Metabolic investigation of patients with staghorn calculus: is it necessary?

Amaro, Carmen Regina Petean Ruiz; Goldberg, José; Agostinho, Aparecido Donizeti; Damasio, Patrícia Capuzzo Garcia; Kawano, Paulo Roberto; Fugita, Oscar Eduardo Hidetochi; Amaro, João Luiz

doi:10.1590/s1677-55382009000600004

Cited by 16 publications

(10 citation statements)

References 10 publications

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“…23,24 Lack of metabolic abnormities appears more common in women (~30%) than men (~10%) with infection stones. 23 However, recurrence after successful surgery and antibiotic regimens is relatively uncommon, consistent with infection being the dominant factor.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic and Pathologic Characterization of Papillary Architecture in Struvite Stone Formers

Jaeger

Rule

Mehta

et al. 2016

Urology

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Objective To describe the endoscopic characteristics of renal papillae in struvite stone formers (SF). Materials and Methods From 2009 to 2014, patients undergoing percutaneous nephrolithotomy were prospectively enrolled in our study. Endoscopic analysis and biopsy of papillae was performed to demonstrate the presence and percentage surface area (SA) of Randall's plaque or ductal plug. Comparison with idiopathic calcium oxalate (CaOx) SF and non-SF controls was performed. Results We identified 29 struvite SF to compare with 90 idiopathic CaOx SF and 17 controls. On endoscopic mapping, 28 struvite SF (97%) demonstrated Randall's plaque and 9 (31%) had plugging. The average mean SA of Randall's plaque in struvite SF (1.5±1.4%) was less than CaOx SF (3.7 ±4.3%, p=0.0018) and similar to controls (1.7 ±2.7%, p=0.76). Average mean plug SA was similar between struvite SF, CaOx SF, and controls. On metabolic assessment, 83% of struvite SF had at least one urine abnormality, with urinary uric acid and oxalate levels significantly higher among struvite SFs compared to controls (p=0.002 ). Despite lack of active UTI, interstitial inflammation was more prevalent in struvite SF compared to CaOx SF (43.5% vs 7.3%, p=0.0001). Conclusions Our findings suggest a limited role for Randall's plaque in struvite stone formation. Struvite SF have less plaque formation than CaOx SF, but demonstrate evidence of severe parenchymal inflammation compared to other stone formers. The role of this prominent interstitial inflammation requires further study.

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Section: Discussionmentioning

confidence: 99%

Endoscopic and Pathologic Characterization of Papillary Architecture in Struvite Stone Formers

Jaeger

Rule

Mehta

et al. 2016

Urology

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“…Amaro et al assessed MAs in 22 of 37 patients with staghorn stones. 21 They studied only those patients whose GFR was >60 ml/min and found metabolic abnormalities in 68.2%. The most common was hypercalciuria in 9 (64.2%) followed by hypocitraturia in 8 (53.3%).…”

Section: Discussionmentioning

confidence: 99%

Metabolic abnormalities in patients treated with percutaneous nephrolithotomy

Nandwani

Stoves

Azhar

et al. 2015

Journal of Clinical Urology

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Objectives: To assess metabolic abnormalities in patients with percutaneous nephrolithotomy (PCNL) that could pose a risk for stone recurrence. Materials and methods: The data was collected retrospectively on all patients who had PCNL and metabolic studies, between January 2000 and September 2012. Results: There were 144 patients; median age and follow up were 49.5 (15-4) years and 80.2 (16-180) months, respectively. Nearly half of the patients had staghorn calculus. Metabolic abnormalities (MAs) were found in 55 (38.2%). The 31 (21.5%) of these had multiple metabolic abnormalities (MMA) while 24 (16.6%) had a single metabolic abnormality (SMA). Uricosuria was found in 24 (16.6%), hyperoxaluria in 22 (15.3%), hyperphosphaturia in 18 (12.5%), hypercalciuria in 10 (7%), hypomagnesuria in 6 (4.2%), cystinuria in 5 (3.5%) and hypocitraturia in 5 (3.5%). Hyperuricaemia was present in 10 (7%), hypercalcaemia in 5 (3.5%), hyperphosphataemia in 7 (5%) and renal tubular acidosis in 1 (0.7%). In nonstaghorn, MAs were found in 25 (35.2%) and 16 (64%) of these had MMA. In patients with staghorn, MAs were present in 30 (41%) patients. Half of the patients 15 (50%) in this group had MMA. A high proportion of the first time stone formers requiring surgical treatment had MAs and 57% of these had MMA. Stone analysis was available for 69 (48%) and 37 (53.6%) of these had mixed composition. The highest proportion of patients with uric acid stones had MA 89% followed by cystine stones 80%, matrix stones 50%, calcium oxalate 36.6%, carbonate apatite 36.4% and triple phosphate 33.3% . Conclusion: A high proportion of first time stone formers, staghorn and non-staghorn stone formers with PCNL had MA. These findings suggest that the treatment of metabolic abnormalities can play an important role in reducing the risk of stone recurrences and management may include referral to dedicated metabolic stone clinics.

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“…In particolare, i batteri organizzati in biofilm sono molto più resistenti all'attività degli antibiotici con diversi meccanismi (“ quorum sensing ”). Le alterazioni urinarie provocate dall'attività ureasica possono sovrapporsi a pre-esistenti alterazioni dei fattori di rischio legati a difetti metabolici associati (4).…”

Section: Patogenesiunclassified

Urinary calculi and infection

Trinchieri

2014

Urologia

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Infection urinary stones resulting from urease-producing bacteria are composed by struvite and/or carbonate apatite. Bacterial urease splits urea and promotes the formation of ammonia and carbon dioxide leading to urine alkalinization and formation of phosphate salts. Proteus species are urease-producers, whereas a limited number of strains of other Gram negative and positive species may produce urease. Ureaplasma urealyticum and Corynebacterium urealyticum are urease-producers that are not isolated by conventional urine cultures, but require specific tests for identification. Primary treatment requires surgical removal of stones as complete as possible. Extracorporeal and endoscopic treatments are usually preferred, while open surgery is actually limited to few selected cases. Residual stones or fragments should be treated by chemolysis via ureteral catheter or nephrostomy or administration of citrate salts in order to achieve a stone-free renal unit. Postoperatively, recurrent urinary tract infection should be treated with appropriate antibiotic treatment although long-term antibiotic prophylaxis can cause resistance. Urinary acidification has been proposed for the prophylaxis of infection stones, but long-term acidification is difficult to achieve in urine infected by urease-producing bacteria. Urease inhibitors lead to prevention and/or dissolution of stones and encrustations in patients with infection by urea-splitting bacteria, but their use is limited by their toxicity. The administration of citrate salts involves an increase of the value of nucleation pH (pHn), that is the pH value at which calcium and magnesium phosphate crystallization occurs, in a greater way than the corresponding increase in the urinary pH due to its alkalinizing effect and resulting in a reduction of the risk of struvite crystallization. In conclusion prevention of the recurrence of infection stones can be achieved by an integrated approach tailored on the single patient. Complete clearance of the stone must be achieved by primary surgical procedure and residual fragments should be extensively treated. In the case of persistent infection, conservative measures, such as acidification and urease inhibitors or citrate administration, should be adopted to minimize its effect on urinary saturation with respect to struvite.

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Metabolic investigation of patients with staghorn calculus: is it necessary?

Cited by 16 publications

References 10 publications

Endoscopic and Pathologic Characterization of Papillary Architecture in Struvite Stone Formers

Endoscopic and Pathologic Characterization of Papillary Architecture in Struvite Stone Formers

Metabolic abnormalities in patients treated with percutaneous nephrolithotomy

Urinary calculi and infection

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