosphonates to act as inhibitors of stone formation in the urinary tract.

PURPOSE: The aim of the present study was to compare sialic acid concentrations of serum and urine specimens in both calcium (Ca)-containing urinary stone formers and non-stone formers. Moreover, we studied inhibitory activity of sialic acid upon the calcium oxalate (CaOx) crystal aggregation and growth. MATERIALS AND METHODS: Sialic acid determinations were done on fresh serum and urine samples of 35 Ca-containing urinary stone formers (stone formers group) and 20 non-stone formers (patient controls group). Inhibitory activity of sialic acid upon the CaOx crystal aggregation and growth was studied by using in vitro assay method of seed crystal system. RESULTS: Serum sialic acid concentrations were found to be similar in the two groups. Urinary sialic acid concentrations were significantly lower in the urine specimens of stone formers than in their patient controls. Sialic acid showed a dose dependent inhibitory activity upon the CaOx crystal aggregation and growth into seed crystal method. CONCLUSION: It is suggested that urinary sialic acid may play some role during the phase of stone formation from the results of the present study, because sialic acid shows marked inhibitory activity upon the CaOx crystal aggregation and growth at concentrations higher than 100 mg/dl.

Urolithiasis is a common nephrologic disorder with an increasing prevalence, probably attributable to lifestyle factors such as diet and obesity. A nationwide survey of urolithiasis in Japan conducted in 2005 showed a steady increase in the number of urolithiasis cases, and the associated life-long risk was estimated to be 15.1% in men and 6.8% in women. Because urolithiasis is a complex disease, an understanding of the epidemiology, particularly of the interactions among different factors, may facilitate the development of measures to reduce the risk of stone formation. In this article, we describe the epidemiologic data and related topics from a nationwide survey in Japan and other studies.

BACKGROUND The indications and suitable operative time of parathyroidectomy for secondary hyperparathyroidism were discussed. METHODS From October 1978 to September 1994 parathyroidectomy was performed for 71 patients who had bone and/or joint pain due to secondary hyperparathyroidism. There were 37 men and 34 women (mean age 48.4 years). The duration of dialysis treatment before parathyroidectomy was 0.8 to 19 years, with a mean of 10.9 years. RESULTS Postoperative subjective improvement was noted in 69% of the patients. No significant difference was observed between the improved and non-improved groups regarding age and the duration of dialysis treatment. But the improvement rate in female patients was significantly lower than that in male patients. CONCLUSION Patients with high carboxyl-terminal PTH level and generalized fibrous osteitis were good suitable objects for parathyroidectomy. But, those with high serum aluminum level were unsuitable objects for it. Furthermore, 99mTc-Pyrophosphate bone scintigraphy and bone mineral determination using dual photon absorptiometry (DPA) or dual energy X-ray absorptiometry (DEXA) were proved to be valuable for patient selection for parathyroidectomy.

Three patients with invasive bladder cancer and concomitant carcinoma in situ were treated sequentially with chemoradiotherapy followed by BCG intravesical infusion therapy to preserve the bladder. Local complete response was achieved in all patients, although lymph node metastasis was noted in one patient. The multimodality therapy could be safely administered without acute or late complications, including decreased bladder capacity.

The chemical nature of urinary stone protein is poorly understood. We have sequenced a cDNA of urinary calcium oxalate stone protein extracted with EDTA. cDNA sequences showed complete identity between urinary stone protein and human osteopontin. Osteopontin protein was detected by staining with Stains-All, which specifically stains phosphoproteins, and by digestion with the highly specific protease thrombin, demonstrating that urinary calcium oxalate stones consist of osteopontin protein. We used a technique of in situ hybridization to detect osteopontin mRNA in the kidney. In control rats, distal tubular cells were sporadically positive, and proximal tubular cells and glomeruli were negative for osteopontin mRNA. A rat model of stone formation was induced with glyoxylic acid. In stone-forming rats, staining of distal tubular cells was remarkably increased, but proximal tubular cells and glomeruli were still negative. Immunostaining for the osteopontin protein also revealed that epithelial cells of distal tubules were weakly positive in control rats and significantly increased in stone-forming rats, although proximal tubular cells and glomeruli were negative. Northern blot analysis showed a significant increase of osteopontin mRNA in stone-forming rats in proportion to the dosage and the duration of the stone-inducing drugs. These results show that osteopontin in the kidney is presumably involved in urinary stone formation as the stone matrix.

The calciuric response and the changes of plasma glucose and insulin produced by a 75-gram oral glucose tolerance test were determined in 27 male patients with idiopathic calcium renal stones (6 with dietary hypercalciuria, 5 with nondietary hypercalciuria and 16 with normocalciuria) and 22 healthy male subjects. The subjects were classified as obese (or = 120% ideal weight) and nonobese. The incidence of an abnormal response to glucose loading was similar in the stone patients and the healthy subjects. In addition, the plasma glucose and insulin levels after oral glucose load did not differ between the stone patients and control subjects and were affected by the individual degree of obesity. Urinary calcium excretion increased significantly after glucose ingestion in both the stone patients and the control subjects. Urinary calcium excretion was greater in the stone patients than in the control subjects due to the presence of patients with nondietary hypercalciuria, and the increment in urinary calcium excretion in the dietary hypercalciuric and normocalciuric stone patients was indistinguishable from that in the control subjects. The degree of obesity did not affect the increment in urinary calcium excretion. These results suggest that overconsumption of refined carbohydrates such as sugar-sweetened soft drinks, soda and cakes may be a risk factor for stone formation, especially in the patients with nondietary hypercalciuria.

We report a 21-year-old woman,who presented with a major complaint of urinary incontinence without dry time. On the basis of computed tomographic examination and vaginography,she was diagnosed as having a hypoplastic left kidney with a solitary ectopic ureteral opening on the left. Transcatheter arterial embolization of the renal artery using anhydrous ethanol was conducted for renal ablation. No postoperative complications were noted,and the symptoms of urinary incontinence were eliminated. Embolization of the renal artery for ablation of a hypoplastic kidney with symptoms can be achieved without laparotomy while causing little stress and few complications,with an outcome comparable to surgical nephrectomy. This procedure is expected to be adopted as a standard therapeutic modality in the future.

The patient, a 67-year-old man, initially visited another institution with asymptomatic macroscopic hematuria as the major complaint. Since imaging revealed a tumor occupying the left kidney, he was referred to our hospital. Computed tomography (CT) was suggestive of a tumor involving the renal pelvis that had infiltrated the renal parenchyma. The patient was scheduled for surgery, which was postponed when pre-operative CT indicated a reduction in the tumor size, leading to a subsequent diagnosis of xanthogranulomatous pyelonephritis. Surgery was eventually conducted to address complaints such as persistent hematuria. The pathological diagnosis was infiltrating transitional cell carcinoma of the kidney. Urinary cytodiagnoses were class II-III throughout the observation period.

An 84-year-old man underwent transurethral resection of the prostate (TURP) with a diagnosis of prostatic hypertrophy at the age of 78. He had a moderately high prostate specific antigen (PSA) level of 4.5 ng/ml before TURP, but without pathological malignancy. Following surgery, his PSA level dropped to 1.7 ng/ml and the patient recovered almost completely. Four years later, however, he underwent a reexamination due to diminished urinary flow. His PSA at that time was 5.2 ng/ml, continuing to rise slowly thereafter. Six years following surgery, his PSA reached 13.7 ng/ml, and the diffusion-weighted image on magnetic resonance imaging showed a high intensity area in the prostatic portion of the urethra. A poorly differentiated adenocarcinoma was detected in TUR-derived tissue fragments of the tumor protruding from the prostate. Tissue obtained via a systematic needle biopsy showed no signs of malignancy. Hormonal therapy was introduced. Five months later, the PSA level fell to 0.130 ng/ml ; the patient is now in clinical follow-up.

Pathogenesis of urolithiasis cannot be explained only by metabolic disorder. In the present study, morphologic differences of the renal pelvic-caliceal system (PCS) were examined on both the stone and normal sides in calcium-containing stone formers. The results indicated that as compared to the normal side, the urine flow in the PCS was stagnant or not straight on the stone side even in the same individual, showing unfavorable conditions for stone formation. It is therefore considered that morphologic disorders of the urinary tract may be one of the causes for stone formation.

A 82-year-old man was referred to our hospital with a chief complaint of macrohematuria and pollakisuria. Cystoscopy showed an abnormal mucosa on the right wall. We suspected carcinoma in situ but two months after cystoscopy showed a non-papillary and sessile tumor with calcification. We performed transurethral resection of the bladder tumor, muscle layer and adipose tissue. Histopathological findings revealed small cell carcinoma of the bladder infiltrating the externaladipose tissue. As postoperative adjuvant therapy, chemotherapy (cisplatin total 150 mg) was performed with 40 Gy of extra beam radiotherapy to the bladder. After chemotherapy and radiotherapy,urinary cytology was negative and cystoscopy showed the scar. Follow up magnetic resonance imaging revealed disappearance of the bladder tumor.

The aims of this study were to define the relationships between prostate-specific antigen (PSA) and alpha 1-adrenergic receptor antagonist (alpha 1 blocker). A prospective clinical study of 48 male patients examined between May 2004 and December 2007 was performed. 4.0-9.9 ng/ml PSA level who had no notable clinical findings of urinary retention, urinary tract infections and prostate cancer (PC) received tamusulosin 0.2 mg once daily for 3 months, and then received prostate biopsy. We divided the patients into two groups: PC and benign prostate hyperplasia (BPH)/lower urinary tract symptom (LUTS) group. In total, the PSA level showed no significant change after treatment. In the PC group, PSA significantly increased after treatment. However, PSA decreased in the BPH/LUTS group. The alpha 1 blocker significantly improved urination status (the subjective symptoms and urodynamics parameters) in the BPH/LUTS group. In two groups, prostate volume showed no significant difference. Among those patients in the BPH/LUTS group, their urination status was significantly improved with alpha 1 blocker and their PSA level dropped slightly. On the other hand, the PSA level was significantly increased in the PC group. This study shows that by using an alpha 1 blocker, it may be possible to avoid conducting the prostate biopsy at an early stage or indeed one may not be needed at all for patients with only slight increases in PSA.

The relationship between the degree of metabolic acidosis and calcium phosphate stone formation was studied. Furthermore, the reasons why renal tubular acidosis (RTA) and primary hyperparathyroidism (PHPT) dominantly occur in women, and female stone formers more often produce calcium phosphate stone are discussed. Blood was slightly more acidotic in women than in men in both the urolithiasis and the control groups. Likewise, blood was significantly more acidotic and urinary pH significantly higher in patients with PHPT. Patients with RTA had severe metabolic acidosis, and urinary pH was highest among all groups. Calcium phosphate concentration was significantly higher in women than in men, and was also higher in patients with PHPT than in those with urolithiasis. All patients with RTA had pure calcium phosphate stones. The reasons why females are more acidotic and have more calcium phosphate in stones are suspected to be related to progesterone and urinary tract infection.

A patient with testicular cancer (non-seminoma, stage IIB) who had undergone resection for primary disease and retroperitoneal lymph node dissection as well as chemotherapy and radiotherapy 6 years before developed iatrogenic retrograde ejaculation. The infertility was treated by oral medications, including herbal medicine and injections of a hormone preparation as well as artificial insemination of husband (AIH). After 24 sessions of AIH for 4 years, his spouse gave birth to a healthy baby girl. We believe that for patients with iatrogenic retrograde ejaculation AIH is an effective method of increasing fertility to be employed more often.

Presuming that complications associated with ureteral stenting vary in type and occurrence depending on the material and cross-section of the stent, six types of stents immersed in 48 different preparations of artificial urine for 1 month to observe surface changes with a scanning electron microscope. As a result, there was less encrustation on the silicone material compared with other material types, probably due to the smoothness of the surface. This may be related with higher frequency of spontaneous removal or migration to the bladder of this catheter type. Because silicone catheters have softer and thicker walls with a narrow lumen, they may be appropriate for long-term stenting, but not for urinary drainage. In alkaline bacteriuria, struvite encrustation was observed on all stents. This reaction was especially intense with Towers peripheral stents, which had most irregular and uneven surfaces. In aseptic alkaline urine, calcium phosphate crystals partly covered with proteinaceous debris were noted on catheter surfaces. Although in some patients encrustation of uric acid occurred in the bladder portion of the stents, there was no uric acid encrustation in this experimental study.

Because human urine contains various substances which can affect each other, it is quite difficult to clarify the mechanism of formation of calcium oxalate (CaOx) crystal in urine. The authors recently determined CaOx crystalline content and the concentrations of other substances in urine specimens from patients with urolithiasis and healthy volunteers, and subjected the data to multi-regressive analysis for the purpose of assessing the effect of these urinary substances on CaOx crystal formation. 1. In analysis of urine from patients with urolithiasis, the partial correlation coefficients of CaOx crystal formation with oxalic acid, sodium, calcium, uric acid magnesium were 0.67, 0.28, 0.18, and -0.10, respectively. The formula of regression was as follows: Amount of CaOx crystal (X 10(6) microns3/ml) = 3.59 X 10(-2) Ox (mM/L) + 4.72 X 10(-3) Ca (mM/L) + 4.52 X 10(-3) Na (mM/L) + 2.51 X 10(-4) UA (mM/L) -2.39 X 10(-2) Mg (mM/L) -1.65. The multiple correlation coefficient was 0.759. Thus, in patients with urolithiasis, urinary crystal formation was most dependent on the oxalic acid level, sodium, calcium, and uric acid were found to promote crystal formation, while magnesium to suppress it. 2. In analysis of urine from healthy volunteers, the partial correlation coefficients of CaOx crystal formation with oxalic acid and inorganic phosphorus were 0.51 and -0.24, respectively. The formula of regression was as follows: Amount of CaOx crystal (X 10(6) microns3/ml) = 1.91 X 10(-2) Ox (mM/L) -3.43 X 10(-4) P (mM/L) +0.29 The multiple correlation coefficient was 0.525.(ABSTRACT TRUNCATED AT 250 WORDS)

With the development of extracorporeal shock wave lithotripsy treatment, the duration of hospitalization for stone patients fortunately has become shorter. However, a detailed analysis of lithogenesis is not possible during such patients' short hospital stays. We prepared a standard diet to be eaten at home for investigation of lithogenesis at the out-patient clinic. This diet was nutritionally well-balanced and contained the following: energy: 2000 Kcal, total protein: 70-75 g, animal protein: 30-35 g, carbohydrate: 510 g, fat and oil: 50-60 g, calcium: 600-630 mg and magnesium: 320 mg. The urine of 24 male patients with stones on a free diet and the same patients after 3 days on the standard diet was analyzed for urea-nitrogen, uric acid, sodium, calcium, phosphorus, magnesium, citric acid and oxalic acid. The results were compared with those in 17 healthy male subjects who were eating the standard diet (controls). It was found that 66% of hypercalciuria (greater than = 300 mg/day) on a free diet became normocalciuria on the standard diet. The hypercalciuria was therefore thought to be of dietary origin. Moreover, urinary excretion of urea nitrogen, uric acid, sodium and phosphorus by patients remarkably decreased after 3 days on the standard diet, which was not different from that of controls. These results suggest that the standard diet at home is useful in the screening of hypercalciuria and also quite adequate for patients with stones.

Dietary and drinking habits of 277 male renal stone patients and the same number of their coworkers, who served as age- and sex-matched controls, were investigated to clarify the effects of dietary habit on stone formation. The results were compared with those for 4, 386 age-matched healthy male Japanese. We found that the stone formers had dietary habits underirable for prevention of stone formation. On the other hand, their co-workers also had more unbalanced dietary habits than the healthy Japanese, and their dietary habits were intermediate between those of the stone formers and the healthy subjects. This investigation revealed that the socio-economic conditions of both the stone formers and their co-workers may play some part in stone formation, and that their co-workers who are in a social situation similar to that of the stone formers may themselves become stone formers eventually if they continue their poor dietary habits such as unbalanced diet and over-eating. It is speculated that greater public awareness of the importance of diet habits is necessary for reducing the risk of renal stone formation.

Objectives To analyze the changes in the annual incidence and epidemiologic details of lower urinary tract stones in Japan, a nationwide survey of urolithiasis was performed. Methods Data were obtained from all patients who had been diagnosed by urologists in 2005 as having lower urinary tract stones, including both first and recurrent stones. The data were separately enumerated according to hospital size, irrespective of admission and treatment. The study included all hospitals approved by the Japanese Board of Urology and thus covered nearly all urologists practicing in Japan. The estimated annual incidence according to sex, age, and stone composition was compared with other nationwide surveys taken from 1965 to 1995. Results The incidence of lower urinary tract stones in Japan has steadily increased from 4.7/100 000 in 1965 to 9.1/100 000 in 2005. However, the age-standardized annual incidence of lower urinary tract stones in Japan decreased slightly from 5.5/100 000 in 1965 to 5.4/100 000 in 2005. The incidence of stones containing calcium has significantly increased from 50.7% to 72.0% among men and the incidence of infection-related stones has decreased significantly from 26.2% to 10.1%. The ratios of uric acid calculi in men and of infection-related stones in women increased with age. Conclusions The increased incidence of lower urinary tract stones is in slight contrast to the sudden increase in the incidence of upper urinary tract stones, which might be associated with the aging of the Japanese population.

We treated 87 patients with calcium-containing urinary stones with either allopurinol alone (44 patients) or in combination with thiazide (43 patients) and studied new stone formation before, during, and after the discontinuation of the drug therapy. The number of stones formed were 1.18, 0.24, and 0.13 before, during, and after discontinuation of the drug therapy, respectively, in the patients treated with allopurinol alone and 1.32, 0.20, and 0.09 in those treated in combination with thiazide. No differences were observed in these values and the duration of each observation period between the two groups. Decreases in the incidence of stone formation even after interruption of drug therapy suggested that recurrence-preventive effects observed following administration of these drugs include the effects of medical guidance. However, allopurinol therapy was effective in preventing recurrence in patients with hyperuricosuria.

High-performance liquid chromatography (HPLC) monitoring with an ultraviolet detector was carried out to measure urinary oxalate levels in urolithiasis. Interfering substances in urine were removed by anion exchange prior to chromatography. This procedure was found excellent with respect to sensitivity, reproducibility, and analytical recovery. The findings were in agreement with colorimetric date. The mean oxalate level in 24-hour urine was 30.5 +/- 15.1 mg in patients with a single episode and 36.3 +/- 9.8 mg in recurrent stone formers. The latter values was significantly higher than the normal control level (27.4 +/- 3.8 mg).

We retrospectively studied the effects and side effects of placing indwelling ureteral stents in 196 cases who underwent extracorporeal shock wave lithotripsy with a ureteral stent. The average period of ureteral stenting was approximately 22 days. Placing ureteral stents was mainly for large renal stones (79.3%), single kidney etc. There were no significant differences between the stunted and non-stunted patients with approximately 2 cm sized single renal stone with respect to the stone free rate, stone free period, and symptoms during stenting, which suggested that ureteral stenting might be unnecessary in those patients. High fever was highest in incidence of the symptoms and complications during stenting (17.2%). It occurred frequently in patients with infected stones or cystine stones. The percentages of pyrexia and stone street in patients using Towers type's stents were higher than those using the others. It was also shown that the bladder portions of the stents in patients using Towers peripheral ureteral stents were densely encased in calculous material and were very brittle. Fortunately the ureteral portions were removed intact. This study suggests that use of an indwelling ureteral stent may not contribute to the higher rate of being free of stones after the treatment of small to medium sized renal calculi, and that stents should be removed or changed early.

We encountered 4 patients with urolithiasis due to renal tubular acidosis (RTA) associated with Sjögren's syndrome. Laboratory results about RTA in 4 patients with Sjögrenhs syndrome were not significantly different from those in patients who suffered from urolithiasis due to RTA without Sjögren's syndrome. The incidence of urolitiasis in these cases was suspected to be higher than that in RTA patients without Sjögren's syndrome, because all 4 patients in this study had urolithiasis. When we examine patients with bilateral and multiple urolithiasis, particularly in middle-aged women, we should bear in mind that RTA and Sjögren's syndrome may exist in the background.

Factors relating alterations in plasma and urine composition to recurrence of urinary stones during drug therapy were investigated by using a multiple regression analysis technique. These factors were influenced not only by the efficacy of the drugs but also by other factors (plasma or urinary constituents and overall health of the patients, etc.). In order to study the effect of drug therapy or other treatment on the alteration of plasma and urine constituents, multiple regression analysis is more appropriate than Student's paired t-test which has been used by some workers. These two analytical methods yield different results even if used on the same data.

The effects of Glu and Asp on calcium stone formation was evaluated in three experiments. Studies using mixed suspension, mixed product removal crystallization and scanning electron microscopy showed that Glu and Asp inhibited the nucleation rate, growth rate and suspension density (crystal mass produced) in proportion to the concentration. The main amino acids in calcium oxalate stones and calcium phosphate stones were Glu and Asp. However, the main amino acids in uric acid stones were glycine and urea, and there were no specific amino acids in struvite stones. The activity of urinary GOT and GPT, which convert Asp and alanine, respectively, to Glu in normal subjects was significantly greater than in calcium stone formation.

Objectives We evaluated the epidemiological details and chronological trends of upper urinary tract stones in Japan using a nationwide survey of urolithiasis. Methods All patient visits to urologists that resulted in a diagnosis of first-episode upper urinary tract stones in 2005 were enumerated irrespective of admission and treatment. The study included all hospitals approved by the Japanese Board of Urology, thus covering nearly all urologists practicing in Japan. We compared the estimated annual incidence according to gender and age with the incidence determined from nationwide surveys between 1965 and 1995. Results The estimated annual incidence of first-episode upper urinary tract stones in 2005 was 134.0 per 100,000 (192.0 in men and 79.3 in women). The estimated age-standardized annual incidence of first-episode upper urinary tract stones in 2005 was 114.3 per 100,000 (165.1 for men and 65.1 for women), which represents a steady increase from 54.2 in 1965. The annual incidence has increased in all age groups except during the first 3 decades of life and the peak age for both men and women has also increased. Conclusions The annual incidence of upper urinary tract stones has steadily increased in Japan and this trend will continue in the near future. This probably results from improvements in clinical-diagnostic procedures, changes in nutritional and environmental factors, and general apathy toward metabolic clarification and metaphylaxis.

A 69-year-old male was admitted to the hospital with the chief complaint of left hydronephrosis and diagnosed. A year ago, he underwent sidmoidectomy to cure sigmoid colon cancer diagnosed as stage IV. Ultrasonography (US) and computed tomography (CT) detected the compression of the ureter at its middle left due to the enlargement of the left iliac lymph node and hydronephrosis and hydroureter at the proximal to the compressed part. Then, a ureteral tumor was suspected and urinary cytology was class V. Cystoscopy detected a papillary tumor projecting from the left ureteral orifice. Because the histopathological manifestation by transurethral resection of bladder tumor and that by the sidmoidectomy were consistent, it was considered that sigmoid colon cancer spread to the urinary bladder via the left ureter. There have been only 4 reported cases of adenocarcinoma that multiplied in the ureter, and this is the fifth case report.

Background: The association between hypercalciuria and bone mineral density (BMD) has been already recognized. The aim of the present study is to relate BMD to age and sex and to evaluate the calcium metabolism and hypercalciuria-defined dietary or non-dietary category in patients with urolithiasis. Methods: The BMI of the L2–L4 lumbar vertebrae was measured in 310 renal stone patients (191 men and 119 women). Percent age matched score (%AMS), which is the percent ratio of measured BMD to the mean BMD of age-matched control subjects, was utilized for the appraisal of BMD. Low BMD groups were defined by lower than 90% of %AMS. Results: Low BMD was observed in 27.7% of urinary stone patients, which was not a significant difference to that of control subjects (23.5%) who were measured in the health examination. In male patients with urolithiasis, the frequency of patients in whom BMD had been apt to decrease since youth was high, but there was not a proven significant difference among the three age groups (20–39 years old, 40–59 years old and 60 years old or older). In contrast, for female stone patients, the frequency of low BMD markedly increased in patients aged 40 years or older, when menopause occurs. Furthermore, in female stone patients with hypercalciuria, the frequency of reduced BMD reached more than 40%. When the cause was non-dietary hypercalciuria (classified mainly on the daily amount of urinary calcium excretion after ingestion of calculus test diet), the frequency of reduced BMD reached 65% (P

A 47-year-old female consulted our hospital with the chief complaints of lower abdominal pain and fever. There was a palpable mass in the lower abdomen. The patient had undergone oophorectomy by lower abdominal median incision. Ultrasonography, computed tomography, and magnetic resonance imaging (MRI) demonstrated a cystic mass above the bladder dome extending to the umbilicus, which was strongly suspected to be a urachal tumor. Enhanced T1 weighted MRI showed a mass enhanced by contrast media. Partial cystectomy with urachal resection was performed by lower abdominal median incision. The histological diagnosis was xanthogranuloma. This is the thirteenth case report of xanthogranuloma of the urachus in the Japanese literature.

A twenty-five-year-old female was admitted with lower right abdominal pain, right coxalgia and an inability to extend her right inferior limb. She had a history of tuberculosis pleurisy two years before. Abdominal ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a right retroperitoneal mass which was suspected to be an abscess or tumor. Percutaneous aspiration of the mass was followed by the administration (p.o.) of antituberculosis drugs (pyrazinamide, ethanbutol, isoniazide, refampicin). One month after initial drainage, the tube was removed but intra-cystic fluid collection was still visible a month later using CT and MRI. Therefore, a second percutaneous aspiration was followed by the instillation of streptomycin and minocycline hydrochloride. Six months after employing this therapy, no fluid collection was found.

We report a case of acute renal failure occurring about 90 days after extracorporeal shock wave lithotripsy (ESWL) for a right renal stone. On left renal needle biopsy, immunofluorescence demonstrated linear fixation of IgG and C3 along the glomerular basement membrane (GBM). Serum circulating antitype IV collagen NC1 domain antibody was detected after ESWL, while it was not detected in the serum taken before ESWL. Based on these findings, the diagnose of anti-GBM antibody-mediated glomerulonephritis was made. Circulating antibodies against several GBM components (type IV collagen NC1 domain, laminin, fibronectin and heparan sulfate proteoglycan) was consistently negative in 9 randomly selected patients who underwent ESWL for renal stones. These findings suggest that the production of these autoantibodies associated with irradiation of shock waves to the kidney was not frequent, but, after ESWL, patients deserve close follow-up.

Background: Many drugs have been utilized for the treatment of renal colic, but to date no drugs that relieve pain quickly and completely have been developed. Thus, we conducted a prospective trial to evaluate the effects of trigger point injection on renal colic. In this study, we used a local injection of lidocaine to the trigger point of patients experiencing renal colic, and evaluated the efficacy in patients using the visual analog scale. Methods: Sixty patients with renal colic were enrolled in this study and divided into two groups by a simple randomization: (i) the butylscopolamine group (n = 30, intravenous injection of butylscopolamine bromide and sulpyrine); and (ii) the lidocaine group (n = 30, local anesthesia to the trigger point with lidocaine). Results: Renal colic had disappeared completely at the end of the trigger point injection in 15/30 patients and the average time required to produce a 50% improvement in symptoms was 9 min in all patients in the group. In the lidocaine group, only one patient needed an additional anodyne treatment after 60 min and none of the 29 patients whose pain disappeared within 60 min needed further anodyne treatment within 24 h. These results were all significantly superior to those of the conventional treatment. No side-effects and complications were observed. Conclusion: Trigger point injection, in our experience, is an easy, safe and effective method for the amelioration of renal colic. It was significantly superior to the combination of intravenous butylscopolamine and sulpyrine.

Using seed crystal method, whole-urine method, and scanning electron microscopy, the inhibitory effects of sialic acid and osteopontin (OPN) on aggregation/growth of CaOx crystals were investigated. Using the seed crystal method, sialic acid showed an inhibitory effect on CaOx crystal aggregation/growth in a concentration-dependent manner, but almost no effect was observed using the whole-urine method. OPN showed an inhibitory effect on aggregation/growth in both experimental systems. The inhibitory effect of asialo-OPN on aggregation/growth was approximately 20% lower than that of OPN in the experiment using the seed crystal method and approximately 15% lower in the experiment using the whole-urine method. Scanning electron microscopy showed that OPN and sialic acid inhibit the aggregation of CaOx crystals. The above findings show that sialic acid accounts for about 15–20% of the involvement of OPN in CaOx crystallization.

Osteopontin (OPN) is a urinary protein which inhibits calcium oxalate (CaOx) crystal growth in the seed crystal system. The aim of this study was to evaluate the effects of OPN immobilized on collagen granules (CG) for CaOx crystal growth and aggregation in this system. OPN-immobilized CG showed a 30% decrease in inhibitory activity compared with non-OPN-immobilized CG. Scanning electron microscopy revealed that 1) OPN-immobilized CG showed more marked aggregation and adhesion of seed crystals (smaller than 0.5 microm in diameter) than non-OPN-immobilized CG, 2) the amount of adherent large type crystals (2-3 microm in diameter) did not differ between OPN immobilized and non-OPN-immobilized CG. In conclusion, immobilized OPN promotes aggregation and adhesion of CaOx crystals smaller than 0.5 microm on CG. These observations suggest that crystal adhesion to immobilized OPN plays a role in the retention of crystals in the kidney.