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

Hypoparathyroidism, deafness and renal dysplasia (HDR) syndrome is an autosomal dominant disorder characterized by hypoparathyroidism, sensorineural deafness and renal dysplasia. Herein, we report a case of HDR syndrome associated with nephrocalcinosis and distal renal tubular acidosis. A 34-year-old woman was admitted to investigate recurrent stone formation and bilateral nephrocalcinosis. As a 3-year-old child, she had been diagnosed with HDR syndrome without chromosome evaluation. She had spontaneous stone passages on several occasions. On laboratory examination, serum calcium and intact parathyroid hormone at lower levels. Urinary citrate excretion was extremely low at 51.6 mg/day. On an ammonium chloride loading test, complete distal renal tubular acidosis was proved. To prevent the nephrocalcinosis from deteriorating, she was given potassium-sodium citrate. Since administration, she has not experienced spontaneous stone passage or renal colic. Nephrocalcinosis and recurrent urolithiasis will strongly affect renal prognosis in this case and we consider that citrate medication is an effective therapy in avoiding progress of her nephrocalcinosis.
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PMID:Case of hypoparathyroidism, deafness and renal dysplasia (HDR) syndrome associated with nephrocalcinosis and distal renal tubular acidosis. 1751 29

There are few publications describing urolithiasis in deployed military personnel. Renal colic was the most common urologic indication for air evacuation from the 47th Combat Support Hospital during the first 6 months of Operation Iraqi Freedom and we describe our observations and experience herein. Institutional review board approval was obtained to create a database of patients presenting to the 47th Combat Support Hospital with urolithiasis. Patient demographics, stone characteristic, imaging modality, urinalysis results, treatment course, and outcomes were evaluated for 182 patients. Sixty percent of patients qualified for conservative treatment and spontaneous stone passage was documented in 28%. We conclude that conservative therapy is safe and appropriate initial treatment for the majority of deployed personnel with urinary calculi, however, many patients were lost to follow-up. No patient treated conservatively required admission for sepsis, azotemia, or other serious stone-related complication.
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PMID:Demographics, stone characteristic, and treatment of urinary calculi at the 47th Combat Support Hospital during the first 6 months of Operation Iraqi Freedom. 1752 Oct 97

Urinary calculi during pregnancy present not only a diagnostic challenge but also a management dilemma. In this retrospective study, we describe our experience with diagnosis and management of symptomatic urolithiasis in pregnant women. A total of 18 pregnant women were treated for urolithiasis at the Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, between 1999 and 2004. The incidence of symptomatic urolithiasis during pregnancy was 0.35%. Of the 20 stones found, nine were on the right side and 11 were on the left, and two patients had bilateral urinary stones. Most urolithiasis cases during pregnancy (55.5%) occurred in the third trimester. Flank pain (94.4%) was the most common clinical presentation. Conservative management was successful in 10 patients until the end of pregnancy and then definite treatment was performed. In four patients, a double-J stent was inserted successfully for persistent pain. In three cases with persistent pain, failure of double-J stent placement was treated with ureteroscopic lithotripsy under epidural anesthesia. One patient received percutaneous nephrostomy for persistent renal colic and pyonephrosis. Ultrasonographic evaluation of pregnant women with suspected renal colic is a reasonable diagnostic procedure. Ureteroscopy is another choice when conservative treatment fails.
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PMID:Management of symptomatic urolithiasis during pregnancy. 1752 6

Computed tomography (CT) is the diagnostic standard in Emergency Department evaluation of suspected renal colic but delivers substantial radiation. We determined the frequency of CT scan in suspected renal colic, diagnosis and outcome, and cumulative CT scans per patient. A retrospective chart review with waiver of informed consent was conducted. A total of 356 patient encounters were reviewed from January to October 2003. Mean age was 39 years. Seventy-four percent included a CT scan, with 38% normal, 58% showing urolithiasis, and 1% showing emergent etiologies. Six percent of patients undergoing CT were admitted for urolithiasis, and 6% had a urologic procedure within 7 days. Sixteen percent of patients did not have a CT scan, and 79% underwent two or more CT scans. Emergency Department patients presenting with symptoms suggesting renal colic are likely to undergo CT on multiple occasions. Radiation exposures from repeated CT scans are substantial, and a clinical decision rule for this scenario is needed.
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PMID:Cumulative CT exposures in emergency department patients evaluated for suspected renal colic. 1769 68

Extracorporeal shock wave lithotripsy (ESWL) is a safe, effective method to treat urinary lithiasis. The success rate in ESWL depends on stone location, size, number, and fragility as well as calceal anatomy and patency of the urinary tract. An association of calcineurin inhibitors and uric acid urolithiasis has been reported in renal allograft recipients, but the mechanism remains unknown. Herein we have reported the case of 68-year-old male patient who developed cryptogenic cirrhosis and underwent liver transplantation. Seven years after transplantation, the patient was admitted to the hospital with right renal colic. An 8.9-mm radiolucent stone at the pyeloureteric junction was associated with moderate consecutive hydronephrosis. The second stone was located in a lower renal calyx. After a failed attempt at retrograde ureteral stenting, we performed a percutaneous nephrostomy. Antegrade pyelography with following ESWL treatment resulted in disintegration of the obstructive stone at the pyeloureteric junction. Afterward, we performed antegrade placement of a double-J stent. Residual stones in the lower renal calyx were successfully treated with a 3-month course of oral intake of a dissolution agent-potassium sodium hydrogen citrate. In this case, we have discussed ESWL and oral dissolution therapy of radiolucent stones in a hydronephrotic right kidney, which resulted in stone-free disease after 3 months of combined therapy. There was neither clinical nor biochemical damage to the transplanted liver.
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PMID:Extracorporeal shock wave lithotripsy of impacted radiolucent stone at the right pyeloureteric junction and oral dissolution therapy in a patient with transplanted liver: a case report. 1808 30

Radiology has a primary role in the work-up of renal colic, both to confirm urolithiasis and to help determine management. The traditional imaging has been conventional radiography and intravenous program with multidetector non-contrast-enhanced helical computed tomography (NCECT) now the modality of choice. Nuclear medicine studies for renal colic are done now infrequently at most institutions. Ultrasound (US) is often done, especially in the emergency department, and magnetic resonance imaging (MRI) is promising. Radiation dose reduction is now on everyone's minds: Lower-dose CT techniques are being tested and used, and US and MR are considered as first modalities of choice in pregnant women and children.
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PMID:State of the art trends in imaging renal of colic. 1838 86

The study has been undertaken to improve the methods for diagnosing urolithiasis, which comprehensively evaluate the severity of a pathological process and the results of treatment in patients with nephrolithiasis. The paper gives the data of investigating the processes of chromatographic mass spectrometric urinalysis in 82 patients aged 15 to 81 years urgently admitted to the units of urology of Moscow City Clinical Hospital Seven for a renal colic attack. The levels of lithogenic substances were measured in patients with different types of metabolic disturbances. There was evidence that the chromatographic mass spectrometric parameters of the level of lithogenic substances and hydrolytic enzymes might be used as diagnostic criteria for the progression of urolithiasis, the prediction of the severity of a pathological process, and the development of preventive methods against lithogenesis in patients with a renal colic attack.
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PMID:[Chromatographic mass spectrometric assessment of the course of different forms of urolithiasis]. 1859 Jan 64

An 8-year-old phenotypic female with campomelic dysplasia (CD) and 46,XY sex-reversal presented with renal colic. Medullary nephrocalcinosis, urolithiasis, and renal malrotation were diagnosed by computed tomographic scanning. Pelvic sonogram identified an enlarged left gonad. Genetic testing revealed a novel SOX9 heterozygous deletion of a cytosine at nucleotide 972 (972delC), causing a frameshift at codon 200, introducing a stop codon 18 codons further downstream (P200fsX218). At laparoscopic gonadectomy, a left dysgerminoma was removed. This first reported case of dysgerminoma in a sex-reversed patient with CD who also had urolithiasis stresses the importance of prophylactic gonadectomy and urologic evaluations in this susceptible population.
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PMID:A novel SOX9 mutation, 972delC, causes 46,XY sex-reversed campomelic dysplasia with nephrocalcinosis, urolithiasis, and dysgerminoma. 1923 56

Idiopathic hypercalciuria is the most important predisposing risk factor for calcium oxalate (CaOx) renal stone formation. We assessed the associations between spontaneous CaOx crystallization based on the Bonn Risk Index (BRI), urinary pH, calciuria, oxaluria, and citraturia in 140 Caucasian patients with hypercalciuria, aged 4-17 years, and compared the findings with those in 210 normocalciuric controls. Of the 140 hypercalciuric patients, 58 had renal stones, and 82 had recurrent erythrocyturia, renal colic, or urinary obstructive symptoms-but without stones. Urinary ionized calcium ([Ca(2+)]) levels were measured using a selective electrode, while the onset of crystallization was determined using a photometer and titration with 40 mmol/L ammonium oxalate (Ox(2-)). The calculation of the BRI was based on the [Ca(2+)]:Ox(2-) ratio. The BRI values were 12-fold higher in hypercalciuric children than in healthy controls, but no differences were found in the BRI between subjects with urinary stones and those with urolithiasis-like symptoms. An increased BRI suggested an association with hypercalciuria, lower urinary pH, hypocitraturia, and hypooxaluria. These data indicate that hypercalciuria is an important factor associated with increased urinary CaOx crystallization, although the causal pathways need further investigation. Determination of the BRI in children with hypercalciuria may improve the risk assessment of kidney stones.
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PMID:Spontaneous urinary calcium oxalate crystallization in hypercalciuric children. 1935 Feb 80

The purpose of this study was to assess the referral patterns and the use of unenhanced renal tract CT (CT KUB) for investigating patients presenting with clinically suspected renal colic. We retrospectively reviewed 500 consecutive CT KUB studies requested for suspected renal colic carried out at a single institution between December 2006 and July 2007. Follow-up radiology reports and discharge summaries on the hospital clinical Intranet were also reviewed. Studies were analysed for characteristics including patient demographics, referring clinical team, time of referral, final diagnosis and requirement for further imaging. The majority of requests were from Emergency (ED) or Urology Departments (49%, 245 out of 500, and 37%, 186 out of 500, respectively). The positive rate for urolithiasis was 67% (337 out of 500), the negative rate was 25% (123 out of 500), and 8% (40 out of 500) of patients had alternative significant findings. Female patients were more likely to have a negative study than male patients (35 versus 20%, P < 0.0001) and more likely to have alternative significant pathology (12 versus 6%, P < 0.0001). Patients referred by specialities other than Urology and ED were more likely to be female and have a negative or alternative finding (P < 0.0001). CT KUB is a widely used first method of investigation for patients with suspected renal colic with a high positive predictive value allowing rapid diagnosis and intervention. However, given the high rate of negative or alternative findings on CT KUB in young women, especially those referred by specialities other than ED or Urology, ultrasound should be considered as an alternative imaging method to minimise unnecessary radiation exposure.
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PMID:Assessment of referral patterns for CT KUB in a tertiary setting. 2000 82


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