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.     

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。     

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

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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.     

Music Does Not Reduce Alfentanil Requirement During Patient-Controlled Analgesia (PCA) Use in Extracorporeal Shock Wave Lithotripsy for Renal Stones

To evaluate the impact of music on opioid requirements and pain levels during renal lithotripsy using alfentanil patient-controlled analgesia (PCA), we conducted a prospective, blinded, randomized controlled trial. Patients undergoing lithotripsy were instructed in PCA use and asked to rate their anxiety and select their preferred type of music. They were then premedicated with morphine and ketorolac and randomly allocated into two groups. Group 1 (n = 97) had music started 10 min before the procedure and maintained until 10 min after its conclusion. Group 2 (n = 96) had music begun at the conclusion of lithotripsy and continued for 10 min. Pain intensity, alfentanil requirement, side effects, quality of analgesia, patient satisfaction, and acceptance of the technique were evaluated. Demographics, alfentanil requirement, pain levels, side effects, quality of analgesia, and patient satisfaction were similar in both groups. The addition of music did not provide any benefit. This result raises the possibility that some nonpharmacologic therapies have minimal impact in settings where the painful stimulus is moderate to severe and adequate pharmacotherapy is available.     

Lead (Pb2+)-induced calcium oxalate crystallization ex vivo is ameliorated via inositol 1,4,5-trisphosphate receptor (InsP3R) knockdown in a Drosophila melanogaster model of nephrolithiasis

Nephrolithiasis causes severe pain and is a highly recurrent pathophysiological state. Calcium-containing stones, specifically calcium oxalate (CaOx), is the most common type accounting for approximately 75 % of stone composition. Genetic predisposition, gender, geographic region, diet, and low fluid intake all contribute to disease pathogenesis. However, exposure to environmental pollutants as a contribution to kidney stone formation remains insufficiently studied. Lead (Pb2+) is of particular interest as epidemiological data indicate that low-level exposure (BLL = 0.48–3.85 μM) confers a 35 % increased risk of developing CaOx nephrolithiasis. However, mechanisms underlying this association have yet to be elucidated. Drosophila melanogaster provide a useful genetic model where major molecular pathophysiological pathways can be efficiently studied. Malpighian tubules (MT) were isolated from either Wild-Type or InsP₃R knockdown flies and treated with oxalate (5 mM) ± Pb²⁺ (2μM) for 1 h. Following exposure, MTs were imaged and crystals quantified. CaOx crystal number and total area were significantly increased (˜5-fold) in Pb²⁺(pre-treatment) + oxalate-exposed MTs when compared to oxalate alone controls. However, CaOx crystal number and total crystal area in Pb²⁺ + oxalate-exposed InsP₃R knockdown MTs were significantly decreased (˜3-fold) indicating the role for principal cell-specific InsP₃R-mediated Ca²⁺ mobilization as a mechanism for Pb²⁺-induced increases in CaOx crystallization inset model of nephrolithiasis.