In vitro studies of epithelium-associated crystallization caused by uropathogens during urinary calculi development

Infectious urinary stones account for about 10% of all urinary stones. In 50% of cases urolithiasis is a recurrent illness, which can lead to the loss of a kidney if not properly treated. One of the reasons for recurrence of the disease may be the ability of bacteria to invade urothelial cells, persist in the host cells and serve as potential reservoirs for infection. Various uropathogens are associated with the formation of bacteria-induced urinary stones but Proteus mirabilis is the most commonly isolated (70%). An in vitro model was used in this study to analyze intracellular growth and crystallization in the presence of P. mirabilis, Klebsiella pneumoniae and Escherichia coli. Human ureter (Hu 609) and bladder (HCV 29) epithelial cell lines were infected with bacteria and incubated (3–72 h) in the presence of synthetic urine and amikacin to prevent extracellular bacterial growth. During the incubation the number of bacteria (CFU/ml) inside epithelial cells and the intensity of crystallization were established. Crystallization was determined as an amount of a calcium radioisotope. The chosen strains of uropathogens were able to invade both types of epithelial cells but the Hu 609 cells were invaded to a higher extent. However, crystallization occurred only in the presence of P. mirabilis strains which were invasive and urease-positive. The highest intensity of cell-associated crystallization was observed when the number of bacteria within the urothelium remained stable during the time of incubation. These results show that P. mirabilis has an ability to form crystals inside the host cells. Under these conditions bacteria are protected from antibiotic killing, which leads to persistent and recurrent infections. We also suspect that this phenomenon may be an important stage of kidney stones formation.     

Prevention of Comorbidity and Acute Attack of Gout by Uric Acid Lowering Therapy

The object of this study was to evaluate the effect of uric acid lowering therapy in reducing the new development of comorbidities and the frequency of acute attacks in gout patients. We retrospectively reviewed patients who were diagnosed to have gout with at least 3 yr of follow up. They were divided into 2 groups; 53 patients with mean serum uric acid level (sUA)<6 mg/dL and 147 patients with mean sUA≥6 mg/dL. Comorbidities of gout such as hypertension (HTN), type II diabetes mellitus (DM), chronic kidney disease, cardiovascular disease (CVD) and urolithiasis were compared in each group at baseline and at last follow-up visit. Frequency of acute gout attacks were also compared between the groups. During the mean follow up period of 7.6 yr, the yearly rate of acute attack and the new development of HTN, DM, CVD and urolithiasis was lower in the adequately treated group compared to the inadequately treated group. Tight control of uric acid decreases the incidence of acute gout attacks and comorbidities of gout such as HTN, DM, CVD and urolithiasis.

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Temporal Trends,Practice Patterns,and Treatment Outcomes for Infected Upper Urinary Tract Stones in the United States

Background

The incidence of infected urolithiasis is unknown, and evidence describing the optimal management strategy for obstruction is equivocal.

Objective

To examine the trends of infected urolithiasis in the United States, the practice patterns of competing treatment modalities, and to compare adverse outcomes.

Design, setting, and participants

A weighted estimate of 396 385 adult patients hospitalized with infected urolithiasis was extracted from the Nationwide Inpatient Sample, 1999–2009.

Outcome measurements and statistical analysis

Time trend analysis examined the incidence of infected urolithiasis and associated sepsis, as well as rates of retrograde ureteral catheterization and percutaneous nephrostomy (PCN) for urgent/emergent decompression. Propensity-score matching compared the rates of adverse outcomes between approaches.

Results and limitations

Between 1999 and 2009, the incidence of infected urolithiasis in women increased from 15.5 (95% confidence interval [CI], 15.3–15.6) to 27.6 (27.4–27.8)/100 000); men increased from 7.8 (7.7–7.9) to 12.1 (12.0–12.3)/100 000. Rates of associated sepsis increased from 6.9% to 8.5% (p = 0.013), and severe sepsis increased from 1.7% to 3.2% (p < 0.001); mortality rates remained stable at 0.25–0.20% (p = 0.150). Among those undergoing immediate decompression, 113 459 (28.6%), PCN utilization decreased from 16.1% to 11.2% (p = 0.001), with significant regional variability. In matched analysis, PCN showed higher rates of sepsis (odds ratio [OR]: 1.63; 95% CI, 1.52–1.74), severe sepsis (OR: 2.28; 95% CI, 2.06–2.52), prolonged length of stay (OR: 3.18; 95% CI, 3.01–3.34), elevated hospital charges (OR: 2.71; 95%CI, 2.57–2.85), and mortality (OR: 3.14; 95%CI, 13–4.63). However, observational data preclude the assessment of timing between outcome and intervention, and disease severity.

Conclusions

Between 1999 and 2009, women were twice as likely to have infected urolithiasis. Rates of associated sepsis and severe sepsis increased, but mortality rates remained stable. Analysis of competing treatment strategies for immediate decompression demonstrates decreasing utilization of PCN, which showed higher rates of adverse outcomes. These findings should be viewed as preliminary and hypothesis generating, demonstrating the pressing need for further study.     

咖啡摄入与尿石症发病风险的Meta分析

目的探讨饮用咖啡与尿石症发生风险的关系。方法计算机检索数据Pub Med、EMBASE、Web of science、Cochhrane Library、万方、维普,收集关于饮用咖啡与尿石症发生风险关系的观察性研究。两名研究员按纳入与排除标准独立筛选文献、提取资料后,应用STATA 11.0软件进行统计分析,并且分析了咖啡摄入与尿石症之间的剂量效应关系。结果共纳入文献6篇,其中队列研究2篇,病例对照研究4篇。Meta分析结果显示咖啡摄入可降低尿石症发生的风险(RR=0.70,95%CI=0.60～0.82)。剂量效应分析也显示了相同的结果。亚组分析结果显示,饮用咖啡的女性尿石症发生风险降低,不同地区的人群饮用咖啡对于降低尿石症风险的程度有差异。结论通过现有文献的Meta分析,饮用咖啡能降低尿石症发生的风险。     

High incidence of urinary stones in Uyghur children may be related to local environmental factors

ObjectiveTo analyze the causes of urolithiasis in Uyghur children from Xinjiang.Patients and methodsWe retrospectively evaluated the clinical features and characteristics of urinary stone composition of 220 Uyghur pediatric patients with urolithiasis between March 2009 and June 2011. The data were compared with that of 100 Uyghur children without urolithiasis who visited the Child Care Clinic for regular health check-ups. The stones were collected by endoscopy or open surgery, and analyzed using infrared spectroscopy.ResultsThe mean age of the 220 Uyghur children was 7.48 ± 4.73 years (range, 0.8–17.0 years). The overall sex ratio (male:female) was 2.23:1. The predominant pure stone was ammonium urate (58.9%), whereas the predominant mixed stone was calcium oxalate mixture (91.1%). Uric acid stones comprised 54% of all stones. Urinary tract infections were observed in 42.3% and 4.0% of the patient and control groups, respectively. The mean urinary pH values were 5.77 ± 0.67 and 6.42 ± 0.67, respectively (p < 0.001). pH values were <5.5 in 52.7% and 6% of the patient and control groups, respectively. On 24-h urine analysis, we found metabolic disturbances in these patients: hypercalciuria in 6.8% cases, hyperphosphaturia in 16.8% cases, hyperuricosuria in 21.4% cases, and hypomagnesiuria in 34.1% cases.ConclusionsUrolithiasis in Uyghur children may be primarily related to local environmental factors.     

Clinical characteristics and metabolic abnormalities in preschool-age children with urolithiasis in southeast Anatolia

ObjectiveData on urolithiasis in preschool-age children are limited. The aim of this study was to investigate the metabolic etiology and clinical findings of preschool-age children with urolithiasis.MethodsThe medical records of 143 preschool-age children (81 boys, 62 girls, aged 2–6 years) with urolithiasis were retrospectively analyzed. Results of physical examination, serum biochemistry, and urine metabolic evaluation (including urinary citrate, oxalate, calcium, uric acid, cystine, and magnesium) were recorded.ResultsThe mean age at diagnosis was 3.7 ± 1.3 years. A family history of stone disease was found in 79.7% of patients, and 37% of parents had consanguineous marriages. The most common presenting symptoms were hematuria (33%) and urinary tract infection (UTI; 29%). Metabolic abnormalities were found in 119 (83.2%) patients, including hyperuricosuria in 24.5%, hypocitraturia in 23.8%, hyperoxaluria in 21.7%, hypercalciuria in 21.0%, cystinuria in 7.7%, and hypomagnesuria in 1.4%. Multiple metabolic abnormalities were found in 24 (16.8%) patients. Results of 28 stone analyses revealed calcium oxalate or phosphate, cystine, and uric acid in 15, nine, and four of the patients, respectively. ^99mTechnetium–dimercaptosuccinic acid renal scintigraphy revealed that 27.8% of the children with UTI had renal parenchymal scarring, with only four of them having vesicoureteral reflux.ConclusionThe most frequent metabolic abnormalities in preschool-age children with urolithiasis were hyperuricosuria and hypocitraturia. A comprehensive investigation of stone disease in children presenting with hematuria and UTI is important to prevent the development of renal parenchymal scarring.     

In vivo efficacy of Trachyspermum ammi anticalcifying protein in urolithiatic rat model

Ethnopharmacological relevance

Many medicinal plants have been employed during ages to treat urinary stones though the rationale behind their use is not well established. Recently, we have successfully purified an anticalcifying protein from the seeds of Trachyspermum ammi (L.) Sprague ex Turril (Umbelliferae) using oxalate depletion assay and deciphered its inhibitory activity against calcium oxalate crystal growth.

Aim

In this report, the antilithiatic activity of Trachyspermum ammi anticalcifying protein (TAP) was studied in urolithiatic rat model.

Methodology

Urolithiasis was induced by exposure of 0.4% ethylene glycol (EG) and 1.0% ammonium chloride (NH₄Cl) for 9 days. The efficacy of TAP was studied in another group given same dose of EG and NH₄Cl in addition to 2 mg/kg body weight of TAP. Further, we evaluated ability of TAP to inhibit the attachment of calcium oxalate (CaO_x) crystal in kidney tissue and studied the consequences of CaO_x adhesion on renal functioning and tissue integrity.

Results

The antilithiatic potential of TAP was confirmed by its ability to maintain renal functioning, reduce renal injury and decrease crystal excretion in urine and retention in renal tissues.

Conclusions

Thus, the present investigation suggests the potential of TAP in preventing calcium oxalate deposition and forms the basis for the development of antilithiatic drug interventions against urolithiasis.     

B 超定位下行体外电磁冲击波碎石术治疗男性尿道结石60例临床体会

目的：总结男性尿道结石在B超定位下行体外电磁冲击波碎石术（ ESWL）治疗的临床体会。方法选取60例男性尿道结石患者在B超定位下采取多种体位行ESWL治疗。结果59例尿道结石ESWL治疗后结石成功排净,1例碎石失败（因患者在碎石过程中情绪过于紧张,放弃碎石治疗）,成功率为98.3％。结论男性尿道结石在B超定位下行ESWL治疗效果好,值得在临床上推广应用。     

液电冲击波体外碎石技术研究——附1222例尿石症及227例胆石症临床治疗总结

本文报告近年来我所对体外冲击碎石技术在设备研制和临床基础方面的研究进展;总结了建所后1222例尿石症及227例胆石症的体外冲击碎石术(ESWL)治疗结果,指出“石街”并发症及时处理的必要性。并认为在目前ESWL治疗还难以单独成为胆石症依赖治疗方法。