Xanthogranulomatous Pyelonephritis: A Clinical Analysis

Xanthogranulomatous pyelonephritis (XGP) is an inflammatory form of chronic renal disease with the characteristics of pyelonephritis. It is associated with staghorn nephrolithiasis, kidney tissue damage, renal function loss, and a nonfunctional kidney. XGP can be confused with neoplastic or inflammatory renal conditions due to its indistinguishable imaging and its vague clinical presentation. The treatment of choice is nephrectomy. Only a few cases of XGP have been treated medically. XGP should be managed by urology and nephrology providers. The nurse practitioner should refer patients with recurrent or persistent urinary tract infections, renal stones, staghorn calculi, or pyelonephritis to nephrology and urology specialists for further evaluation and management.     

Chlorthalidone with potassium citrate decreases calcium oxalate stones and increases bone quality in genetic hypercalciuric stone-forming rats

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经乙二醇诱导的改良型草酸钙肾结石果蝇模型

目的:通过一种改良方法构建果蝇草酸钙肾结石模型。方法:配制标准培养基和造模用培养基，空白对照组果蝇仅予标准培养基，而传统模型组和改良模型组分别从成虫期和幼虫期开始摄入含 0.5%乙二醇( EG)的造模用培养基。于偏光显微镜下观察并评估各组果蝇马氏管内成石情况，分别记录模型组成石率达 100%所花时间，并对成石率 100%时模型组间“ ++”和“ +++”所占比率进行比较；用傅立叶变换拉曼光谱仪鉴定模型组果蝇马氏管内结石成分。绘制各组果蝇生存曲线，并比较生存周期差异。结果:改良模型组和传统模型组分别在果蝇成虫日龄 14 d和 22 d，马氏管内成石率达到 100%。当改良模型组和传统模型组成石率均达到 100%时，两组“ ++”与“+++”所占比率分别为(40.5±4.4)%和(39.0±4.2)%，差异无统计学意义(P＞ 0.05)；拉曼位移的主峰主要集中在 1 462 cm-1、1 463 cm-1和 1 473 cm-1，说明模型组果蝇马氏管内结石成分均为草酸钙。空白对照组、传统模型组和改良模型组的最高寿命分别为 76 d、70 d和 68 d，中位生存时间分别为 35 d、30.5 d和 30 d，与空白对照组相比，模型组生存周期均显著缩短(P均＜ 0.01)，但传统模型组与改良模型组间差异无统计学意义( P＞ 0.05)。结论:改良型造模方法使果蝇在其幼虫期即摄入 0.5% EG，缩短了模型构建周期且具有可重复性，值得进一步研究推广。     

The role of Randall plaques on kidney stone formation

Randall’s plaque is microscopically a plaque of calcium deposited in the interstitial tissue of the renal papilla. These plaques are thought to serve as a nidus for urinary stone formation. Large amounts of Randall’s plaque are unique to idiopathic calcium oxalate stone formers. Although Randall’s plaques can be found in other stone formers, only in idiopathic calcium oxalate stone formers, the detailed mechanism of stone overgrow on plaque was thoroughly studied. Calcification is invariably located in the basement membrane of the loops of Henle and from there plaques spread through the interstitium toward urothelium. Within the basement membrane, mineral deposits are individual laminated particles in which zones of crystal and organic matrix overlay each other. In the interstitium, the particles appear to fuse on the collagen bundles to form a syncytium of crystal islands in an organic sea. By loss of integrity of urothelium, regions of plaque are exposed to urine. The exposed surface will touch and be covered by molecules of urine origin, including osteopontin, Tamm Horsfall protein, and crystals formed under urine supersaturations, resulting in a ribbon of alternating matrix and crystal. Eventually crystallization escapes from matrix modulation and crystals extend outward into the space of urine and begin to form a calcium oxalate stone proper. Randall’s plaque plays an important role and is prerequisite of kidney stone formation in idiopathic calcium oxalate stone formers.     

Calcium‐sensing receptor gene polymorphism (rs7652589) is associated with calcium nephrolithiasis in the population of Yi nationality in Southwestern China

The calcium‐sensing receptor (CaSR) gene plays an important role in regulating the Ca²⁺ balance and reducing the risk for calcium stones. In this study, we evaluated the association of CaSR polymorphisms with calcium nephrolithiasis in the population of Yi nationality in Southwestern China. Biochemical variables were evaluated in 624 calcium nephrolithiasis patients and 470 age‐matched healthy controls without a history of nephrolithiasis. CaSR polymorphisms rs7652589, rs1501899, rs1801725 (Ala986Ser), rs1042636 (Arg990Gly) and rs1801726 (Gln1011Glu) were investigated between the calcium nephrolithiasis patients and healthy controls, using direct sequencing. Compared with the healthy controls, serum creatinine and 24‐hour urine calcium levels were significantly higher in calcium nephrolithiasis patients. Among these five polymorphisms, the genotypic and allelic frequency distributions of rs7652589 SNP was significantly associated with the risk of calcium nephrolithiasis. However, there were no genotypic or allelic distribution differences for rs1501899, rs1801725, rs1042636, and rs1801726 polymorphisms between calcium nephrolithiasis patients and healthy controls. Moreover, the association between rs7652589 SNP genotypes and the biochemical variables was not found. Our study showed that CaSR rs7652589 polymorphism had a significant effect on the risk of developing calcium nephrolithiasis in the population of Yi nationality in Southwestern China.