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Query: UMLS:C0451641 (urolithiasis)
 3,973 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The paper provides the results of a study into a therapeutic effect produced by the Soviet agent Marelin used in the treatment of urolithiasis. The study was undertaken to examine 52 patients with severe nephrolithiasis, of them 33 had undergone an operation. The purpose of the study was to investigate spasmolytic, lithagogue, and anti-inflammatory effects of the drug, its impact on phosphorus and calcium exchange, uric acid metabolism, bacterial flora, urine excretion and pH. A pronounced spasmolytic effect was found almost in all the patients. Expelling of small concrements and fragments was observed in 14 cases, almost in all (80%) had crystallines of uric salts, mucus, and pus. Some of them had small calculi moved from the calyces and pelves into the ureter. No pathogenic urinary bacterial flora was found in 12.2% of the cases. Calciuria was normalized in 18 patients, reduced on an average of up to 5.2 mmol/l in 16. Phosphaturia (false or true) occurred in 20 of 52 patients, its severity diminished in two thirds of the cases. Hyperuricemia improved in 6 out of 13 patients who had oxalate calculi. With Marelin, diuresis increased in 48 of 52 patients by 25-30% and 10-20% within the first 2-9 days and the subsequent 20 days, respectively. There was a decrease in pH from 7.8 to 6.8 in some patients with urinary alkaline reaction. The findings suggest that Marelin should be recommended for its wide clinical application.
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PMID:[Marelin in the treatment of urolithiasis]. 239 35

The incidence and prevalence of urolithiasis in the Czechoslovak Socialist Republic is as high as in other countries of Central and Western Europe, and lower than in the Scandinavian countries. Apart from its high incidence, urolithiasis is characterized by its high tendency to recurrence. New knowledge of its pathogenesis helps to diagnose metabolic disorders responsible for increased excretion of concretion-producing substances and/or for deficiency in protective factors. In case of calcium oxalate lithiasis, with the highest incidence, attention is to be paid to its various forms of hypercalciuria, and, more recently, to moderate hyperoxaluria, and as regards protective factors, to magnesium, citrates, pyrophosphates and mucopolysaccharides. The determination of the type of metabolical disorder in patients with lithiasis enables to modify the diet and/or medication leading to causal prophylaxis against recurrence, i.e. metaphylaxis. At our Prague urological clinic, a consultation centre for lithiatic patients has been in operation since 1977. Long-term experience has shown that it has been successful especially in preventing recurrence or a in a substantial reduction in recurrence in 94% of the followed-up patients. Although the centre's activity is demanding both on the personnel and laboratory, even first sufferers from ilthiatic attacks should take advantage of it. At this early stage, such patients were found to have a metabolic disorders in 60%. In the past 7 years of treating nephrolithiasis and ureterolithiasis, new methods have been introduced which substantially improve the results and are less invasive than a classical operation. Among others, they comprise percutaneous endoscopic methods of disintegration and concrement extraction from the kidney and ureter, uteroscopy and extracorporeal shock-wave lithotripsy. It is to be expected that these methods will replace classical operations at a rate of 90%.
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PMID:[Urolithiasis. Review of present knowledge of epidemiology, pathogenesis, metaphylaxis and treatment]. 266 71

The authors considered an important problem of in vivo verification of urolith composition as specifying the choice of drug treatment and prevention of urolithiasis. 84 nephrolithiasis patients were allocated to 4 groups according to their concrement compositions (after spontaneous or surgical removal): 23 patients with urate calculus, 19 with oxalate, 20 with phosphate and 22 with oxalate-phosphate concrements. Polarizing microscopy, x-ray structural analysis and infrared spectrophotometry were employed for verification of calculi composition. Biochemical assay was used for the assessment of serum and circadian excretion of calcium, phosphates, sodium, potassium, uric acid, oxalates and uroacidimetric values. The findings were subjected to discriminant computed analysis which resulted in 6 linear computable functions defining 4 selective groups with regard to biochemical blood and urine data. The aforementioned functions were used in diagnostic routine for the in vivo assessment of calculous composition in 26 controls. In 61.5 per cent of the patients the diagnosis was confirmed, in 34.6 per cent it was verified, and only in 3.9 per cent the diagnosis turned to be erroneous.
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PMID:[Determination of the composition of the concretions in patients with nephrolithiasis by metabolic indices]. 267 29

A total of 191 children with oxalate-phosphate urinary concrements and 28 virtually healthy ones were studied for the main parameters of acid-base blood status with the use of Astrup's microtest. Besides, the urine circadian levels of acid and ammonium were followed up too. The proportion of the main and H+-secreting insertion cells of collecting tubes were calculated in 46 operative biopsy specimens, cells studied with electron microscopy. Advanced metabolic acidosis associated with a decrease in acid and ammonium titration was diagnosed in all patients with bilateral and in 81.6 per cent with unilateral nephrolithiasis. Regardless of acid-base blood status biopsy examination revealed a decrease in the number of insertion cells in renal collecting tubes of the patients mostly pronounced in those with bilateral concrement localization. Ultrastructure of insertion cells in children with oxalate-phosphate urolithiasis featured by a sharp decrease in mitochondria number, absence of smooth-walled vesicles, frequency of myelinoid lysosomes pointed to the failed competence of these cells to efficient H+ secretion. The data obtained evidence of the relationship between the metabolic acidosis and primary disability of the children's kidney to excrete H+.
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PMID:[Acid-base balance of the blood and possible renal mechanisms of its imbalance in children with oxalate-phosphate stones of the urinary tract]. 277 79

To investigate whether overall tubular dysfunction is encountered in a particular subgroup of patients with urolithiasis, the following parameters of renal tubular function have been measured in fasting morning urine in 124 male stone formers: excretion of lysozyme and gamma-glutamyl transpeptidase (gamma-GT), fractional excretion (FE) or glucose, insulin, bicarbonate after an alkali load, and theoretical phosphate threshold (TmP/GFR). The following have been diagnosed: primary hyperparathyroidism (n = 3), medullary sponge kidneys (n = 5), hyperuricemia (n = 8), cystinuria (n = 1), struvite nephrolithiasis (n = 2), idiopathic hypercalciuria of the absorptive (n = 16), dietary (n = 46) or renal (n = 5) type, and normocalciuric idiopathic urolithiasis (n = 38). Urinary excretion of lysozyme and of gamma-GT were elevated in 14% and 21% of patients respectively; FE glucose and FE insulin were elevated in 6% and 8% of patients respectively. In 62% of the patients TmP/GFR was below 0.95 mmol/l and in 52% of the patients FE HCO3 after alkali load was above normal. The findings show that a large number of stone formers have signs of renal tubular dysfunction; apparent renal leaks of phosphate and of bicarbonate are the most frequently encountered defects; while they are not specific for a given etiologic group of patients, they have been found in each group. The latter observation suggests that nephrolithiasis itself can damage renal tubular function.
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PMID:[Tubular dysfunction in renal lithiasis: cause or consequence?]. 285 24

To address whether a renal tubular dysfunction is encountered in a particular patient subgroup with urolithiasis, the following parameters of tubular function were measured in urine taken in the morning from 214 stone formers after fasting: pH, excretion of lysozyme and gamma-glutamyl transferase (gamma-GT); fractional excretion (FE) of glucose, insulin, Mg, K, and HCO3 after an alkali loading; and the renal threshold for phosphate (TmP/GFR). The following diagnoses were made in the patient group: primary hyperparathyroidism (N = 8), medullary sponge kidneys (N = 21), hyperuricemia (N = 10), cystinuria (N = 2), struvite stone disease (N = 6), idiopathic hypercalciuria of the absorptive (N = 25), dietary (N = 69) or renal (N = 7) type, and normocalciuric idiopathic urolithiasis (N = 66). In 31% of the patients TmP/GFR was below 0.80 mmole/liter and in 13% of the patients, FE HCO3 after alkali loading was above normal. Urinary excretion of lysozyme and that of gamma-GT both were elevated in 17% of the patients. FE glucose, FE insulin, FE Mg, and FE K were elevated in 8, 9, 3, and 7% of the patients, respectively. This study demonstrates that a significant number of stone formers present with signs of renal tubular dysfunction, primarily involving the proximal tubule since apparent leaks of phosphate and of bicarbonate were most frequently encountered. The defects were not specific for a given etiologic group of patients; on the other hand, occurrence was related to the presence of large stones in the pyelocaliceal system at the time data were gathered. Taken together these data suggest that the tubulopathy in nephrolithiasis is the consequence rather than the cause of the stone.
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PMID:Tubulopathy in nephrolithiasis: consequence rather than cause. 287 Dec 16

Surgery is indicated for patients with obstructive uropathy; calcium oxalate, calcium phosphate, silica, and perhaps cystine uroliths; uroliths refractory to medical dissolution; nephrolithiasis and progressive renal dysfunction; anatomic defects predisposing to urinary tract infection; and problems precluding medical management. The goals of surgical management include removal of all uroliths while preserving organ function, eliminating partial or complete obstruction to urine outflow, and correction of anatomic abnormalities that predispose the patient to infection and or urolithiasis.
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PMID:Surgical removal of canine uroliths. 348 20

In 78 patients with hypomagnesemia in urolithiasis the clinical course of disease was established in relation to therapy and dynamics of changes of serum magnesium levels. Almost 70% of patients had multiple, bilateral or recurrent nephrolithiasis or nephrocalcinosis. 70% of patients had Ca-oxalate stones or bilateral nephrocalcinosis. In 52% of patients a long-term magnesium supplementation was necessary. Significant progress of nephrolithiasis and nephrocalcinosis was observed in 80% of patients with permanent hypomagnesemia and in 4% of patients with normalization of serum magnesium level. Three of 15 patients with hypomagnesemia and progress of disease were transplanted a kidney and two were treated by hemodialysis. All five patients with renal failure had bilateral nephrocalcinosis, in three of them familiar occurrence of nephrolithiasis and hypomagnesemia was found.
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PMID:Prognosis of urolithiasis and nephrocalcinosis in hypomagnesemia. 393 9

Using the ambulatory protocol previously described, 241 patients with nephrolithiasis were evaluated. They could be categorized into 10 groups from the results obtained. Absorptive hypercalciuria type I (87 per cent male) comprised 24.5 per cent and was characterized by normocalcemia, normal fasting urinary calcium (less than 0.11 mg/100 ml glomerular filtration), an exaggerated urinary calcium following an oral calcium load (greater than 0.20 mg/mg creatinine), normal urinary cyclic adenosine monophosphate (AMP) (less than 5.4 nmol/100 ml glomerular filtration) and serum parathyroid hormone (PTH), and hypercalciuria (greater than 200 mg/day during a calcium- and sodium-restricted diet). Absorptive hypercalciuria type II (50 per cent male) accounted for 29.8 per cent; its biochemical features were the same as those for absorptive hypercalciuria type I, except for normocalciuria during a restricted diet and low urine volume (1.42 +/- 0.55 SD liter/day). Renal hypercalciuria (56 per cent male), disclosed in 8.3 per cent, was represented by normocalcemia and high values for fasting urinary calcium (0.160 +/- 0.054 mg/100 ml glomerular filtration), urinary cyclic AMP (6.80 +/- 2.10 nmol/100 ml glomerular filtration) and serum PTH. Primary hyperparathyroidism (57 per cent female), accounted for 5.8 per cent, typically included hypercalcemia, hypophosphatemia, hypercalciuria and high urinary cyclic AMP. Hyperuricosuric calcium urolithiasis (100 per cent male) comprised 8.7 per cent, and was characterized by hyperuricosuria (776 +/- 164 mg/day) and urinary pH exceeding pK for uric acid (5.91 +/- 0.33). In enteric hyperoxaluria (60 per cent female), encountered in 2.1 per cent of cases, urinary oxalate was increased (6.29 +/- 13.2 mg/day). Noncalcium-containing stones were found in 2.1 per cent of the patients with uric acid lithiasis (100 per cent male) and in another 2.1 per cent of the patients with infection lithiasis (60 per cent female). These conditions were typified by low urinary pH (5.29 +/- 0.12) and high urinary pH (6.69 +/- 1.16), respectively. Renal tubular acidosis was found in one patient (male, 0.4 per cent). In 10.8 per cent of the patients (81 per cent male), no metabolic abnormality could be found, although urine volume was low (1.41 +/- 0.51 liter/day). Hypercalciuria could not be differentiated between absorptive hypercalciuria and renal hypercalciuria in 5.4 per cent of the patients. Thus, this ambulatory protocol disclosed a physiologic disturbance in nearly 90 per cent of the cases and provided a definitive diagnosis in 95 per cent of the patients.
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PMID:Ambulatory evaluation of nephrolithiasis. Classification, clinical presentation and diagnostic criteria. 624 14

For the last 30 years urolithiasis incidence in Kirghizia has been growing. Its prevalence is the highest in Chu and Osh rural areas (89%) where farmers widely use toxic insecticides. Urban population develop the disease more often (63%), especially employees (57.7%) versus workers (27.7%). Urolithiasis occurs in workers 8 times more frequently than in farmers. Food products contain insecticides in quantities much higher than MAC. The contamination concerns fruit and vegetables in a lesser and meat, milk products in greater degrees. In renal tissue, blood, urine of urolithiasis patients concentrations of the chemicals were increased 4 times against the control samples. In renal tissue and fat of urolithiasis animals nephrotoxic insecticides levels surpassed those in the controls 2-3 times. Uroliths contain chemicals in great concentrations also. Basing on the conformity of geography of insecticides us a ge with urolithiasis epidemiological data, high concentrations of the chemicals in food and biological objects, frequent occurrence of recurrent urolithiasis in patients known to acquire high chemicals levels in renal tissue and urine, it is inferred that toxic chemicals are involved in nephrolithiasis genesis by tubular impairment.
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PMID:[Poisonous chemicals and urolithiasis]. 752 29


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