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Purpose: We aimed to investigate controversial pediatric urolithiasis issues systematically, integrating expert consensus and comprehensive guidelines reviews. Methods: Two semi-structured online focus group meetings were conducted to discuss the study's need and content, review current literature, and prepare the initial survey. Data were collected through surveys and focus group discussions. Existing guidelines were reviewed, and a second survey was conducted using the Delphi method to validate findings and facilitate consensus. The primary outcome measures investigated controversial issues, integrating expert consensus and guideline reviews. Results: Experts from 15 countries participated, including 20 with 16+ years of experience, 2 with 11–15 years, and 4 with 6–10 years. The initial survey identified nine main themes, emphasizing the need for standardized diagnostic and treatment protocols and tailored treatments. Inter-rater reliability was high, with controversies in treatment approaches (score 4.6, 92% agreement), follow-up protocols (score 4.8, 100% agreement), and diagnostic criteria (score 4.6, 92% agreement). The second survey underscored the critical need for consensus on identification, diagnostic criteria (score 4.6, 92% agreement), and standardized follow-up protocols (score 4.8, 100% agreement). Conclusion: The importance of personalized treatment in pediatric urolithiasis is clear. Prioritizing low-radiation diagnostic tools, effectively managing residual stone fragments, and standardized follow-up protocols are crucial for improving patient outcomes. Integrating new technologies while ensuring safety and reliability is also essential. Harmonizing guidelines across regions can provide consistent and effective management. Future efforts should focus on collaborative research, specialized training, and the integration of new technologies in treatment protocols. [ABSTRACT FROM AUTHOR]

We reviewed the proper evaluation process, diagnostic work-up, and treatment procedures for patients with urolithiasis to prevent the recurrence of stone formation. It is essential to determine the type of stone and conduct specific blood and urine analyses to inform the course of treatment for patients. The aim of this review was to define patients who are at high risk of recurrence of urolithiasis, to delineate diagnostic and therapeutic algorithms for each type of stone, and to clarify general guidelines and recommendations for prevention of recurrence. A professional research librarian carried out literature searches for all sections of the urolithiasis guidelines, covering the timeframe between 1976 and June 2023. For every patient with urolithiasis, an attempt should be made to analyse the stone. Patients should be given general instructions on how to prevent recurrence, including adequate fluid and calcium intake, and low consumption of sodium and protein. Identifying and correcting the causative factors is a cornerstone in preventing the recurrence of urolithiasis. Diagnostic and therapeutic algorithms by stone composition are available. Every patient should undergo baseline metabolic screening, while patients with calcium stones, who are at high risk of relapse and complications, should undergo extensive metabolic screening with two 24-h urine collections and should receive targeted therapy. Patients with uric acid, infection, or cystine stones are at high risk of relapse. All patients at high risk of recurrence should be closely monitored, especially those not complying with therapy in the long term. Metabolic stone evaluation and patient follow-up are highly recommended to prevent urolithiasis recurrence. [ABSTRACT FROM AUTHOR]

This study was designed to scrutinize the practical health index of uroliths for investigating composition, structural characterization, phase quantification and shape of kidney stone patients with respect to socioeconomically status in territory of Bahawalpur, southern Punjab, Pakistan. Morphology of the kidney stones were determined using SEM. The Ultra violet spectra of kidney stones in narrow range of 220–280 nm. Quantitative phase analysis of stones indicates as oxalate, calcium oxalate monohydrate, calcium oxalate dehydrates, calcium phosphate, cysteine and uric acid with 40.51 %, 26.24 %, 14.24 %, 36.45 %,13.18 % and 9.86 % respectively. A survey analysis also supports the vitro data showing patient age with 30–40 years with more predominance in males than females. Metabolic abnormalities were detected in 75 % patients with stone recurrence 15 % complained of having digestive disease. The overall concludes from qualitative and quantitative results suggested the community for preventive measures in reducing the risk of pervasiveness and relapse of urolithiasis.

BackgroudRoutine metabolic assessments for methylmalonic acidemia (MMA), propionic acidemia (PA), and homocysteinemia involve detecting metabolites in dried blood spots (DBS) and analyzing specific biomarkers in serum and urine. This study aimed to establish a liquid chromatography–tandem mass spectrometry (LC–MS/MS) method for the simultaneous detection of three specific biomarkers (methylmalonic acid, methylcitric acid, and homocysteine) in DBS, as well as to appraise the applicability of these three DBS metabolites in monitoring patients with MMA, PA, and homocysteinemia during follow-up.MethodsA total of 140 healthy controls and 228 participants were enrolled, including 205 patients with MMA, 17 patients with PA, and 6 patients with homocysteinemia. Clinical data and DBS samples were collected during follow-up visits.ResultsThe reference ranges (25th–95th percentile) for DBS methylmalonic acid, methylcitric acid, and homocysteine were estimated as 0.04–1.02 μmol/L, 0.02–0.27 μmol/L and 1.05–8.22 μmol/L, respectively. Following treatment, some patients achieved normal metabolite concentrations, but the majority still exhibited characteristic biochemical patterns. The concentrations of methylmalonic acid, methylcitric acid, and homocysteine in DBS showed positive correlations with urine methylmalonic acid (r = 0.849, p

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. [ABSTRACT FROM AUTHOR]

Une prise en charge efficace de la lithiase rénale passe par la réalisation d'un bilan métabolique dès le premier épisode de calcul. Malgré son coût moindre et sa mise en place aisée, celui-ci reste peu prescrit. L'objectif de cette revue est de donner les éléments clés pour interpréter facilement et rapidement un bilan métabolique de première intention et de pouvoir détecter les anomalies nécessitant une prise en charge spécialisée. A metabolic evaluation must be carried out from the first episode of stone for effective management of renal lithiasis. Despite its lower cost and accessibility, it remains rarely prescribed. The aim of this publication is to provide keys to easily and quickly interpret a metabolic evaluation and to detect anomalies requiring specialized care. [ABSTRACT FROM AUTHOR]

Purpose: In this study, we aimed to identify the compliance rates of calcium-oxalate stone patients for metabolic evaluation, diet and medical treatment and also determine the factors that are associated with poor compliance rates. Methods: This study was conducted by the EULIS eCORE working group prospectively. In the initial visit, demographic and stone-related characteristics were recorded. Patients were suggested metabolic evaluation, dietary advices and medical treatment. Follow-up visit was performed after 3 months and compliance rates were recorded. Logistic regression analysis was performed to determine factors associated with poor compliance to metabolic evaluation, diet and medical treatment. Results: Data of 346 patients from nine centers were analyzed. Compliance rates were 71.7%, 65.3%, and 63.7% for metabolic evaluation, diet, and medical treatment, respectively. In multivariate analysis, level of education (p = 0.003), history of emergency department visit (p = 0.04), number of stone surgeries (p = 0.03), patient care in dedicated stone clinic (p = 0.03), and history of shock wave lithotripsy (p = 0.005) were detected as independent predictors of compliance to metabolic analysis. Level of education (p < 0.001) and history of emergency department visit (p = 0.01) were detected as independent predictors of patient compliance to diet. Number of stone episodes (p = 0.03), family history of stones (p = 0.02), and polypharmacy (p < 0.001) were detected as independent predictors of patient compliance to medical treatment. Conclusions: Patient compliance to metabolic evaluation, diet, and medical therapy is important for successful management of urolithiasis. Dietary advices and medications should be personalized by taking in to account the factors associated with poor compliance. [ABSTRACT FROM AUTHOR]

Aim: This study aims to analyze the stones and evaluate for any metabolic cause in pediatric patients with urolithiasis. Materials and methods: A prospective observational study was done in the department of urology, NIMS, on 30 patients with urolithiasis. Results: Calcium oxalate stones were the most common type of stone found in patients with renal stones and ureteric stones discreetly. Hypercalciuria was the most prevalent metabolic abnormality found in this study. Conclusion: Owing to the high prevalence of metabolic risk factors and the significant risk of recurrence, all children with urolithiasis need complete evaluation with metabolic workup and ensure complete removal of stone. [ABSTRACT FROM AUTHOR]

Copyright of Urologie Pro Praxi is the property of SOLEN sro 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.)

Abstract Objective To assess the routine serum and 24-hour urine tests proficiency in diagnosing the baseline metabolic abnormality of kidney stone formers. Methods This study analyzes the routine serum and 24-hour urine tests proficiency in diagnosing the baseline metabolic abnormality of kidney stone formers. The sensitivity and specificity, false positive, and negative results of the tests are extracted from diagnostic kits used in the laboratories of the target community. To accurately infer the results, a simulation based on 1000 people was used through 22 standard laboratory tests (Additional File 2), including calcium, oxalate, phosphate, uric acid, sulfate, potassium, sodium, citrate, and magnesium in 24-hour urine; and calcium, creatinine, Vit D, uric acid, and intact parathyroid hormone (PTH) in serum. The incremental cost-effectiveness ratio (ICER) was calculated and compared for each diagnostic test versus other diagnostic tests according to the incremental cost required for correct diagnoses of stone causes. Results Urinary uric acid, citrate, and serum potassium constitute the cost-effectiveness boundary curve in this study. This means that other diagnostic tests are not cost-effective compared to these three tests in terms of indexing at least one item of cost and effectiveness. The ICER index for each correct diagnosis with the urinary uric acid test was $ 1.25 per diagnosis, the most cost-effective test compared to serum potassium and urinary citrate. Conclusion The simplified blood and 24-hour urine metabolic evaluation, including urinary uric acid, citrate, and serum potassium, constitute the cost-effectiveness boundary curve. The most cost-effective test was urinary uric acid measurement.

Objective To review the experience of metabolic evaluation of urinary stones in Peking Union Medical College Hospital, and summarize the ‘PUMCH model’ of metabolic evaluation. Methods With descriptive evaluation method, this study reviewed and analyzed 534 metabolic evaluation cases in the urology department of Peking Union Medical College Hospital from Jan. 2016 to Dec. 2021. The distribution differences of stone patients in gender, medical history, stone shape, stone composition, renal function, systemic metabolism and 24-hour urine metabolism were observed. Results This study found that males were more than females in terms of gender differences in stone patients; The average course of stone disease was about 10 years, and the first symptom was mainly renal colic; Calcium oxalate was the most common stone component; Kidney stone was more than urethral stone; Hyperlipidemia was the most common in patients with stones; The low concentration of urinary citrate was the most significant. Conclusions As a new method of stone diagnosis and treatment, the ‘PUMCH model’ of metabolic evaluation can comprehensively evaluate the patients' stone incidence and systemic metabolic abnormalities, which has a strong guiding role in stone treatment and prevention.

Objective: To assess the routine serum and 24-hour urine tests proficiency in diagnosing the baseline metabolic abnormality of kidney stone formers. Methods: This study analyzes the routine serum and 24-hour urine tests proficiency in diagnosing the baseline metabolic abnormality of kidney stone formers. The sensitivity and specificity, false positive, and negative results of the tests are extracted from diagnostic kits used in the laboratories of the target community. To accurately infer the results, a simulation based on 1000 people was used through 22 standard laboratory tests (Additional File 2), including calcium, oxalate, phosphate, uric acid, sulfate, potassium, sodium, citrate, and magnesium in 24-hour urine; and calcium, creatinine, Vit D, uric acid, and intact parathyroid hormone (PTH) in serum. The incremental cost-effectiveness ratio (ICER) was calculated and compared for each diagnostic test versus other diagnostic tests according to the incremental cost required for correct diagnoses of stone causes. Results: Urinary uric acid, citrate, and serum potassium constitute the cost-effectiveness boundary curve in this study. This means that other diagnostic tests are not cost-effective compared to these three tests in terms of indexing at least one item of cost and effectiveness. The ICER index for each correct diagnosis with the urinary uric acid test was $ 1.25 per diagnosis, the most cost-effective test compared to serum potassium and urinary citrate. Conclusion: The simplified blood and 24-hour urine metabolic evaluation, including urinary uric acid, citrate, and serum potassium, constitute the cost-effectiveness boundary curve. The most cost-effective test was urinary uric acid measurement. [ABSTRACT FROM AUTHOR]

Abstract Background The purpose of this study was to assess the metabolic abnormalities in high-risk stone formers. Methods This was a retrospective observational study done at Tribhuvan University Teaching Hospital, Nepal, over 1-year period. High-risk stone formers were identified and were evaluated with serum chemistries and 24-h urinary chemical evaluation. Stone analysis was also included whenever available. Common metabolic abnormalities and stone analysis results were reported and compared with different studies. Continuous variables were expressed as mean ± SD. Categorical variables were expressed as percentage and proportions. Results During 1 year of period, sixty-five patients had undergone extensive metabolic evaluation, but complete data were available for only forty-six patients. Of the total patients (n = 46), 63% were male (n = 29) and rest (36.9%) were female. Mean age of patients was 34.4 ± 15.1 years. Common reasons for metabolic evaluation were multiple stones (40%), bilateral stones (27%), recurrent stones (17%) and others (16%). Most common stone type was mixed stone with predominant composition being calcium oxalate mono- and dihydrate (62.9%). Twenty-four-hour urinary metabolic evaluation showed hyperoxaluria (32.6%) as most common abnormalities followed by hypocitraturia (21.7%) and hypocalciuria (21.7%). Conclusion Hyperoxaluria and hypocitraturia are common metabolic abnormalities in our patients. These findings help in counselling dietary measures to patients.

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. [ABSTRACT FROM AUTHOR]

Objective To review the experience of metabolic evaluation of urinary stones in Peking Union Medical College Hospital, and summarize the ‘PUMCH model’ of metabolic evaluation. Methods With descriptive evaluation method, this study reviewed and analyzed 534 metabolic evaluation cases in the urology department of Peking Union Medical College Hospital from Jan. 2016 to Dec. 2021. The distribution differences of stone patients in gender, medical history, stone shape, stone composition, renal function, systemic metabolism and 24-hour urine metabolism were observed. Results This study found that males were more than females in terms of gender differences in stone patients; The average course of stone disease was about 10 years, and the first symptom was mainly renal colic; Calcium oxalate was the most common stone component; Kidney stone was more than urethral stone; Hyperlipidemia was the most common in patients with stones; The low concentration of urinary citrate was the most significant. Conclusions As a new method of stone diagnosis and treatment, the ‘PUMCH model’ of metabolic evaluation can comprehensively evaluate the patients’ stone incidence and systemic metabolic abnormalities, which has a strong guiding role in stone treatment and prevention. [ABSTRACT FROM AUTHOR]

Although stone disease is an important health problem with high incidence and recurrence rates, it is a preventable disease. Attitudes and practices of urologists regarding the prevention of recurrence continue to be a subject of debate. In this context, an online survey study was conducted involving 305 urologists from 57 different countries. The first 7 questions collected demographic data about the urologists and the remaining 23 questions were about the recurrence and metabolic evaluation, medical treatment, and follow-up of urinary stone disease. Most urologists (85.2%) thought that metabolic examination was important. Approximately one-third of the participants (34.1%) performed 24-hour urine analysis and stone analysis was ordered by 87.5% of the urologists. Metabolic analysis was performed for all patients by 14.7% of the participants. For pediatric patients this rate was 68.5%, and for adults with recurrence the rate was 81.6%. Reasons cited by the urologists for not performing metabolic analysis included not feeling confident doing so (18.3%), having limited facilities in their hospital (26.5%), having an excessive daily workload (31.8%), patient-related factors (27.5%), and referring patients to other departments for metabolic evaluation (20.9%). Although majority of the responding urologists do consider the metabolic analysis as vital important, they seemed not to be willing to perform these tests with the same degree of enthusiasm in their daily practice. Our results show that urologists need support in performing and interpreting 24-hour urine analysis, improving their knowledge levels, and communicating with patients. Urology residency training should focus more on the prevention of urinary stone recurrence in addition to the surgical training. [ABSTRACT FROM AUTHOR]

Abstract Background Urolithiasis is a multi-etiological disease resulting from a combination of environmental and genetic factors. One of the most challenging aspects of this disease is its high recurrence rate. For most patients, an in-depth metabolic evaluation may reveal the presence of urinary stones. The fact that different urinary stone-related compounds (USRCs) are measured by different methods renders the metabolic evaluation of urolithiasis quite tedious and complex. Methods A three-channel ion chromatograph (IC) that automatically measures the concentration of common metabolic indicators of urolithiasis in urine (i.e., oxalate, citrate, uric acid, calcium, and magnesium) was developed to improve the efficiency. To validate its precision and specificity, standard curves were prepared using working solution of these indicators. 100 standard solutions of these indicators were measured with our new IC and three other ICs as the control instruments; analyte concentrations in 100 24-h urine samples from volunteers and 135 calculi patients were also measured. Results All analytes had good linear relationships in concentration ranges of 0–10 mg/L. The precision experiments in the standard and urine samples showed that the measurement errors of the newly developed IC were all less than 5%. In urine, the recovery rate ranged from 99.6 to 100.4%, the coefficient of variation ranged from 1.39 to 2.99%, and the results matched between our newly developed IC and the control ICs. The results of the efficiency test showed that we can finish the analysis at the average number of 14 people per day with the new IC. While the average number in the control group is 3.85/day (p = 0.000). Conclusions Overall, this multi-channel system significantly improves the efficiency of metabolic evaluation while retaining accuracy and precision.

• There is no need of preserving 24 h urine samples when stored at room temperature for up to 72 h. • This finding facilitates sample collection and may improve patient compliance and safety. • If needed, preservation may be done only after collection and prior to analysis. Recommendations on the optimal preservation of 24 h urine for the metabolic work-up in urolithiasis patients are very heterogeneous. In case two such tests with different storage condition recommendations are being analysed, multiple collections would be needed, challenging especially elderly and very young patients. We therefore aimed to evaluate the stability of urine constituents under different storage conditions. We collected urine samples from ten healthy volunteers and prepared aliquots to be stored either at room temperature or 4 °C. Some aliquots were preserved using hydrochloric acid prior to storage, some thereafter, some using the BD Urine preservation tube and some were not preserved at all. Storage duration was 0, 24, 48 or 72 h. In all samples calcium, magnesium, phosphorus, creatinine, oxalate, citrate and uric acid were measured and compared to the according reference sample. We could not find any significant deviation for any of the analytes and preanalytical treatment conditions compared to the associated reference sample. Preservation of 24 h urine for the metabolic evaluation in stone formers might not be necessary for sample storage up to 72 h. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: Infection-associated renal stones are commonly composed of magnesium-ammonium-phosphate (MAP) and carbonate apatite (CA). The clinical implications of these two different, but closely related stone types, are unknown. We sought to compare the clinical, microbiologic, and metabolic characteristics of patients with MAP and CA stone types. Methods: We retrospectively reviewed the medical records of patients from two centers (one in the United States and one in Israel) who underwent ureteroscopy or percutaneous nephrolithotomy between 2012 and 2020 and identified patients with a predominant stone analysis component of CA or MAP and clinical data supporting an infection stone. We analyzed and compared demographic data, medical history, postoperative fever, stone and urinary microbiology, and 24-hour urine studies. Results: A total of 79 and 75 patients met the inclusion criteria for the MAP and CA cohorts, respectively. No significant difference was found in patient demographics or comorbidities between the MAP and CA cohort. Female predominance was noted in both. Although there were no significant differences in 24-hour urine parameters between the cohorts, hypercalciuria was common in both cohorts (38% and 32% of patients in the MAP and CA cohorts, respectively). Gram-negative bacteria were more common in the MAP stone cultures. Postoperative fever was significantly more common in the MAP cohort (14.7% vs 3.8%, p < 0.016). Conclusions: MAP and CA stone formers share similar demographic characteristics with a clear female predominance. MAP stones patients appear more likely to develop postoperative fever, possibly related to a higher occurrence of gram-negative bacteria in the stone cultures of the MAP cohort. Although there were no significant differences among metabolic parameters, hypercalciuria was noted in approximately a third of the cohort. The clinical significance of this finding is yet to be determined. [ABSTRACT FROM AUTHOR]

Background: Urolithiasis is a multi-etiological disease resulting from a combination of environmental and genetic factors. One of the most challenging aspects of this disease is its high recurrence rate. For most patients, an in-depth metabolic evaluation may reveal the presence of urinary stones. The fact that different urinary stone-related compounds (USRCs) are measured by different methods renders the metabolic evaluation of urolithiasis quite tedious and complex.Methods: A three-channel ion chromatograph (IC) that automatically measures the concentration of common metabolic indicators of urolithiasis in urine (i.e., oxalate, citrate, uric acid, calcium, and magnesium) was developed to improve the efficiency. To validate its precision and specificity, standard curves were prepared using working solution of these indicators. 100 standard solutions of these indicators were measured with our new IC and three other ICs as the control instruments; analyte concentrations in 100 24-h urine samples from volunteers and 135 calculi patients were also measured.Results: All analytes had good linear relationships in concentration ranges of 0-10 mg/L. The precision experiments in the standard and urine samples showed that the measurement errors of the newly developed IC were all less than 5%. In urine, the recovery rate ranged from 99.6 to 100.4%, the coefficient of variation ranged from 1.39 to 2.99%, and the results matched between our newly developed IC and the control ICs. The results of the efficiency test showed that we can finish the analysis at the average number of 14 people per day with the new IC. While the average number in the control group is 3.85/day (p = 0.000).Conclusions: Overall, this multi-channel system significantly improves the efficiency of metabolic evaluation while retaining accuracy and precision. [ABSTRACT FROM AUTHOR]

Background: Stone prevention is dependent on high fluid intake, with evidence that low urine volume (LUV) can promote nephrolithiasis in the absence of other metabolic abnormalities. Herein, we investigate patient-related factors associated with LUV on initial 24-hour urine collection in an underserved population. Materials and Methods: A retrospective chart review was performed of patients treated by a single surgeon for nephrolithiasis from August 2014 to January 2019. Patients who submitted 24-hour urine samples were divided into two groups based on whether their initial collection was >2 L or not. Factors associated with 24-hour urine volume were analyzed using bivariate and multivariate analyses. As a secondary outcome, we investigated factors associated with corrected 24-hour urine volume on repeat 24-hour urine collection. Results: Two hundred eight patients (45.1%) submitted 24-hour urine collections, 63.9% (133/208) of which demonstrated a urine volume of <2 L. LUV was more common in female patients (77.1% vs 49.5%; p = 0.001) and patients with no insurance and Medicaid (no insurance [100%] vs Medicaid [74.1%] vs Medicare/private [58.6%]; p = 0.02). Female gender and insurance status were independent predictors of LUV in the multivariable analysis. Seventeen of 43 patients (39.5%) with LUV who provided a subsequent collection were able to correct their urine volume. Patients who improved their LUV were older (58.5 vs 45.9 years, p = 0.0149) and more likely to have surgical intervention for their kidney stones (94.1% vs 53.8%, p = 0.006). In our multivariable analysis, surgical intervention was associated with correcting urine volume. Conclusions: Female patients and those with no insurance or Medicaid were more likely to have LUV on an initial 24-hour urine collection. Further research into barriers to fluid intake is important for these two groups, along with directed patient education on strategies for increasing fluid intake. [ABSTRACT FROM AUTHOR]

Introduction Urolithiasis, a common urological disorder affecting the global population, demonstrates geographical diversity due to factors such as water quality, climate variations, health conditions, and dietary habits. This study, conducted in Northern Sri Lanka, examines urinary stone compositions and assesses the prevalence of metabolic disorders among urolithiasis patients. Methods This prospective cross-sectional study, conducted at Jaffna Teaching Hospital, Jaffna, Sri Lanka, from July 2022 to June 2023, focused on surgically treated urolithiasis patients. Institutional ethical clearance was obtained. Patient details and investigational findings were collected through questionnaires and data extraction forms. Stone analysis utilized Fourier transform infrared spectroscopy, and a detailed metabolic evaluation of a 24-hour urine collection sample was carried out. Results This study followed 153 surgically treated urolithiasis patients, primarily male (64.3%), with a mean age of 48.64. Ureteric colic (48.4%) was common, with kidney stones (45.8%) prevalent; 57.52% had recurrent stones. Diabetes mellitus (DM; 23.5%) was the top comorbidity. Calcium oxalate monohydrate (COM) stones (78.4%) were the most frequent, followed by uric acid (12.4%). COM predominated in the 40-59 age group. There was no significant gender-stone type association. A total of 86.9% had metabolic abnormalities, notably hypocitraturia (60.1%). Moreover, 23% had both hypocitraturia and hypomagnesuria. Some metabolic disorders showed gender differences, with a marginal age-metabolic disorder association (p < 0.061). Urine oxalate levels were normal, with higher variability in males. Conclusion Middle-aged males with urolithiasis commonly presented with ureteric colic and predominantly had COM stones. Recurrent stones were common, often accompanied by metabolic abnormalities such as hypocitraturia and hypomagnesuria, with DM as the primary comorbidity., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Review Committee, Jaffna Teaching Hospital issued approval J/ERC/22/133/NDR/270. Ethical clearance was obtained from the institution, and informed written consent was obtained from participants. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: This research study was funded by university of Jaffna research grant - (URG/2022/SEIT/10). Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Balasingam et al.)

Backgroud: Routine metabolic assessments for methylmalonic acidemia (MMA), propionic acidemia (PA), and homocysteinemia involve detecting metabolites in dried blood spots (DBS) and analyzing specific biomarkers in serum and urine. This study aimed to establish a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the simultaneous detection of three specific biomarkers (methylmalonic acid, methylcitric acid, and homocysteine) in DBS, as well as to appraise the applicability of these three DBS metabolites in monitoring patients with MMA, PA, and homocysteinemia during follow-up., Methods: A total of 140 healthy controls and 228 participants were enrolled, including 205 patients with MMA, 17 patients with PA, and 6 patients with homocysteinemia. Clinical data and DBS samples were collected during follow-up visits., Results: The reference ranges (25th-95th percentile) for DBS methylmalonic acid, methylcitric acid, and homocysteine were estimated as 0.04-1.02 μmol/L, 0.02-0.27 μmol/L and 1.05-8.22 μmol/L, respectively. Following treatment, some patients achieved normal metabolite concentrations, but the majority still exhibited characteristic biochemical patterns. The concentrations of methylmalonic acid, methylcitric acid, and homocysteine in DBS showed positive correlations with urine methylmalonic acid ( r  = 0.849, p  < 0.001), urine methylcitric acid ( r  = 0.693, p  < 0.001), and serum homocysteine ( r  = 0.721, p  < 0.001) concentrations, respectively. Additionally, higher levels of DBS methylmalonic acid and methylcitric acid may be associated with increased cumulative complication scores., Conclusion: The LC-MS/MS method established in this study reliably detects methylmalonic acid, methylcitric acid, and homocysteine in DBS. These three DBS metabolites can be valuable for monitoring patients with MMA, PA, and homocysteinemia during follow-up. Further investigation is required to determine the significance of these DBS biomarkers in assessing disease burden over time., 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 © 2024 Liu, Ma, Kang, Jin, Li, Song, Li, Cao and Yang.)

Purpose: To investigate the prevalence of inherited causes in an early onset urolithiasis cohort and each metabolic subgroup. Methods: A retrospective analysis of both metabolic and genomic data was performed for the first 105 pediatric urolithiasis patients who underwent exome sequencing at our hospital from February 2016 to October 2018. Measurements included the diagnostic yield of exome sequencing in the entire cohort and each metabolic subgroup (hyperoxaluria, hypocitraturia, hypercalciuria, hyperuricosuria and cystine stone subgroups). The conformity between molecular diagnoses and metabolic evaluation was also evaluated. Results: The present study involved a cohort of 105 pediatric patients with urolithiasis, from which diagnostic variants were identified in 38 patients (36%), including 27 primary hyperoxaluria and 11 cystinuria. In the metabolic subgroup analyses, 41% hyperoxaluria cases were primary hyperoxaluria caused by monogenic defects, and 100% of the causes of cystine stones could be explained by monogenic defects. However, no appropriate inherited causes were identified for hypocitraturia, hypercalciuria, or hyperuricosuria in the cohort. A high conformity (100%) was obtained between the molecular diagnoses and metabolic evaluation. Conclusion: Exome sequencing in a cohort of 105 pediatric patients with urolithiasis yielded a genetic diagnosis in 36% of cases and the molecular diagnostic yield varies substantially across different metabolic abnormalities. [ABSTRACT FROM AUTHOR]

Objective: To identify how demographic factors, stone-associated medical comorbidities, and treatment predict compliance with 24-hour urine collection.Materials and Methods: A retrospective medical record review of patients treated for urolithiasis between August 2014 and March 2017 was performed. Patient demographics, medical characteristics, stone factors, type of treatment, and compliance data were included for patients requested to submit a collection. Variables that were statistically significant on bivariate analysis were then used to formulate a model predicting submission of a 24-hour urine sample.Results: Of the 303 patients who met inclusion criteria, 183 (60.4%) submitted an initial 24-hour urine collection. On bivariate analysis, patients older than 50 were more likely to submit a 24-hour urine collection (71.4% vs 51.5%; P <.001), patients with a metabolic predisposition for stones were more likely to submit a 24-hour urine collection (70.6% vs 53.1%; P <.003), and patients who did not have surgery were more likely to submit a 24-hour urine collection (97.9% vs 53.5%; P <.001). Our 3-variable prediction model found that not undergoing surgery was a strong predictor of 24-hour urine collection.Conclusions: We suspect that patients perceive surgery as a more definitive treatment for kidney stones than conservative management. Patient education on the natural history and role of metabolic management in the prevention of nephrolithiasis is essential in improving compliance with 24-hour urine collection. [ABSTRACT FROM AUTHOR]

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Objective: To evaluate the impact of stone free status on the outcomes of metabolic evaluation in recurrent stone formers after ureteroscopic stone removal., Patients and Methods: A total of 78 patients undergoing retrograde intrarenal surgery (RIRS) for renal stones were included and cases were divided into two groups after 4 weeks based on the NCCT findings. While cases in the Group 1 (n = 54) was completely stone free, cases in Group 2 (n = 24) had residual fragments in the kidney. A full 24-h urine analysis for relevant stone forming risk factors has been performed after 4 weeks following the fURS procedures in all patients of both groups. Outcomes of metabolic evaluation (24-h urine and serum) have been comparatively evaluated in both groups., Results: Evaluation of the preoperative serum and urine stone forming risk factors revelaed no statistical difference in both groups. Comparative evaluation of the 24-h urinary stone forming risk factors also revealed no statistically significant difference between preoperative and postoperative findings in cases of Group 2 with residual stones. Last but not least, no significant difference was observed between the mean preoperative and postoperative serum variables between two groups., Conclusions: Our results show that in the light of the similar metabolic evaluation outcomes obtained in cases with and without residual fragments, 'stone free status' may not be an essential factor to perform a detailed metabolic evaluation (24-h urine analysis and serum parameters) after endourological stone removal procedures., (Copyright © 2023. Published by Elsevier España, S.L.U.)

Objective: As the urolithiasis is an endemic situation in our country, the urologists are well-experienced about this situation. The prevention of urolithiasis recurrence is as important as the surgical treatment. For this reason metabolic evaluation and medical treatment of stone disease is extremely important. This study aimed to evaluate urological specialists' views of metabolic evaluation and medical treatment of urolithiasis. Thus, the main problems and the probable solutions about medical treatment and metabolic evaluation of urinary system stone disease can be evaluated. Methods: The urologists working at Tekirdag were invited to the study. A face-to-face questionnaire, which was composed of three parts, was performed to the participants. In the first section, the demographic characteristics of the participants were evaluated. In the second and third sections, the approach of participants to metabolic evaluation and medical treatment in urolithiasis were investigated, respectively. Results: A total of 29 urologist who routinely performed endourological surgery were included to the study. When we evaluated their endourological practice, 65.5% of the participants were performing 10-25 endourological surgery per month. When we asked the approach of participants about the metabolic evaluation, 34.5% reported that they did not perform metabolic evaluation to their adult patients and 65.5% did not perform to the children with urolithiasis. All participants believed the efficacy of medical treatment however, 66% of the participants were performing at less than half of their patients in clinical practice. Conclusions: The clinical practice about metabolic evaluation, stone analysis and metaphylaxis were lower than expected. Most of the participants were not able to make metabolic evaluation and stone analysis. Further studies are needed to resolve the problems associated with metabolic evaluation and metaphylaxis administration. Giriş: Üriner sistem taş hastalığı coğrafyamız açısından endemik bir durum olup, ülkemizdeki üroloji uzmanlarının üriner sistem taş hastalığı ile ilgili tecrübeleri oldukça yüksektir. Üriner sistem taş hastalığının cerrahisi kadar bu hastalığın nüksünü engellemek de bir o kadar önemlidir. Bu bağlamda, taş hastalığının metabolik değerlendirmesi ve medikal tedavisi son derece önem taşımaktadır. Bu çalışmada, Tekirdağ ilinde çalışan üroloji uzmanlarının, üriner sistem taş hastalığında metabolik değerlendirme ve medikal tedaviye bakış açılarının değerlendirmesi amaçlanmıştır. Yöntemler: Çalışmaya Tekirdağ ilindeki hastanelerde çalışan üroloji uzmanları davet edildi. Katılımcılara, toplam üç bölümden oluşan anket yüz-yüze uygulandı. Anketin ilk bölümde katılımcıların demografik özellikleri değerlendirildi. Anketin ikinci ve üçüncü bölümlerde ise sırasıyla üriner sistem taş hastalığında metabolik değerlendirme ve medikal tedaviye yönelik katılımcıların yaklaşımları incelendi. Bulgular: Klinik pratiğinde rutin endoürolojik cerrahi uygulayan toplam 29 üroloji uzmanı çalışmaya dahil edildi. Katılımcıların %65,5'i ayda ortalama 10-25 endoürolojik cerrahi uygulamaktaydı. Metabolik değerlendirme ile ilgili görüşleri sorgulandığında katılımcıların %34,5'i erişkinlerde ve %65,5'i çocuk taş hastalarında metabolik değerlendirme uygulamadığını belirtti. Tüm katılımcılar üriner sistem taş hastalığında medikal tedavinin etkinliğine inanmaktaydı. Ancak katılımcıların %66 'sı klinik pratikte medikal tedaviyi hastaların yarısından azında uygulamaktaydı. Bunun sebebi sorulduğunda katılımcıların yarısına yakını, metabolik değerlendirme için olanaklarının olmadığını belirtti. Tartışma: Çalışmamızda, katılımcıların metabolik değerlendirme, taş analizi ve metafilaksi konusundaki uygulamalarının beklenilenden daha düşük olduğu görüldü. Katılımcıların çoğu metabolik değerlendirme ve taş analizi yapamadıklarını belirtti. Metabolik değerlendirme ve metafilaksi uygulanması ile ilgili problemlerin çözülmesine yönelik daha fazla çalışmaya ihtiyaç vardır. [ABSTRACT FROM AUTHOR]

Currently an evidence-based approach to nephrolithiasis is hampered by a lack of randomized controlled trials. Thus, there is a need for common platforms for data sharing and recruitment of patients to interventional studies. A first step in achieving this objective would be to share practice methods and protocols for subsequent standardization in what is still a heterogeneous clinical field. Here, we present the results of a pilot survey performed across 24 European clinical kidney stone centers. The survey was distributed by a voluntary online questionnaire circulated between June 2017 and January 2018. About 46% of centers reported seeing on average 20 or more patients per month. Only 21% adopted any formal referral criteria. Centers were relatively heterogeneous in respect of the definition of an incident stone event. The majority (71%) adopted a formal follow-up scheme; of these, 65% included a follow-up visit at 3 and 12 months, and 41% more than 12 months. In 79% of centers some kind of imaging was performed systematically. 75% of all centers performed laboratory analyses on blood samples at baseline and during follow-up. All centers performed laboratory analyses on 24-h urine samples, the majority (96%) at baseline and during follow-up. There was good correspondence across centers for analyses performed on 24-h urine samples, although the methods of 24-h urine collection and analysis were relatively heterogeneous. Our survey among 24 European stone centers highlights areas of homogeneity and heterogeneity that will be investigated further. Our aim is the creation of a European network of stone centers sharing practice patterns and hosting a common database for research and guidance in clinical care. [ABSTRACT FROM AUTHOR]

The cold-tolerance of 'Kristall' (Euro-Amur-American origin), 'Dostoyniy' and 'Krasnostop AZOS' (interspecific hybrids of Euro-American origin) grapevine varieties in the winter conditions of South Russia is characterised by the second (true dormancy) and third (induced dormancy) winter-resistance components. Here we used a complex approach to estimate plant adaptation to abiotic stress factors. We used the gravimetric method for humidity assessment and water content, spectral analysis for detection of the protein level and pigments and capillary electrophoresis to determine the level of carbohydrates, Krebs cycle organic acids, phenolcarbonic, ascorbic acids, and amino acids. The obtained results allow to suggest various mechanisms of adaptation of the studied varieties to the winter period stressors. The water content of shoots, levels of protein, amino acids, proline, sugars and the sum of phenolcarbonic acid and ascorbic acid are the most informative indicators of grape plants frost-resistance in the climate conditions of the Anapa–Taman region. [ABSTRACT FROM AUTHOR]

There is a paucity of studies addressing the accuracy of 24-hour urine collection for assessing stone risk parameters. Collection accuracy is thought to be essential for assigning optimal therapy for stone prevention. The objective of this study was to determine factors associated with accurate and inaccurate collections. During a 2-year period (2015-2016), 241 stone formers completed 24-hour urine collections. They were divided into accurate collectors (AC), defined as at least one accurate urine collection, and inaccurate collectors (IC). Accuracy was assessed by 24-hour urine creatinine (Cr) excretion indexed to body weight (normal: males, 20-25 mg Cr/kg; females, 15-20 mg Cr/ kg). Demographic data analyzed included age, gender, race, insurance status, partner status, income, and education. Statistical analysis methods included the chi-square test, Fisher's exact test, and the two-group t-test. Average age was 50.7 years at the time of collection; 50.2% were men, 86% were white, and 14% were black. Overall, 51.0% of collections were inaccurate. There was no statistical significance between AC and IC for gender (P = 0.85), race (P = 0.90), insurance status (P = 0.85), recurrence (P = 0.87), stone type (P = 0.57), education (P = 0.35), income (P = 0.42), or poverty (P = 0.35). Older age (P = 0.017) and having a partner (P = 0.022) were significantly associated with AC. The high rate of inaccurate 24-hour urine collections is a concern. The only factors we identified as influencing collection accuracy were age and partner status. These results underscore the importance of developing methods to improve the accuracy of collecting 24-hour urine samples. [ABSTRACT FROM AUTHOR]

In this review, a simplified straightforward algorithmic approach to the metabolic evaluation and treatment of the at-risk or recurrent urolithiasis patient is provided. Eight diagnoses and eight therapies are provided, which cover over 95% of renal stone disease. [ABSTRACT FROM AUTHOR]

Objectives: To characterize the stone risk and the impact of parathyroidectomy on the metabolic profile of patients with primary hyperparathyroidism (PHPT) and urolithiasis. Patients and Methods: We analysed the prospectively collected charts of patients treated at our stone clinic between January 2001 and January 2016 searching for patients with PHPT and urolithiasis. Imaging evaluation of the kidneys, bones and parathyroid glands was assessed. We analysed the demographic data, serum and urinary variables before and after parathyroidectomy. We used a paired t‐test, Fisher's test, Spearman's test and anova in the statistical analysis. Results: A total of 51 patients were included. The mean patient age was 57.1 ± 12.1 years and 82.4% were women. Before parathyroidectomy, mean calcium and parathyroid hormone (PTH) levels were 11.2 ± 1.0 mg/dL and 331 ± 584 pg/dL, respectively. Hypercalcaemia was present in 84.3% of patients. All eight patients with normal calcium levels had elevated PTH levels. Only two patients did not have PTH above the normal range, although both had elevated calcium levels. The most common urinary disorders were low urinary volume (64.7%), hypercalciuria (60.8%), high urinary pH (41.2%) and hypocitraturia (31.4%). After parathyroidectomy, the number of patients with hypercalcaemia (n = 4; 7.8%), elevated PTH (n = 17; 33.3%) and hypophosphataemia (n = 3; 5.9%) significantly decreased (P < 0.001). The number of urinary abnormalities decreased and there was a reduction in urinary calcium (P < 0.001), pH (P = 0.001) and citrate levels (P = 0.003). Conclusion: Individuals with PHPT and nephrolithiasis frequently have elevated baseline PTH and calcium levels. Low volume, hypercalciuria, high urinary pH, and hypocitraturia are the most frequent urinary disorders. Parathyroidectomy is effective in normalizing serum calcium and PTH levels, although other urinary metabolic may persist. Patients should be monitored for the need for citrate supplementation. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this review was to provide current best evidence for evaluation, dietary, and medical management of patients with urolithiasis. Methods: Literature addressing evaluation, dietary, and medical management of urolithiasis was searched. Papers were analyzed and rated according to level of evidence (LOE), whereupon a synthesis of the evidence was made. Grade of recommendation (GOR) was judged from individual clinical experience and knowledge of the evidence according to the Oxford Centre for Evidence-based Medicine. Results: It is obvious that different stone diseases influence the life of stone-forming individuals very differently, and that evaluation and medical management should be personalized according to risk of recurrence, severity of stone disease, presence of associated medical conditions, and patient's motivation. With regard to evaluation, dietary and medical management of patients with urolithiasis evidence from the literature suggest that selective metabolic evaluation may lead to rational dietary and medical management. Statements based on LOE and GOR are provided to guide clinical practice. Conclusion: The provided evidence for evaluation of patients with urolithiasis aims at defining patients at high risk for recurrent/complicated stone disease. Based on this approach, evidence-based dietary and medical management regimes are suggested. [ABSTRACT FROM AUTHOR]

Nothing is known about how well stone formers understand physician's explanations of stone formation, and a few data are available on adherence to provided recommendations. In this study, two groups of recurrent calcium stone formers (RCSFs) were compared. Group 1: 153 consecutive RCSF (118 men, 35 women) referred 1/2011-6/2014. At least 3 months after a 60-75 min consultation explaining metabolic evaluation and therapeutic measures, RCSF received a questionnaire by mail, regarding understanding of stone formation and adherence to therapeutic recommendations (diet, lifestyle, drug treatment). Response rate was 62 %. Group 2 (control): 81 consecutive RCSFs referred 7/2014-3/2016 (60 men, 21 women) were asked to answer the same questionnaire in the stone center while waiting for their follow-up consultation 3 months after starting prevention; response rate was 100 %. Alkali citrate was prescribed in 45 %. Answer sheets were analyzed anonymously, and frequencies of answers were compared by Chi-square test. Results: 67 % (group 1) and 62 % (group 2) indicated >80 % understanding of the given information (NS). Over 80 % adherence to recommendations occurred in 26 and 30 % (NS). Most frequent changes in dietary/lifestyle habits were increases in calcium (93 vs. 89 %) and fluid intakes (81 vs. 78 %); lowering psychosocial stress (23 vs. 24 %) was least popular. Adherence to 100 % on 6-7 days/week was significantly more frequent for medication than for dietary/lifestyle interventions, both in group 1 (84 vs. 24 %, p < 0.001) and group 2 (91 vs. 28 %, p < 0.001). Conclusions: (1) results do not differ whether RCSFs are voluntarily participating by mail or asked to answer questionnaires in the stone clinic; (2) pathophysiologic explanations of stone disease are understood to >80 % by 2/3 of RCSFs; (3) after 3 months, perfect adherence to recommended treatment is more frequent on alkali citrate than on dietary/lifestyle measures; and (4) increasing calcium and fluid intake are the most popular dietary measures. [ABSTRACT FROM AUTHOR]

Purpose: Patients living in underserved areas do regularly express an interest in stone prevention; however, factors limiting participation, aside from obvious cost considerations, are largely unknown. To better understand factors associated with compliance with submitting 24-hour urine collections, we reviewed our patient experience at the kidney stone clinic at a hospital that provides care for an underserved urban community. Materials and Methods: A retrospective chart review of patients treated for kidney and/or ureteral stones between August 2014 and May 2016 was performed. Patient demographics, medical characteristics, stone factors, and compliance data were compiled into our data set. Patients were divided into two groups: those who did and did not submit the requested initial 24-hour urine collection. Analysis of factors related to compliance was performed using univariate analysis and multivariate logistic regression. Results: A total of 193 patients met inclusion criteria for our study, 42.5% (82/193) of whom submitted 24-hour urine samples. Of the 82 collections submitted, 34.1% (28/82) were considered inadequate by creatinine level. A second urine collection within 6 months was obtained in 14.0% (27/193) of patients. Univariate analysis demonstrated that African American (AA) patients were less likely to submit an initial 24-hour urine collection than Caucasian patients (collected: 30.9% vs 51.8%; p < 0.05, respectively). Patients with a family history of kidney stones were more likely to submit an initial 24-hour urine collection than patients without a family history of kidney stones (61.1% vs 38.2%, p < 0.02, respectively). On multivariate analysis, both factors remained significant predictors of compliance with submitting a 24-hour urine collection. Conclusions: In our underserved patient population, AA patients were half as likely to submit a 24-hour urine collection than Caucasian patients, whereas patients with a positive family history of stones were more than twice as likely to submit than patients with no family history. [ABSTRACT FROM AUTHOR]

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.)