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

scholarly journals SLIPS-LAB—A bioinspired bioanalysis system for metabolic evaluation of urinary stone disease

2020 ◽  
Vol 6 (21) ◽  
pp. eaba8535
Author(s):  
Hui Li ◽  
Eugene Shkolyar ◽  
Jing Wang ◽  
Simon Conti ◽  
Alan C. Pao ◽  
...  
Keyword(s):  
Urinary Stone ◽  
Stone Disease ◽  
Clinical Samples ◽  
Metabolic Evaluation ◽  
Biologically Inspired ◽  
Urinary Stone Disease ◽  
Liquid Handling ◽  
Stone Formers ◽  
Pharmacologic Treatments ◽  
Urine Testing

Urinary stone disease is among the most common medical conditions. Standard evaluation of urinary stone disease involves a metabolic workup of stone formers based on measurement of minerals and solutes excreted in 24-hour urine samples. Nevertheless, 24-hour urine testing is slow, expensive, and inconvenient for patients, which has hindered widespread adoption in clinical practice. Here, we demonstrate SLIPS-LAB (Slippery Liquid-Infused Porous Surface Laboratory), a droplet-based bioanalysis system, for rapid measurement of urinary stone–associated analytes. The ultra-repellent and antifouling properties of SLIPS, which is a biologically inspired surface technology, allow autonomous liquid handling and manipulation of physiological samples without complicated sample preparation procedures and supporting equipment. We pilot a study that examines key urinary analytes in clinical samples from patients with urinary stone. The simplicity and speed of SLIPS-LAB hold the potential to provide actionable diagnostic information for patients with urinary stone disease and rapid feedback for responses to dietary and pharmacologic treatments.

scholarly journals Urinary extracellular vesicle-associated MCP-1 and NGAL derived from specific nephron segments differ between calcium oxalate stone formers and controls

2019 ◽  
Vol 317 (6) ◽  
pp. F1475-F1482 ◽  
Author(s):  
Robin S. Chirackal ◽  
Muthuvel Jayachandran ◽  
Xiangling Wang ◽  
Samuel Edeh ◽  
Zejfa Haskic ◽  
...  
Keyword(s):  
Surface Area ◽  
Kidney Stone ◽  
Extracellular Vesicle ◽  
Stone Disease ◽  
Calcium Oxalate Stone ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Nephron Segments ◽  
Stone Formers ◽  
Noninvasive Biomarkers ◽  
Neutrophil Gelatinase

Randall’s plaque (RP; subepithelial calcification) appears to be an important precursor of kidney stone disease. However, RP cannot be noninvasively detected. The present study investigated candidate biomarkers associated with extracellular vesicles (EVs) in the urine of calcium stone formers (CSFs) with low (<5% papillary surface area) and high (≥5% papillary surface area) percentages of RP and a group of nonstone formers. RPs were quantitated via videotaping and image processing in consecutive CSFs undergoing percutaneous surgery for stone removal. Urinary EVs derived from cells of different nephron segments of CSFs ( n = 64) and nonstone formers ( n = 40) were quantified in biobanked cell-free urine by standardized and validated digital flow cytometer using fluorophore-conjugated antibodies. Overall, the number of EVs carrying surface monocyte chemoattractant protein (MCP)-1 and neutrophil gelatinase-associated lipocalin (NGAL) were significantly lower in CSFs compared with nonstone former controls ( P < 0.05) but did not differ statistically between CSFs with low and high RPs. The number of EVs associated with osteopontin did not differ between any groups. Thus, EVs carrying MCP-1 and NGAL may directly or indirectly contribute to stone pathogenesis as evidenced by the lower of these populations of EVs in stone formers compared with nonstone formers. Validation of EV-associated MCP-1 and NGAL as noninvasive biomarkers of kidney stone pathogenesis in larger populations is warranted.

scholarly journals Altered Calcium and Vitamin D Homeostasis in First-Time Calcium Kidney Stone-Formers

PLoS ONE ◽  
2015 ◽  
Vol 10 (9) ◽  
pp. e0137350 ◽  
Author(s):  
Hemamalini Ketha ◽  
Ravinder J. Singh ◽  
Stefan K. Grebe ◽  
Eric J. Bergstralh ◽  
Andrew D. Rule ◽  
...  
Keyword(s):  
Vitamin D ◽  
Kidney Stone ◽  
Stone Formers ◽  
First Time

scholarly journals Risk of Hypertension among First-Time Symptomatic Kidney Stone Formers

2017 ◽  
Vol 12 (3) ◽  
pp. 476-482 ◽  
Author(s):  
Wonngarm Kittanamongkolchai ◽  
Kristin C. Mara ◽  
Ramila A. Mehta ◽  
Lisa E. Vaughan ◽  
Aleksandar Denic ◽  
...  
Keyword(s):  
Kidney Stone ◽  
Stone Formers ◽  
First Time

scholarly journals P0175DETERMINANTS OF RENAL PAPILLARY APPEARANCE IN RENAL STONE FORMERS: AN IN-DEPTH EXAMINATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Matteo Bargagli ◽  
Rossella De Leonardis ◽  
Mauro Ragonese ◽  
Angelo Totaro ◽  
Francesco Pinto ◽  
...  
Keyword(s):  
Kidney Stones ◽  
Kidney Stone ◽  
Medical Condition ◽  
Stone Formation ◽  
Blood Parameters ◽  
Stone Disease ◽  
Stone Composition ◽  
Stone Recurrence ◽  
Stone Formers

Abstract Background and Aims Nephrolithiasis is a medical condition characterized by high prevalence among the general population both in Europe and in the U.S. and it is responsible for high costs reaching up to $10 billion per year. It is associated with specific comorbidities such as obesity, arterial hypertension, diabetes mellitus, metabolic syndrome and chronic kidney disease. Kidney stones development is believed to start either from Randall’s plaques or from stone plugs. Both these lesions can be seen on renal papillary surfaces, but what promotes the formation of plaques and plugs is not entirely understood. The aim of this study is to investigate the association between the urinary metabolic milieu and a published endoscopic papillary evaluation score (PPLA). We also evaluated the correlation of PPLA score with kidney stone recurrence during follow-up. Method We prospectively enrolled 31 stone forming patients who undergone retrograde intrarenal surgery procedures. Visual inspection of the accessible renal papillae was performed in order to calculate the PPLA score based on the appearance of ductal plugging, surface pitting, loss of papillary contour and Randall’s plaque extension. Demographic information, blood samples, 24h urine collections and kidney stone events during follow-up were collected. Stone composition was analyzed using infrared-spectroscopy. Relative urinary supersaturations (RSS) for calcium oxalate (CaOx), calcium phosphate (CaPi) and uric acid (UA) were calculated using the Equil2 software. PPLA score &gt; 3 was defined as high. Results Median follow-up period was 11 (min/max 5, 34) months. PPLA score was inversely correlated with BMI (rho = −0.39, p = 0.035) and history of recurrent kidney stones (median PPLA 5.0 vs 2.5, p = 0.029), these results were confirmed when PPLA was considered as a categorical variable (median BMI 27 vs 24, recurrent stone disease 12 vs 62%, p= 0.006). Furthermore, high PPLA score was associated with lower odds of new kidney stone events during follow-up (OR 0.154, 95% confidence interval 0.024, 0.998, p = 0.05). No significant correlations were found between PPLA score, stone composition, blood parameters, 24h urine solute excretions and RSS for CaOx, CaPi and UA. Conclusion Different papillary abnormalities seem to be linked to specific mechanisms of stone formation. Although data regarding PPLA score are inconsistent, it may be a valid asset for both medical and surgical management of nephrolithiasis. Larger, long-term prospective clinical studies need to be conducted to assess the validity of PPLA score system in evaluating risk of stone recurrence.

scholarly journals Patient’s perception of kidney stone prevention within the emergency department and its adherence factors: A single institution study.

2019 ◽  
Author(s):  
Mohamad Moussa ◽  
Mohamed Abou Chakra
Keyword(s):  
Emergency Department ◽  
Kidney Stones ◽  
Kidney Stone ◽  
Compliance Rate ◽  
Primary Care Providers ◽  
Care Providers ◽  
Prevention Measures ◽  
Single Institution ◽  
Stone Formers ◽  
Stone Prevention

Abstract Background: No known data in the literature assessing practice of kidney stone prevention in the emergency department (ED) is available. Objectives: Assess patient perception and compliance to kidney stone prevention given within the emergency department. It also indirectly detects the attitude and practice patterns of primary care providers in kidney stone prevention. Materials and Methods This is a qualitative study done in a single institution from January 2018 to January 2019 that includes 99 patients that were diagnosed with kidney or ureteral stone in ED and were discharged home, all of them where stone formers. They were asked to fill a self- administered questionnaire when they are able to read, or interviewed by the resident within the ED when they are unable to read. Results The majority of patients (68%) did not receive any instructions about kidney stones prevention within the ED. Most of patients who follow instructions if it was given were educated (90 %), had an insurance coverage (85%), and had an income higher than $1000 per month (76%), (p<0.05). Seventy one percents of patients believe in the effectiveness of stone prevention if it was provided and most of them are interested in learning about these preventive strategies (82%). Reasons for not following the instructions about kidney stones prevention measures were the cost (53.1%) following by the lack of explanation by ED physicians (18.8%). The majority of patients (62.6%) prefer to receive kidney stones prevention measures from urologists. Conclusion: Most of patients in our institute did not receive kidney stones prevention measures in ED despite that they declared their interest in following these measures. Most of the time they did not adhere to those measures due to socioeconomic factors and lack of clarifications. If these instructions were given within the ED, it could lead to an acceptable compliance rate.

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.

The impact of metaphylaxis of kidney stone disease in the renal function at long term in active kidney stone formers patients

2011 ◽  
Vol 40 (3) ◽  
pp. 225-229 ◽  
Author(s):  
Jose A. Meneses ◽  
Fernando M. Lucas ◽  
Fernando C. Assunção ◽  
Junia P. P. Castro ◽  
Rogério B. Monteiro
Keyword(s):  
Renal Function ◽  
Kidney Stone ◽  
Stone Disease ◽  
Kidney Stone Disease ◽  
Stone Formers ◽  
The Impact
Sign in / Sign up

Export Citation Format

Share Document