Nephrolithiasis

2016 ◽  
Author(s):  
Peregrine Dalziel ◽  
Nicholas Schirmer
Keyword(s):  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Renal Stones ◽  
Renal Calculi ◽  
Renal Calculus ◽  
Ultrasound Images ◽  
Drug Induced ◽  
Size Category ◽  
Test Characteristics ◽  
Twinkling Artifact

The term nephrolithiasis, often used synonymously with urolithiasis, refers to the formation of solid concretions consisting of both protein and crystalline materials in the lumen of the urinary tract. These calculi, or “stones,” become symptomatic when they cause acute obstruction, and as such, there are an unknown but probably large number of individuals with nephrolithiasis who are subclinical, without signs or symptoms. This review covers the pathophysiology, stabilization and assessment, diagnosis, and treatment of nephrolithiasis. Figures show ultrasound images of a stone with shadowing, a stone with a twinkling artifact, hydronephrosis, and a stone with shadowing at the ureterovesicular junction and a computed tomographic (CT) image showing a renal calculus at the ureterovesicular junction. Tables list drug-induced renal calculi, the proportion of stones spontaneously passing depending on size category as identified on CT, diagnostic test characteristics for renal colic diagnosis, the clinical prediction rule for the risk of renal stones, an example of the theoretical probability of stone disease using Moore and colleagues’ risk stratification, pooled test characteristics, bayesian analysis, and important pathology diagnosed on CT scan in the investigation of flank pain in four studies.   Key words: kidney stone, nephrolithiasis, renal calculus, renal stone, urolithiasis This review contains 5 highly rendered figures, 6 tables, and 75 references.

Study of calcium oxalate monohydrate of kidney stones by X-ray diffraction

2008 ◽  
Vol 23 (S1) ◽  
pp. S59-S64 ◽  
Author(s):  
M. T. D. Orlando ◽  
L. Kuplich ◽  
D. O. de Souza ◽  
H. Belich ◽  
J. B. Depianti ◽  
...  
Keyword(s):  
Calcium Oxalate ◽  
Powder Diffraction ◽  
Renal Stones ◽  
Renal Calculi ◽  
Calcium Oxalate Monohydrate ◽  
Renal Calculus ◽  
Southeastern Brazil ◽  
Second Phase ◽  
X Ray ◽  
Papillary Type

X-ray powder diffraction was used to study the phase composition of human renal calculi. The stones were collected from 56 donors in Vitória, Espírito Santo state, southeastern Brazil. An XRD phase quantification revealed that 61% of the studied renal stones were composed exclusively of calcium oxalate [34% formed only by calcium oxalate monohydrate (COM) and 27% presents both monohydrate and dihydratate calcium oxalate]. The 39% multi-composed calculi have various other phases such as uric acid and calcium phosphate. Rietveld refinement of XRD data of one apparent monophasic (COM) renal calculus revealed the presence of a small amount of hydroxyapatite. The presence of this second phase and the morphology of the stone (ellipsoidal) indicated that this calculus can be classified as non-papillary type and its nucleation process developed in closed kidney cavities. In order to show some advantages of the X-ray powder diffraction technique, a study of the phase transformation of monohydrate calcium oxalate into calcium carbonate (CaCO3) was carried out by annealing of a monophasic COM calculi at 200, 300, and 400 °C for 48 h in a N2 gas atmosphere. The results of the XRD for the heat treated samples is in good agreement with the thermogravimetric analysis found in the literature and shows that X-ray powder diffraction can be used as a suitable technique to study the composition and phase diagram of renal calculi.

Use of non-contrast computed tomography determined urinary stone fragility in predicting the outcome of extracorporeal shockwave lithotripsy treatment: a single-center study

2020 ◽  
Vol 14 (2) ◽  
pp. 59-63
Author(s):  
Athar Hameed ◽  
Khazir Hayyat Gondal
Keyword(s):  
Shock Waves ◽  
Renal Stone ◽  
Plain Film ◽  
Renal Stones ◽  
Renal Calculus ◽  
Urinary Stone ◽  
Stone Disease ◽  
Urinary Stones ◽  
Fisher Exact Test

Background: Renal stones represent a common urological pathology where standard treatment advised is ESWL in current practice. However, NCCT based determination of stone fragility may help to predict the outcome of ESWL treatment, hence optimizing its clinical use. Therefore, this study evaluated the role of NCCT determined urinary stone fragility in predicting the outcome of ESWL treatment in local clinical settings. Patients and methods: One hundred patients with single renal calculus of 0.6-2 cm in size were included. NCCT based determination of stone fragility in HU units was done for all patients. Patients were then subjected to ESWL, with a maximum of 3000 shock waves given per ESWL session. Plain film and/or ultrasonography was used to monitor ESWL treatment progress with a final NCCT evaluation at 12 weeks to determine the clearance of the calculi for each patient. Association of NCCT based stone fragility and outcome of ESWL was statistically analyzed using Fisher exact test. Results: The mean age of the patients was 37.7 ± 10.9 years with 54% being male. Decreasing stone fragility on NCCT (high = <500HU, moderate = 500-1000HU, and high = 1000HU) required more number and intensity of ESWL sessions (1-2 visits and 3000-6000 shock waves for high stone fragility group, 3-5 visits and 7000-18000 shock waves for the moderate group, and 6 visits and >18000 shock waves for low fragility group, respectively) necessary for clearance of urinary stones (p<0.001). In 98% of patients, the clearance of urinary stones was excellent. Conclusion: Renal stone patients with NCCT determined high and moderate stone fragility show an optimal response after ESWL treatment, whereas, for low fragility renal stones attenuative treatment like percutaneous nephrolithotomy and/or ureteroscopy should be considered instead of ESWL. This approach can enable patient stratification before ESWL therapy ensuring better clinical management of the renal stone disease.

The effect of Gokshura Churna over Tilanalakshara Yoga in the management of Mutrashmari - A Randomized Comparative Clinical Study

2018 ◽  
Vol 3 (5) ◽  
Author(s):  
Dr. Anil M. Sanshi ◽  
Dr.Pallavi A. Hegde
Keyword(s):  
Abdominal Pain ◽  
Renal Calculi ◽  
Renal Calculus ◽  
P Value ◽  
Standard Group ◽  
Standard Drug ◽  
Female Ratio ◽  
Comparative Clinical Study ◽  
Group B ◽  
Trial Drug

Background: Mutrashmari is a stone like structure anywhere in the Mutravaha Srothas which can be compared with renal calculi and one among the Astamahagada, clinical features as renal angle pain, haematuria, pyuria and dysuria. Peak age is 3rd to 5th decade while majority of patients report regarding onset of disease in 2nd decade of life and male to female ratio is 3:1. Objectives: To compare the effect of Gokshura Churna over Tilanalakshara Yoga in the management of Mutrashmari with special reference to Renal calculi. Materials and Methods: 30 patients were selected on the basis of inclusion criteria and divided into 2 groups with 15 patients in each group by chit method. Group A was treated with standard drug Tilanalakshara Yoga and Group B was traeted with trial drug Gokshura Churna. Results: It was found that standard group reduced the abdominal pain by 85.1%, dysuria by 89.4%, renal angle tenderness 88.4%, haematuria 100%, pyuria 100%, size of renal calculus 41.9% by 21st day of treatment. In study group it was observed that abdominal pain reduced by 92%, dysuria 96.1%, renal angle tenderness 91.6%, haematuria 100%, pyuria 100% and size of renal calculus 48.5% by 21st day of treatment. Conclusion: This assessment showed Gokshura Churna had significant result over Tilanala Kshara Yoga in both subjective and objective parameters with P value less than 0.0001.

scholarly journals Development and validation of a clinical prediction rule for development of diabetic foot ulceration: an analysis of data from five cohort studies

2021 ◽  
Vol 9 (1) ◽  
pp. e002150
Author(s):  
Francesca M Chappell ◽  
Fay Crawford ◽  
Margaret Horne ◽  
Graham P Leese ◽  
Angela Martin ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Secondary Care ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Initial Assessment ◽  
Validation Dataset ◽  
Benefit Analysis ◽  
Clinical Prediction ◽  
Net Benefit ◽  
Foot Ulceration

IntroductionThe aim of the study was to develop and validate a clinical prediction rule (CPR) for foot ulceration in people with diabetes.Research design and methodsDevelopment of a CPR using individual participant data from four international cohort studies identified by systematic review, with validation in a fifth study. Development cohorts were from primary and secondary care foot clinics in Europe and the USA (n=8255, adults over 18 years old, with diabetes, ulcer free at recruitment). Using data from monofilament testing, presence/absence of pulses, and participant history of previous ulcer and/or amputation, we developed a simple CPR to predict who will develop a foot ulcer within 2 years of initial assessment and validated it in a fifth study (n=3324). The CPR’s performance was assessed with C-statistics, calibration slopes, calibration-in-the-large, and a net benefit analysis.ResultsCPR scores of 0, 1, 2, 3, and 4 had a risk of ulcer within 2 years of 2.4% (95% CI 1.5% to 3.9%), 6.0% (95% CI 3.5% to 9.5%), 14.0% (95% CI 8.5% to 21.3%), 29.2% (95% CI 19.2% to 41.0%), and 51.1% (95% CI 37.9% to 64.1%), respectively. In the validation dataset, calibration-in-the-large was −0.374 (95% CI −0.561 to −0.187) and calibration slope 1.139 (95% CI 0.994 to 1.283). The C-statistic was 0.829 (95% CI 0.790 to 0.868). The net benefit analysis suggested that people with a CPR score of 1 or more (risk of ulceration 6.0% or more) should be referred for treatment.ConclusionThe clinical prediction rule is simple, using routinely obtained data, and could help prevent foot ulcers by redirecting care to patients with scores of 1 or above. It has been validated in a community setting, and requires further validation in secondary care settings.

scholarly journals Developing a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040730
Author(s):  
Gea A Holtman ◽  
Huibert Burger ◽  
Robert A Verheij ◽  
Hans Wouters ◽  
Marjolein Y Berger ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Somatic Symptoms ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Model Discrimination ◽  
Clinical Prediction ◽  
Internal Validation ◽  
Predictive Values ◽  
Healthy Activity

ObjectivesPatients who present in primary care with chronic functional somatic symptoms (FSS) have reduced quality of life and increased health care costs. Recognising these early is a challenge. The aim is to develop and internally validate a clinical prediction rule for repeated consultations with FSS.Design and settingRecords from the longitudinal population-based (‘Lifelines’) cohort study were linked to electronic health records from general practitioners (GPs).ParticipantsWe included patients consulting a GP with FSS within 1 year after baseline assessment in the Lifelines cohort.Outcome measuresThe outcome is repeated consultations with FSS, defined as ≥3 extra consultations for FSS within 1 year after the first consultation. Multivariable logistic regression, with bootstrapping for internal validation, was used to develop a risk prediction model from 14 literature-based predictors. Model discrimination, calibration and diagnostic accuracy were assessed.Results18 810 participants were identified by database linkage, of whom 2650 consulted a GP with FSS and 297 (11%) had ≥3 extra consultations. In the final multivariable model, older age, female sex, lack of healthy activity, presence of generalised anxiety disorder and higher number of GP consultations in the last year predicted repeated consultations. Discrimination after internal validation was 0.64 with a calibration slope of 0.95. The positive predictive value of patients with high scores on the model was 0.37 (0.29–0.47).ConclusionsSeveral theoretically suggested predisposing and precipitating predictors, including neuroticism and stressful life events, surprisingly failed to contribute to our final model. Moreover, this model mostly included general predictors of increased risk of repeated consultations among patients with FSS. The model discrimination and positive predictive values were insufficient and preclude clinical implementation.

scholarly journals Prognostic value of the ABCD2 clinical prediction rule: a systematic review and meta-analysis

2011 ◽  
Vol 28 (4) ◽  
pp. 366-376 ◽  
Author(s):  
R. Galvin ◽  
C. Geraghty ◽  
N. Motterlini ◽  
B. D. Dimitrov ◽  
T. Fahey
Keyword(s):  
Systematic Review ◽  
Prognostic Value ◽  
Meta Analysis ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Clinical Prediction

The Risk of Severe Postoperative Pain: Modification and Validation of a Clinical Prediction Rule

2008 ◽  
Vol 107 (4) ◽  
pp. 1330-1339 ◽  
Author(s):  
Kristel J. M. Janssen ◽  
Cor J. Kalkman ◽  
Diederick E. Grobbee ◽  
Gouke J. Bonsel ◽  
Karel G. M. Moons ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Clinical Prediction ◽  
Severe Postoperative Pain
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