Correlation of Unilateral Urolithiasis With Sleep Posture

Shekarriz, Bijan; Lu, Hsu‐Feng; Stoller, Marshall L.

doi:10.1097/00005392-200104000-00006

Cited by 18 publications

(28 citation statements)

References 9 publications

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“…Renal flow studies have found increased blood flow to the dependent kidney when patients are positioned in a lateral decubitus position for at least 30 min. This hemodynamic difference leading to increased blood flow to the dependent kidney may result in hyperfiltration and may be partially responsible for stone formation [23].…”

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Vascular theory of the formation of Randall plaques

Taylor

Stoller

2014

Urolithiasis

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formation remain a mystery as well. Urinary stone formation is likely a multifactorial process dependent upon environmental and genetic factors. Furthering the complexity of stone formation, several types of calculi exist, each possibly with a disparate process of formation. Certainly, the formation of cystine stones is genetically based and is dependent upon urinary nucleation and supersaturation. A similar process of increasing supersaturation leading to nucleation also likely explains uric acid stone formation. Urinary mineral supersaturation and nucleation do not appear to adequately explain the entire process of calciumbased nephrolithiasis formation, which remains the most common type of urinary calculi and is often represented by idiopathic calcium stone formation [3]. The relationship between these calcium-based calculi, particularly calcium oxalate, and Randall plaques has been well documented.Randall's work decades ago supports alternate theories of calcium stone formation independent of urinary supersaturation. After performing more than a 1,000 cadaveric renal dissections, Randall implicated the renal papilla tip as the initiating site of calcium-based urolithiasis. He observed calcium salt deposits in nearly 20 % of non-selected cadaveric units [4]. The presence of Randall plaques may be associated with urinary stones in some, but this does not necessarily implicate subsequent stone formation in all. Work by others suggests that these calcium salt deposits are present in nearly all calcium oxalate stone formers. Furthermore, calcium oxalate calculi are adherent to Randall plaques in up to 50 % stone formers [5].The calcium deposits identified by Randall, termed plaques, were located within the renal interstitium of papillae. He postulated that the basement membrane of the collecting ducts calcified and, overtime, eroded into the papillary luminal surface [4]. Randall plaques remain implicated with the process of urolithiasis formation, but how this Abstract The relationship between calcium-based calculi and Randall plaques is well documented, but the role these plaques play in the early process of urinary stone formation remains unknown. The vascular hypothesis of Randall plaque formation has been proposed, and recent works support this concept. The renal papilla's vascular environment is subject to relative hypoxia, hyperosmolar surroundings, and turbulent blood flow. These factors together create an environment prone to vascular injury and may potentiate Randall plaque precipitation. Recent data support the similarity between the vascular calcification process itself and urinary stone formation. Furthermore, epidemiological studies have suggested an association between urinary stones, adverse cardiovascular events, and vascular calcification risk factors. The concept that an initial vascular insult precipitates a Randall plaque and subsequent urolithiasis is compelling and represents an area in need of continued research. This may lead to future novel treatment approaches to urolithiasis. Keywords...

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Vascular theory of the formation of Randall plaques

Taylor

Stoller

2014

Urolithiasis

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“…11 Apesar de não existir na literatura um consenso sobre a lateralidade do cálculo, há relatos de que o lado mais acometido no homem é o esquerdo e, na mulher, o direito. 2 Shekarriz et al 15 postularam que existe uma ligação entre a lateralidade do cálculo e o lado sobre o qual o paciente tem o hábito de dormir.…”

Section: Resultsunclassified

Dados demográficos, clínicos e laboratoriais de pacientes com litíase urinária em Fortaleza, Ceará

Silva¹,

Silva²,

Campos³

et al. 2011

J. Bras. Nefrol.

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O referido estudo foi realizado na UFC, UNIFOR e UFRN.Os autores declaram a inexistência de confl itos de interesse. [1996][1997][1998][1999][2000][2001][2002][2003][2004][2005][2006]. Clinical evaluation and 24-h urine collection for measurements of urinary volume, creatinine, calcium, phosphorous, uric acid, sodium, potassium and magnesium were performed. Density and pH value were determined in a first-voided morning urine sample. Cystinuria was detected by stone and/or crystal analysis. Results: The male/female ratio was 1:1.7. The average age of symptom onset was 35.8 ± 13.3 years, with no significant difference between the genders. The most affected age range was 20-39 years (56.3%). Patients reported renal colic (72.4%), emergency room attendance (69.5%), a single episode of lithiasis (46.7%) or recurrent episodes (53.3%). The right kidney was most often affected in women (44.4%), while men suffered predominantly from bilateral lithiasis (39.7%). The main metabolic changes observed were hypernatriuria (80.7%), hypercalciuria (48.7%), hyperuricosuria (17.3%), and cystinuria in 5 patients (2.5%). The average pH value and density were 5.74 ± 0.59 and 1015.6 ± 7.1, respectively. Urinary volume was low in 43% of the cases. Conclusion: Lithiasis was most prevalent in adults aged 20-39 years, and affected predominantly women in our region. The most frequent metabolic changes, in descending order, were hypernatriuria, followed by hypercalciuria and hyperuricosuria, associated with low fluid intake.

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“…4,5,7,9 Yet to date, no data exists comparing excretory renal function between patients with unilateral and bilateral stone disease. The lungs provide and ideal example of a paired organ system where variations in anatomy, position, and perfusion have profound effects on mate pulmonary function and underlying pathology.…”

Section: Discussionmentioning

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“…6 Some have surmised that differences in renal perfusion or anatomy have led to such observations. 4,5 …”

Section: Introductionmentioning

confidence: 99%

Differences in quantitative urine composition in stone-forming versus unaffected mate kidneys

Konety¹

2009

RRU

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Objectives: Many patients present with bilateral stones. There is a unique group of patients, however, that presents with stones exclusively on one side. We hypothesize that in such situations, 24-hour urine collections may not reveal specific defects on the affected stone-bearing kidney. We therefore evaluated selective 12-hour urine collections after percutaneous nephrolithotomy (PNL) to help determine if there is differential renal excretion. Methods: We collected urine specimens from patients with nephrolithiasis who underwent unilateral PNL. Urine samples were collected and analyzed from nephrostomy tubes, representing the affected kidneys, and from Foley bladder catheters, representing the contralateral mate kidney. Results: Thirty-one patients were studied (14 with unilateral nephrolithiasis and 17 with bilateral). Treated kidneys from patients with unilateral nephrolithiasis displayed lowered urine excretion of uric acid, sodium, chloride, calcium, and total osmoles when compared to patients with bilateral nephrolithiasis. Stone size and length of procedure were not predictive of urine composition after PNL. Conclusions: Treated kidneys from patients with a history of unilateral stone disease revealed marked differences in urine excretion compared to those with bilateral nephrolithiasis after unilateral PNL. These findings could be secondary to the surgical insult, urinary stone disease, or could be a responsible factor for stone pathogenesis.

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Correlation of Unilateral Urolithiasis With Sleep Posture

Cited by 18 publications

References 9 publications

Vascular theory of the formation of Randall plaques

Vascular theory of the formation of Randall plaques

Dados demográficos, clínicos e laboratoriais de pacientes com litíase urinária em Fortaleza, Ceará

Differences in quantitative urine composition in stone-forming versus unaffected mate kidneys

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