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

The introduction of the multichannel autoanalyser made measurement of serum calcium concentrations easier, and led to a dramatic change in clinical presentations. The reliable methods such as computed tomography (CT), ultrasonography (US) and magnetic resonance imaging (MRI) for preoperative localization of abnormal parathyroid glands has long been sought to increase the cure rate of surgical treatment. We report the clinical feature of primary hyperparathyroidism (PHPT). Patients were classified into four stages in chronological order. The early patients (the first stage, 1970-1979) were mainly diagnosed in the treatment of urolithiasis. Approximately 20% of patients in the second stage (1980-1986) were symptom-free, and hypercalcemia was detected by autoanalyzer. Patients in the third stage (1987-1993) underwent preoperative localization studies including CT. scintigraphy, ultrasonography and MRI. The recent patients (the fourth stage, 1993-1999) were mostly treated in the present hospital. In the first stage, PHPT was an uncommon metabolic disorder hat was typically associated with nephrolithiasis and was two to three times more common in men than in women. In the second, third and fourth stages, PHPT is a common and often symptomless endocrine disorder. The ratio of male to female is decreasing, because men are dominant in stone-formers. Four parathyroid glands were searched carefully in the first and second stages, and unilateral cervical exploration was performed in some preoperatively localized parathyroid glands in the third and fourth stages.
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PMID:Clinical features of primary hyperparathyroidism: preoperative localization and parathyroidectory. 1091 95

Etiological factors and pathogenetic mechanisms were studied in 538 patients with nephrolithiasis. By composition of uroliths and salts, all the patients were divided into groups by types of urolithiasis (oxalate, urate, phosphate, cystic and mixed). After elimination of the uroliths using different methods, metaphylaxis of nephrolithiasis was conducted in all the patients. It varied with type of lithogenesis, etiology and pathogenesis. Antirecurrence therapy included diet with restriction of lithogenic substances, endogenic reduction of lithogenic metabolites and measures to decrease and block crystallization and lithogenesis. The treatment has diminished the incidence of recurrences from 32.3 to 9.6% (total), from 14.4 to 5.3% (in oxalate type), 47.2 to 16.9% (in phosphate type), 39.7 to 6.7% (in urate type), 40.5 to 17.7% (in mixed type).
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PMID:[Metaphylaxis of nephrolithiasis]. 1115 Jan 46

Evaluation of the risk for developing renal insufficiency is generally not considered during the clinical metabolic workup of the stone-forming patient. This review approaches the problem of the severity of nephrolithiasis by addressing the renal risk. Although renal stones are an infrequent cause of renal failure, some lithiasic forms present a greater risk, such as in hereditary stone diseases (eg, cystinuria, primary hyperoxaluria, Dent's disease), primary struvite stones, and infection-related urolithiasis associated with anatomic and functional urinary tract anomalies and spinal cord injury. Recurrent bouts of obstruction and/or crystal-specific biological effects on tubular epithelial cells and interstitial renal cells may activate the fibrogenic cascade responsible for the loss of renal parenchyma. In clinical terms, frequent stone relapses, episodes of urinary tract infection and obstruction, number of urological interventions, and size of the gravel are all significantly associated with the risk for renal failure. Percutaneous and extracorporeal urological methods for the treatment of renal stones may also lead to some chronic deterioration of renal function, particularly in recurrent stone formers treated with multiple therapeutic sessions. Although still speculative, concerns exist about the effect of extracorporeal shock wave lithotripsy on small or pathological kidneys. Without doubt, the medical prevention of stones would be more sensible.
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PMID:Risk for renal failure in nephrolithiasis. 1115 64

A retrospective comparison of the evidence obtained at preoperative examination of 68 patients with urolithiasis operated with the use of percutaneous technologies has demonstrated that the risk of postoperative infectious-inflammatory complications depends much on the immune status of the patient. Patients with initially different states of phagocytic immunity and antibody production had different courses of the postoperative period. An algorithm of immunological prediction of an acute pyelonephritis attack after percutaneous operations for nephrolithiasis is proposed.
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PMID:[Immunologic assessment of the risk of developing infectious-inflammatory complications after percutaneous operations for nephrolithiasis]. 1187 65

Analysis of 22,510 urinary calculi between January 1991 to July 2000 performed by infrared spectroscopy allows for separation of drug-induced urolithiasis into two categories: first, the drugs physically embedded in the stone (n = 238; 1.0 per cent), notably indinavir monohydrate (n = 126; 52.9 per cent), followed by triamterene (n = 43; 18.1 per cent), sulphonamides (n = 29; 12.2 per cent) and amorphous silica (n = 24; 10.1 per cent); second, the category of metabolic nephrolithiasis induced by drugs (n = 140; 0.6 per cent), involving mainly calcium and vitamin D supplementation (n = 56; 40.0 per cent) and carbonic anhydrase inhibitors (n = 33; 23.6 per cent). Composition of the stone depended not only on the inducer drug but also on the metabolic state of the patient. Today, drug-induced stones comprise about 1.6 per cent of all calculi in France. Physical analysis and therapeutic history recall of such patients are the keys to diagnosis. Medical care is based on drug avoidance or dose adjustment with increased diuresis and, if necessary, change in urinary pH.
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PMID:[Urinary lithiasis of medical origin]. 1187 1

This paper deals of kidney stones, hard concretions that grow within the urinary tract, 71.5% of which have calcium contents. A high rate of recurrences underscores the importance of medical prevention with a variety of conservative (increased fluid intake and dietary modifications) and drug therapy (potassium citrate, potassium magnesium citrate, thiazides, allopurinol). In single stone formers and mild recurrent diseases, the conservative therapy may alone be effective and should be maintained in more severe recurrent disease, together with drug treatment. In particular, in idiopathic calcium oxalate nephrolithiasis, the importance of sodium restriction in the diet, that should reduce calcium excretion, has been recently shown, limiting the old assumption of the value of dietary calcium restriction; in fact normal or higher calcium intake, binding oxalate in the intestinal tract, seems to confer protection against stone formation. The urologic approach to urolithiasis has changed with the introduction of extracorporeal shock wave lithotripsy (ESWL), a technique that allows a relatively noninvasive removal of stones. Nevertheless ESWL does not change the propensity of recurrence of stone formers, and the importance of medical prevention remains paramount in the management of renal stone disease.
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PMID:[Etiopathogenesis and clinical aspects of nephrolithiasis--at present]. 1267 82

Cystinuria is an autosomal recessive defect in transepithelial transport of dibasic amino acids (e.g. cystine) which involves the proximal canaliculi, small intestine and central nervous system. It is the least common cause of nephrolithiasis, accounting for 1 to 3% of renal calculi. The natural course of the disease, characterised by recurrent stone formation, can frequently lead to renal failure, if left untreated. Until recently, treatment of cystinuria has been limited to symptomatic management including intensive hydration and urine alkalinisation. Different drugs that react with cystine to form soluble complexes have been used but their efficacy remains questionable. We present the case of a 6-year-old boy with severe, recurrent cystine urolithiasis treated with captopril. The diagnosis of cystine urolithiasis was established after a 3-year course of clinically apparent nephrolithiasis, characterised by stone passage. At the age of 5 years he underwent lithotripsy and nephrolithotomy for removal of staghorn calculi. Since then treatment with citrate and magnesium supplementation combined with captopril was introduced. After a follow-up of 12 months the patient remained stone-free. Urinary cystine decreased from 230 to 136 mg per gram creatinine. We conclude that captopril can be useful in the treatment of cystine urolithiasis in children.
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PMID:[Beneficial effect of angiotensin converting enzyme inhibitor treatment in severe cystine urolithiasis]. 1291 8

The case histories of 299 patients examined at the Urogenital Department, Novosibirsk Research Institute of Tuberculosis, were analyzed to define the etiology of urogenital diseases. The diagnosis of urogenital tuberculosis was established in 112 (37.4%) patients; that of chronic nonspecific pyclonephritis was in 90 (30.1%) patients; chronic nonspecific prostatitis was detected in 49 (16.4%) males; urolithiasis was found in 20 (6.7%) patients. Twelve (4%) and 60 (20.1%) patients were diagnosed as having urinary system cancer and hematuria, respectively. Hematuria most frequently (75%) was indicative of the presence of a tumor. However, in renal tuberculosis, this sign was also revealed in 24.1% of the patients. It should be noted that there is a recent tendency for an increase in the incidence of diseases concurrent with hematuria: the kidney has been found to be concomitantly afflicted with tuberculosis and cancer in 2 patients; tuberculosis is concurrent with nephrolithiasis in 2 other patients.
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PMID:[Significance of hematuria in phthisiourology]. 1452 93

The Siemens Lithostar Litotriptor was used to treat 6 children with cystine nephrolithiasis, previously treated by open surgery. Five children had renal calculi (3 multiple caliceal, 2 pelvis) and one had ureteral calculus. Stone size ranged from 0.2-2.5 cm in diameter, and stone burden was from 0.24 to 10.81 cm3 per kidney. From one to 4 ESWL sessions per unit were applied, with a total of 1,800 to 12,000 shock waves. The stone free rate at 3 months was 50%. A complete elimination was obtained with cystine stones in renal pelvis and ureter, however, up to 4 ESWL treatments failed in caliceal stones. Rather location of cystine calculi than previous surgery was associated with ESWL success rate. Two patients with positive urine cultures were successfully treated with appropriate antibiotics before ESWL was attempted. Perirenal hematoma was major complication demonstrated by radionuclide scintigraphy in one patient, and resolved spontaneously by 3 months. In the combined treatment of cystine urolithiasis in children ESWL, as auxillary procedure, was safe and effective in pelvis stone but failed in caliceal stones. Medical dissolution for retained fragments was found effective.
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PMID:Extracorporeal shock wave lithotripsy for cystine urolithiasis in children: outcome and complications. 1457 84

OBJECTIVE: To analyze the clinical history and evolution of children and adolescents with IH, emphasizing some of their peculiar features. METHODS: We followed 471 patients with IH at an outpatient clinic. Patients were submitted to the following protocol: abdominal X-ray, kidney and urinary tract ultrasonography; urinary ionogram, blood gas and biochemical analyses; 24-hour urine for measurement of calcium and other electrolytes and creatinine; urinalysis, urine culture and phase-contrast microscopy; second morning urine collected after fasting for measurement of calcium and creatinine. RESULTS: At the time of diagnosis, 6% of the patients were infants, 15% pre-school children, 55% school children, and 24% adolescents; 56% of them were boys. Clinical and laboratory findings were: 47% had hematuria and abdominal pain, 31% had isolated hematuria, 14% isolated abdominal pain, and 8% had urinary tract infection, nocturnal enuresis, suprapubic pain or urethralgia, or the frequency/urgency syndrome with urinary incontinence. Hypercalciuria was associated with urolithiasis in 56% of patients. There was association with hyperuricosuria in 18.5% of the cases, and hypocitraturia in 8.5% of the cases. Evolution was poor for 33% of the patients, with recurrence of nephrolithiasis, persistence of hematuria, and abdominal pain. CONCLUSIONS: IH must be diagnosed and treated with criteria in order to reduce consequences such as hematuria, abdominal pain, urinary stone formation and possible bone involvement. Signs and symptoms such as urgency and urinary incontinence, suprapubic pain and nocturnal enuresis may result from renal hyperexcretion of calcium.
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PMID:[Idiopathic hypercalciuria: presentation of 471 cases] 1464 99


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