scholarly journals Urolithiasis: Update on Metabolic Evaluation of Stone Formers

2005 ◽  
Vol 5 ◽  
pp. 902-914 ◽  
Author(s):  
Sangtae Park ◽  
Margaret S. Pearle
Keyword(s):  
Medical Therapy ◽  
Substantial Reduction ◽  
Screening Tests ◽  
Risk Level ◽  
Initial Screening ◽  
Metabolic Evaluation ◽  
Recurrence Rates ◽  
Stone Recurrence ◽  
Stone Formers ◽  
First Time

Metabolic abnormalities are identified in over 90% of stone formers and the institution of preventative dietary and medical measures has resulted in substantial reduction in stone recurrence rates. We review the contemporary approach to metabolic evaluation of urolithiasis.A careful medical and dietary history, stone analysis, serologic tests, and urinalysis constitute the initial screening regimen in patients who have been diagnosed with stones. Risk stratification of patients, based on the outcome of the initial screening tests, determines the need for and extent of urinary evaluation in individual stone formers. Conservative dietary measures or a simple metabolic evaluation and treatment has been described for first-time or low-risk stone formers, although the number of 24-h urine collections needed is debatable. A more extensive metabolic evaluation is recommended for recurrent or high-risk stone formers or for those in whom empiric treatment or medical therapy based on simplified evaluation is unsuccessful.Regardless of etiology, all stone formers should be counseled on dietary measures for stone prevention. The need for medication is determined by the results of 24-h urine analysis and the risk level of the patient. Cost effectiveness of the metabolic evaluation and treatment is strongly influenced by recurrence rate and efficacy of therapy.Metabolic evaluation and treatment has clearly been shown in randomized trials to reduce stone recurrence rates. Further study will determine the extent of evaluation necessary and the need for selective vs. empiric medical therapy for first-time and recurrent stone formers.

MP73-03 CHARACTERIZATION AND RECURRENCE RATES OF FIRST TIME STONE FORMERS IN THE ERA OF CT

2014 ◽  
Vol 191 (4S) ◽  
Author(s):  
Justin Friedlander ◽  
Jodi Antonelli ◽  
Shreeya Popat ◽  
Margaret Pearle ◽  
Yair Lotan
Keyword(s):  
Recurrence Rates ◽  
Stone Formers ◽  
First Time

Evaluation of stone formers

2017 ◽  
Author(s):  
Muhammad Waqas Iqbal ◽  
Ghalib Jibara ◽  
Michael E. Lipkin ◽  
Glenn M. Preminger
Keyword(s):  
Stone Formation ◽  
Stone Disease ◽  
Metabolic Evaluation ◽  
Recurrence Rates ◽  
Preventative Measures ◽  
Stone Formers ◽  
Increased Risk ◽  
High Incidence ◽  
Recurrent Stone ◽  
Environmental Temperatures

Urolithiasis is among the most common urologic disorders with high incidence and recurrence rates. High environmental temperatures, prevalence of the Western diet, obesity, age, gender, and race are among the common risk factors associated with this disease. The primary goal of evaluating these patients is to provide a simple, economic, and effective workup, which yields information that is directly applicable to providing relevant medical preventative measures. The management of urolithiasis requires a relevant history, targeted physical exam, appropriate chemistry, urinary and stone analyses results, radiological imaging to accurately identify number, location, and size of stones, as well as a metabolic evaluation. All stone formers whether single or recurrent should have a basic evaluation to identify any factors that may predispose to recurrent stone formation. Comprehensive metabolic evaluations are offered to patients at increased risk of recurrence or morbidity from stone disease, or have difficult to treat stones.

scholarly journals Metabolic evaluation guidelines in patients with nephrolithiasis: Are they being followed? Results of a national, multi-institutional, quality-assessment study

2018 ◽  
Vol 12 (10) ◽  
Author(s):  
Sabrina S. Harmouch ◽  
Hiba Abou-Haidar ◽  
Hassan ElHawary ◽  
Thomas Grgic ◽  
Andrea G. Lantz ◽  
...  
Keyword(s):  
Kidney Stone ◽  
Best Practice ◽  
Stone Disease ◽  
Metabolic Evaluation ◽  
Best Practice Guidelines ◽  
Stone Formers ◽  
Canadian Population ◽  
Quality Assessment Study ◽  
Stone Prevention ◽  
First Time

Introduction: The significant cost burden of kidney stones underscores the importance of best clinical practice in kidney stone management. We evaluated adherence to kidney stone metabolic evaluation guidelines in a Canadian population and the interest of patients with regard to prevention.Methods: A questionnaire based on Canadian Urological Association (CUA) best practice guidelines was designed. Patients presenting for extracorporeal shockwave lithotripsy treatment (ESWL) were administered this questionnaire to evaluate risk factors of stone disease and assess the use of metabolic evaluations. Patients were asked if they received explanations about their results and if they were interested in kidney stone prevention.Results: We identified 530 patients at five academic institutions; 79.4% had at least one indication to receive a metabolic evaluation (high-risk stone formers), which increased to 96.6% if first-time stone formers whom reported an interest in metabolic evaluation were included. However, only 41.1 % of these patients had a metabolic evaluation. Endourologists ordered metabolic evaluation more often than other referring urologists (63.6% vs. 36.5%; p<0.001). Furthermore, urologists ordered metabolic evaluations more often than other prescribing physicians (68.9% vs. 31.1%; p<0.001). Sixtytwo percent of patients received explanations about their metabolic evaluation results and 77.5% understood them. Regarding prevention, 84.1% and 83.8% were interested in more explanations and in following a diet or taking a medication, respectively.Conclusions: Adherence to CUA metabolic evaluation guidelines is suboptimal and could be improved by urologists referring patients for ESWL. Communication between physician and patient may not be adequate. The majority of stone formers are interested in kidney stone prevention.

scholarly journals Stone Composition Among First-Time Symptomatic Kidney Stone Formers in the Community

2015 ◽  
Vol 90 (10) ◽  
pp. 1356-1365 ◽  
Author(s):  
Prince Singh ◽  
Felicity T. Enders ◽  
Lisa E. Vaughan ◽  
Eric J. Bergstralh ◽  
John J. Knoedler ◽  
...  
Keyword(s):  
Kidney Stone ◽  
Stone Composition ◽  
Stone Formers ◽  
First Time

Newborn Screening for Cystic Fibrosis

PEDIATRICS ◽  
1991 ◽  
Vol 87 (6) ◽  
pp. 954-955
Author(s):  
IAN C. T. LYON ◽  
DIANNE R. WEBSTER
Keyword(s):  
Cystic Fibrosis ◽  
Newborn Screening ◽  
Elevated Level ◽  
Meconium Ileus ◽  
Screening Tests ◽  
Initial Screening ◽  
False Negatives ◽  
Immunoreactive Trypsinogen

To the Editor.— The report on newborn screening for cystic fibrosis1 illustrates the need for continued evaluation of such programs. The authors state that the identification of cases of cystic fibrosis (CF) by an elevated level of immunoreactive trypsinogen (IRT) in second (follow-up) samples from infants with positive initial screening tests could result in false negatives in 27% of cases of cystic fibrosis without meconium ileus (MI). We have screened 401 122 infants using the method originally reported.2

scholarly journals Estimating the public health impact of a national guideline on cervical cancer screening: an audit study of a program in Campinas, Brazil

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Diama Bhadra Vale ◽  
Talita Lourenço Menin ◽  
Joana Froes Bragança ◽  
Julio Cesar Teixeira ◽  
Lucas Almeida Cavalcante ◽  
...  
Keyword(s):  
Public Health ◽  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Health Impact ◽  
Screening Tests ◽  
The Public ◽  
Frequent Interval ◽  
Cancer Screening Tests ◽  
First Time

Abstract Background A Brazilian guideline on cervical cancer screening was released in 2011. The objective was to verify changes in screening indicators around this period. Methods An audit study which sample was all screening tests performed by the public health system of Campinas city from 2010 to 2016. Variables were absolute tests numbers, excess tests, intervals and results, by age. For trend analysis was used Cochran-Armitage × 2 and linear regression. Results Were carried out 62,925 tests in 2010 and 43,523 tests in 2016, a tendency at a reduction (P = 0.001). Excess tests were higher than 50% over the years, with a tendency at a reduction (P < 0.001). Tests performed on women under 25 ranged from 20.2 to 15.4% in the period (P < 0.001), while in the 25–64 years age-group, it ranged from 75.1 to 80.2% (P < 0.001). In 2010 the most frequent interval was annual (47.5%) and in 2016 biennial (34.7%). There was a tendency at a reduction in the proportion of tests performed at the first time and those with an annual interval (P < 0.001), and also a tendency at an increase in tests with intervals equal to or greater than biannual (P < 0.001). We observed a tendency at a reduction in LSIL and HSIL-CIN2 results (P = 0.04 and P = 0.001, respectively), and a tendency at an increase in HSIL-CIN3 result (P = 0.02). Conclusion The proportion of cervical cancer screening tests performed out of the recommendation showed a significant reduction in the period. This indicates a tendency to align cervical cancer screening in Campinas with the standards recommended.

Metabolic evaluation in calcium oxalate stone formers

2019 ◽  
Vol 18 (7) ◽  
pp. e2993
Author(s):  
D. Petrova ◽  
K. Petkova ◽  
I. Saltirov ◽  
T. Kolev
Keyword(s):  
Calcium Oxalate ◽  
Metabolic Evaluation ◽  
Calcium Oxalate Stone ◽  
Stone Formers
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