Endotoxin Content in Renal Calculi

Abstract

Large endotoxin concentrations can be found in renal infection calculi. Noninfection stones can contain endotoxin but in much lower amounts. Massive endotoxin release could occur with infection stone manipulation, possibly producing increased serum endotoxin concentrations similar to those seen in gram-negative sepsis. Anti-endotoxin strategies may be beneficial in preventing and treating stone induced endotoxemia and the sepsis syndrome.

Importance of microbiological evaluation in management of infectious complications following percutaneous nephrolithotomy

“…Although, this comment is a result of an objective study, our experience showed that in febrile patients even though they are hemodynamically stable, antibacterial treatment may not be required whereas the microbiological evaluation should immediately be done for future management. Sepsis may develop as a result of bacteriemia or endotoxemia after stone or urinary tract manipulation [11] and stimulate inflammatory cascade that can result in septic shock. Septic shock-with up to 66-80% mortality-occurs in 1% of patients following stone manipulation [3,10].…”

Mortality and flexible ureteroscopy: analysis of six cases

“…This is a controversial issue. Even if there is currently no official recommendation as to the use of the UAS during RIRS and there are no guidelines on the correct UAS diameter for the definitive stone sizes, the placement of a UAS could prevent pyelolymphatic and pyelovenous bacterial backflow [5][6][7] with protection from the risk of bacterial dissemination during stone fragmentation. Even if the use of UAS depends on the surgeon's preference, we think that UAS might be considered among the best practices in order to prevent the risk of endotoxin resorption and bacterial dissemination after lithotripsy [5,8].…”

Systemic Inflammatory Response Syndrome Following Percutaneous Nephrolithotomy: Assessment of Risk Factors and Their Impact on Patient Outcomes

“…Incidence of sepsis is 40-50% if RPUC or stone culture is positive as compared to 25% if previous urine culture was positive and only 14 and 9% if RPUC and stone culture are sterile respectively. However, those who developed SIRS, around half of them had sterile renal pelvic urine and stone culture underscoring the role of endotoxins from dead bacteria in inciting SIRS and sepsis [6,17,18]. …”