Urolithiasis medical therapies
|
|
- Nickolas Gordon
- 5 years ago
- Views:
Transcription
1 Urolithiasis medical therapies Daniel Spernat and John Kourambas Department of Urology, Monash Medical Centre, Victoria, Australia SUMMARY This review paper provides a summary of medical therapies available for urolithiasis. The summary includes general medical advice, prophylactic medications, dissolution therapy and medical expulsion therapy. The paper is designed to provide a management strategy for all physicians who treat urolithiasis, from general practitioners, to emergency physicians, to urologists. OBJECTIVE To provide an up to date review of the literature in relation to the medical management of stone disease. This will encompass prophylaxis, dissolution therapy and medical expulsion therapy. What s known on the subject? and What does the study add? The medical management of urolithiasis is complex. There are many papers written on the topic and many conflicting views. It can be difficult for physicians to interpret these data and have a stepwise approach to the medical treatment of stones. Thus this study provides a framework and a review of the literature to allow physicians to practise evidence-based medicine when medically managing urolithiasis. due to the low incidence of a reversible metabolic cause. However, stone disease is common and over a lifetime urolithiasis can affect up to 10 15% of the population. RESULTS CONCLUSIONS Recurrent stone formers should have dietary optimization to decrease the risk of further stones. Furthermore, the correct use of prophylactic and therapeutic medications can decrease the morbidity associated with ureteric calculi. PATIENTS AND METHODS First-time stone formers do not regularly have a full urine and electrolyte evaluation Medical management of stone disease encompasses preventative measures, medical dissolution and medical expulsion therapy. KEYWORDS urolithiasis, prophylaxis, dissolution therapy, medical expulsion therapy INTRODUCTION Stone disease is common and affects 0.131% of the population at any time [1 ]. Over a lifetime urolithiasis can affect up to 10 15% of the population [2 ]. After passage of a first stone, the risk of recurrence is 40% at 5 years and 75% at 20 years [3 ]. First-time stone formers do not regularly have a full urine and electrolyte evaluation due to the low incidence of a reversible metabolic cause. However, a reversible metabolic abnormality can be identified in over 90% of recurrent stone formers [2 ]. Here we will focus on prophylactic management of urolithiasis, dissolution therapy of urolithiasis and medical management of ureteric colic. PROPHYLACTIC MANAGEMENT IN A URINARY STONE FORMER GENERAL MEDICAL ADVICE All patients presenting with renal colic should be given general medical advice to decrease the risk of a future stone episode. This advice includes increasing fluid intake so that urine output is >2 L/day. Furthermore, the best estimation of urine output is clear looking urine. This prevents urine stagnation, and thus decreases stone risk. Patients should increase their urinary citrate level through increased consumption of citric juices. Urinary citrate is a potent stone inhibitor. Citrate binds calcium in the urine, decreasing supersaturation and reducing the growth of crystals [3 ]. Furthermore, an increase in urinary citrate level even in patients with normal urinary citrate helps prevent stone recurrence [4 ]. Purine intake (animal meat) should be moderated as it increases urinary calcium, oxalate and uric acid secretion. Restricting animal protein and salt while maintaining a normal calcium intake decreases stone recurrence rates compared with a low calcium diet [5 ]. A high sodium load can increase the risk of calcium oxalate stone formation and thus salt restriction is also advised. Furthermore, obesity increases the risk of stone disease by increasing urinary acidity, hypocitraturia and hyperuricosuria. Consequently, weight loss and a low fat diet should be encouraged , SUPPLEMENT 2,
2 SPERNAT and KOURAMBAS This is especially important in patients with bowel disease or malabsorptive conditions. Calcium intake within dietary recommendations should be continued even in patients with calcium oxalate stones. Low dietary calcium leads to increased unbound oxalate to be reabsorbed in the gut and thus further increases the risk of calcium oxalate stones [6 ]. The relationship between dietary and urinary oxalate is complex. When Holmes et al. [7 ] varied the amount of dietary oxalate and calcium they found that urinary oxalate excretion increased as dietary oxalate intake increased. Furthermore as the dietary calcium decreased the urinary oxalate also increased. Thus we recommend avoiding large quantities of oxalate especially with low calcium diets [7 ]. Patients should also avoid excessive (maximum daily dose 2 g) vitamin C supplements, as this can increase oxalate excretion [8 ]. PROPHYLACTIC MEDICATIONS Thiazide diuretics Thiazides stimulate calcium reabsorption in the distal nephron while promoting excretion of sodium. This decreases urinary calcium excretion but may lead to hypokalemia. Hypokalemia can in turn cause hypocitraturia. Thus potassium citrate supplementation (40 60 meq/day) is recommended with thiazide diuretics. A recent Cochrane review has demonstrated that, in patients with idiopathic hypercalciuria and recurrent stones, the addition of thiazides to a normal or modified diet decreases stone recurrence and formation rate [9 ]. has several features. First it maintains the urine ph above the p K a for uric acid thus promoting dissolution of uric acid crystals. This decreases uric acid and calcium stone formation by decreasing formation of a nidus. Second, citrate also directly prevents the complexation of calcium. In patients with either hypocitraturia or acidic urine ph, treatment with this medication increases urinary citrate levels, ph and potassium [ 10 ]. This is associated with a remission rate of stone disease of up to 91% [10 ]. Allopurinol Allopurinol inhibits xanthine oxidase converting xanthine to uric acid, and therefore decreases uric acid production and hyperuricosuria. This in turn reduces the spontaneous nucleation of calcium oxalate. Randomized controlled trials have demonstrated that allopurinol decreases stone recurrence in patients with idiopathic calcium oxalate stones who had hyperuricosuria [11 ]. Allopurinol is therefore effective in decreasing pure uric acid calculi and calcium based calculi. UroPhos-K UroPhos-K is a slow release neutral form of potassium phosphate. It produces a sustained hypocalciuric response and maintains bone mass in patients with absorptive hypercalciuria. This effect is achieved by directly impairing the renal tubular reabsorption of calcium and by binding calcium in the gut. It also raises the urine ph. UroPhos-K causes a sustained and marked reduction in urinary calcium [12 ]. This effect occurs by a combination of reduced intestinal absorption, bone reabsorption and improved renal calcium reabsorption. The drug is well tolerated compared with placebo [13 ]. Sodium bicarbonate The major goal of sodium bicarbonate therapy is to increase the urine ph above 5.5 and preferably to This treatment enhances dissociation of uric acid and inhibits uric acid stone formation. However, treatment may be complicated by calcium oxalate (due to the sodium load) or calcium phosphate (due to ph above 7.0) stone formation. Thus potassium citrate is preferable as it avoids the sodium load that may precipitate calcium oxalate stone formation [14 ]. D penicillamine D penicillamine is used in cystinuria to enhance the solubility of the cystine by formation of a mixed disulfide bond. That is, the cystine binds to the medication instead of itself [15 ]. D penicillamine is very effective but has a significant side effect profile including nephrotic syndrome, dermatitis and pancytopenia. Use must be closely monitored with regular full blood counts, urea and electrolytes, and vitamin B 6 (pyridoxine) must be replaced. Alpha mercaptopropionylglycine Alpha mercaptopropionylglycine was introduced because of the poor tolerance of D penicillamine. It has a sulfhydryl group that forms a disulfide bond with cystine thus increasing its solubility. Common side effects include asthenia, gastrointestinal tract upset, rash, joint aches, and mental state changes. It is much better tolerated than D penicillamine [16 ]. However, alpha mercaptopropionylglycine is less effective than D penicillamine at lowering the cystine crystal volume in urine specimens of cystinuric patients [17 ]. Thus it is an arguably less effective agent in preventing recurrent cystine stones. Moreover, it is not easily available. Sodium cellulose phosphate Sodium cellulose phosphate is largely outdated by the above listed medications. It has become a medication of last resort due to its significant gastrointestinal side effects. It is a non-absorbable ion exchange resin that binds calcium and inhibits calcium absorption, and is used in patients with absorptive hypercalciuria type 1. Acetohydroxamic acid Acetohydroxamic acid is a urease inhibitor. It reduces the urine saturation of struvite and therefore retards stone formation in patients with chronic urea-splitting infections. It is given at a dose of 250 mg three times per day. Acetohydroxamic acid effectively inhibits the growth of struvite stones in the short term [18 ]. However, thrombosis has been observed with unusual frequency in patients receiving acetohydroxamic acid. It was subsequently determined that this medication causes a low grade intravascular coagulability [19 ]. Up to 15% of patients may develop a deep vein thrombosis. DISSOLUTION THERAPY ORAL MEDICATIONS Sodium bicarbonate Sodium bicarbonate may be used to increase the urinary ph to the target range of It is an effective agent for the
3 UROLITHIASIS MEDICAL THERAPIES TABLE 1 Spontaneous stone passage at one month Control Tamsulosin Terazosin Doxazosin Alfuzosin 53.57% 79.31% 78.57% 75.86% 70.5% dissolution of uric acid calculi [20 ] and the most commonly used agent in Australia. However, sodium bicarbonate increases calcium excretion and reduces citrate. These mitigate some of the benefits of increased urinary ph. Consequently potassium citrate is the preferred agent. However, potassium citrate is not appropriate for some patients due to poor renal function or high baseline serum potassium levels. Further, the gastrointestinal side effects of potassium citrate can limit its application. In this situation sodium bicarbonate or sodium citrate are the preferred agents. One must be careful of the sodium load in patients with congestive heart failure or poorly controlled hypertension [21 ]. has been demonstrated to be effective in the dissolution of uric acid calculi [ 22 ]. It is the preferred agent over sodium bicarbonate as monopotassium urate is more soluble than monosodium urate [ 21 ]. Further, it avoids the increase in calcium excretion and reduction in citrate excretion associated with sodium loading. PERCUTANEOUS INSTILLATION Calcium oxalate stones are resistant to dissolution therapy. However, struvite calculi have been associated with (limited) successful dissolution therapies since 1943 (Suby s solution G) [ 23 ]. The following two solutions are still used in limited cases. Hemiacidrin/renacidrin Hemiacidrin/renacidrin is no longer in routine use. After surgical removal of the bulk of the stone residual struvite stone fragments can be dissolved with this agent. Prior to treatment infection and bacterial colonization must be treated. Further, the renal pelvis is irrigated initially with saline to ensure no leakage or fever. The renal pelvis washout continues for h. If the patient s condition remains haemodynamically stable then irrigation with hemiacidrin is commenced. The flow is continued at 120 ml per hour. The stone burden is assessed at regular intervals and the chemolysis continues for h after the last radiographic stone is visible. Research suggests that concurrent use with shock wave lithotripsy may provide a useful adjunctive measure for improving the efficacy of stone comminution [24 ]. Tham E Tham E is the most efficacious agent for the dissolution of cystine stones [25 ]. Its use is limited by the need to place nephrostomy tubes and then instil the agent. While this treatment has been reported on an outpatient basis [26 ], most patients require prolonged inpatient care which limits its desirability as a treatment. MEDICAL EXPULSION THERAPY Medical expulsion therapy (MET) is beneficial for distal ureteric calculi. There is no evidence that MET improves the spontaneous stone passage rate of proximal ureteric calculi. However, tamsulosin has been shown to significantly increase the passage of stones between 5 and 10 mm from the proximal to the distal ureter [27 ]. High fluid intake A large diuresis that pushes the stone into the bladder sounds plausible; however, studies have demonstrated that it is actually more likely to counteract the passage of the stone and to cause more pain. A Cochrane database review from 2005 found no evidence to support diuresis as a method of pain relief or stone expulsion [28 ]. Alpha blockers Alpha blockers inhibit ureteral muscle contraction, reduce the basal tone, and decrease peristaltic frequency and colic pain facilitating ureteral stone expulsion. Meta-analysis has demonstrated an advantage to alpha blocker use that it increases spontaneous stone passage rate by 14 29% which is statistically significant. This is the recommended MET (combined AUA and European Association of Urology (EAU) guidelines 2007). Tamsulosin is the most commonly used and studied agent. A study comparing the efficacy of tamsulosin to terazosin and doxazosin has not demonstrated any significant difference. Furthermore, a study comparing the efficacy of tamsulosin to alfuzosin has not shown any significant difference [29 31 ]. While there has not been a head-to-head comparison of terazosin or doxazosin to alfuzosin, it would appear that these alpha blockers are equally efficacious at MET. Table 1 demonstrates the combined data on spontaneous stone passage at 1 month. Calcium channel blockers Nifedipine has been extensively studied as an agent for MET. Nifedipine is effective at increasing the spontaneous stone passage rate. Meta-analysis has demonstrated an increase in the spontaneous stone passage rate of 9%. This is not statistically significant and the combined AUA and EAU guidelines (2007) have described the positive effect of nifedipine as marginal. Further, a multicentre, prospective, randomized trial comparing the efficacy of tamsulosin and nifedipine in MET for distal ureteric stones has demonstrated that tamsulosin was significantly better than nifedipine in relieving renal colic and facilitating ureteric stone expulsion [32 ]. Corticosteroids Corticosteroids have been reported to facilitate stone expulsion compared with placebo [30 ]. Compared with alpha blockers, steroids demonstrate a lower rate of spontaneous stone expulsion (37.5% vs 60%) [34 ]. However, the combination of steroids (deflazacort) and alpha blockers (tamsulosin) demonstrates a statistically significant advantage over tamsulosin alone [33,34 ]. Common medications that do not improve spontaneous stone passage It is important to mention that antimuscarinics such as buscopan have no role in MET. Randomized controlled trials involving buscopan have shown not only no
4 SPERNAT and KOURAMBAS TABLE 2 First-line agents in routine use Uric acid stone prevention Calcium stone prevention with hypercalciuria Cystine stone prevention Uric acid stone dissolution Medical expulsion therapy Struvite stones analgesic benefit for ureteric obstruction [35 ] but no increases in stone expulsion rates [36 ] either. NSAIDs lead to decreased ureteral contractility, inflammation, glomerular filtration rate and intrarenal pressure [37 ]. Therefore, they provide excellent analgesic benefit in renal colic. In fact, a Cochrane review has reported that lower pain scores have been demonstrated in patients receiving NSAIDs compared with opioid analgesia. Further, patients treated with NSAIDs were significantly less likely to require rescue medication [38 ]. However, stone expulsion rates were not affected in double-blinded placebo-controlled trials [39,40 ]. Thus, the recommended first line agents in routine use have been summarised in Table 2. CONFLICT OF INTEREST Neither author has a conflict of interest, nor has there been any financial support provided to either author. REFERENCES 1 Du J, Johnston R, Rice M. Temporal trends of acute nephrolithiasis in Auckland, New Zealand. N Z Med J 2009 ; 24 ; Long LO, Park S. Update on nephrolithiasis management. Minerva Urol Nefrol 2007 ; 59 : Coe FL, Worcester EM. Calcium kidney stones. N Engl J Med 2010 ; 363 : Singh SK, Agarwal MM, Sharma S. Medical therapy for calculus disease. BJU Int 2011 ; 107 : Borghi L, Schianchi T, Meschi T et al. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med 2002 ; 346 : Stitchantrakul W, Sopassathit W, Prapaipanich S, Domrongkitchaiporn UroPhos-K D penicillamine or alpha mercaptopropionylglycine Alpha blockers Surgical treatment is first-line therapy S. Effects of calcium supplements on the risk of renal stone formation in a population with low oxalate intake. SE Asian J Trop Med Public Health 2004 ; 35 : Holmes RP, Goodman HO, Assimos DG. Contribution of dietary oxalate to urinary oxalate excretion. Kidney Int 2001 ; 59 : Traxer O, Huet B, Poindexter J, Pak CY, Pearle MS. Effect of ascorbic acid consumption on urinary stone risk factors. J Urol 2003 ; 170 : Escribano J, Balaguer A, Pagone F, Feliu A, Roqu é I Figuls M. Pharmacological interventions for preventing complications in idiopathic hypercalciuria. Cochrane Database Syst Rev 2009 ; 1 : CD Fabris A, Lupo A, Bernich P et al. Long-term treatment with potassium citrate and renal stones in medullary sponge kidney. Clin J Am Soc Nephrol ; 5 : Ettinger B, Tang A, Citron JT, Livermore B, Williams T. Randomized trial of allopurinol in the prevention of calcium oxalate calculi. N Engl J Med 1986 ; 315 : Heller HJ, Reza-Albarr á n AA, Breslau NA, Pak CY. Sustained reduction in urinary calcium during long-term treatment with slow release neutral potassium phosphate in absorptive hypercalciuria. J Urol 1998 ; 159 : Breslau NA, Heller HJ, Reza-Albarr á n AA, Pak CY. Physiological effects of slow release potassium phosphate for absorptive hypercalciuria: a randomized double-blind trial. J Urol 1998 ; 160 : Cicerello E, Merlo F, Maccatrozzo L. Urinary alkalization for the treatment of uric acid nephrolithiasis. Arch Ital Urol Androl ; 82 : Hutchison AG. Cystine stones treated by surgery and D-penicillamine. Proc R Soc Med 1968 ; 61 : Hautmann R, Terhorst B, Stuhlsatz HW, Lutzeyer W. Mercaptopropionylglycine: a progress in cystine stone therapy. J Urol 1977 ; 117 : Daudon M, Cohen-Solal F, Barbey F, Gagnadoux MF, Knebelmann B, Jungers P. Cystine crystal volume determination: a useful tool in the management of cystinuric patients. Urol Res 2003 ; 31 : Williams JJ, Rodman JS, Peterson CM. A randomized double-blind study of acetohydroxamic acid in struvite nephrolithiasis. N Engl J Med 1984 ; 311 : Rodman JS, Williams JJ, Jones RL. Hypercoagulability produced by treatment with acetohydroxamic acid. Clin Pharmacol Ther 1987 ; 42 : Preminger GM. Pharmacologic treatment of uric acid calculi. Urol Clin North Am 1987 ; 14 : Ngo TC, Assimos DG. Uric acid nephrolithiasis: recent progress and future directions. Rev Urol 2007 ; 9 : Trinchieri A, Esposito N, Castelnuovo C. Dissolution of radiolucent renal stones by oral alkalinization with potassium citrate/potassium bicarbonate. Arch Ital Urol Androl 2009 ; 81 : Hosomi M, Maeda O, Matsumiya K et al. Dissolution therapy of struvite calculi with solution G. Hinyokika Kiyo 1988 ; 34 : Heimbach D, Kourambas J, Zhong P et al. The use of chemical treatments for improved comminution of artificial stones. J Urol 2004 ; 171 : Dretler S, Pfister R. Percutaneous dissolution of renal calculi. Ann Rev Med 1983 ; 34 : Berkhoff WB, van Haga JJ, Roodvoets AP. Percutaneous chemolitholysis of cystine stones. Possibilities for ambulatory procedure. Eur Urol 1988 ; 14 : Yencilek F, Erturhan S, Canguven O, Koyuncu H, Erol B, Sarica K. Does tamsulosin change the management of proximally located ureteral stones? Urol Res ; 38 : Worster AS, Richards CG. Fluids and diuretics for acute ureteric colic. Cochrane Database Syst Rev 2005 ; 3 : CD Zehri AA, Ather MH, Abbas F, Biyabani SR. Preliminary study of
5 UROLITHIASIS MEDICAL THERAPIES efficacy of doxazosin as a medical expulsive therapy of distal ureteric stones in a randomized clinical trial. Urology 2010 ; 75 : Agrawal M, Gupta M, Gupta A, Agrawal A, Sarkari A, Lavania P. Prospective randomized trial comparing efficacy of alfuzosin and tamsulosin in management of lower ureteral stones. Urology 2009 ; 73 : Yilmaz E, Batislam E, Basar MM, Tuglu D, Ferhat M and Basar H. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol 2005 ; 173 : Ye Z, Yang H, Li H et al. A multicentre, prospective, randomized trial: comparative efficacy of tamsulosin and nifedipine in medical expulsive therapy for distal ureteric stones with renal colic. BJU Int 2011 ; 108 : Salehi M, Fouladi M, Mehr H et al. Does methylprednisolone acetate increase the success rate of medical therapy for passing distal ureteral stones? Eur Urol 2005 ; 3 (Suppl. 4 ); Porpiglia F, Vaccino D, Billia M et al. Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association? Eur Urol 2006 ; 50 : Holdgate A, Pollock T. Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. BMJ 2004 ; 5 : Erturhan S, Erbagci A, Yagci F, Celik M, Solakhan M, Sarica K. Comparative evaluation of efficacy of use of tamsulosin and/or tolterodine for medical treatment of distal ureteral stones. Urology 2007 ; 69 : Ahmad M, Chaughtai MN, Kahn FA. Role of prostaglandin synthesis inhibitors in the passage of ureteric calculus. J Pak Med Assoc 1991 ; 41 : Holdgate A, Pollock T. Nonsteroidal anti-inflammatory drugs (NSAIDs) versus opioids for acute renal colic. Cochrane Database Syst Rev 2005 ; 2 : CD Laerum E, Ommundsen OE, Gr ø nseth JE, Christiansen A, Fagertun HE. Oral diclofenac in the prophylactic treatment of recurrent renal colic. A double-blind comparison with placebo. Eur Urol 1995 ; 28 : Phillips E, Hinck B, Pedro R et al. Celecoxib in the management of acute renal colic: a randomized controlled clinical trial. Urology 2009 ; 74 : Correspondence: Daniel Spernat, Department of Urology, Monash Medical Centre, Victoria, Australia. spernat1@hotmail.com Abbreviation : MET, medical expulsion therapy
Medical Approach to Nephrolithiasis. Seth Goldberg, MD September 15, 2017 ACP Meeting
Medical Approach to Nephrolithiasis Seth Goldberg, MD September 15, 2017 ACP Meeting DISCLOSURES Seth Goldberg, MD Assistant Professor of Medicine Research support Abbott Kadmon Otsuka Pfizer Introduction
More informationSchool of Medicine and Health Sciences Division of Basic Medical Sciences Discipline of Biochemistry and Molecular Biology PLB SEMINAR
1 School of Medicine and Health Sciences Division of Basic Medical Sciences Discipline of Biochemistry and Molecular Biology PLB SEMINAR URINARY (RENAL) STONE FORMATION An Overview What are Urinary (Renal)
More informationUrolithiasis. Ali Kasraeian, MD, FACS Kasraeian Urology Advanced Laparoscopic, Robotic & Minimally Invasive Urologic Surgery
Urolithiasis Ali Kasraeian, MD, FACS Kasraeian Urology Advanced Laparoscopic, Robotic & Minimally Invasive Urologic Surgery Urolithiasis: Why should we care? Affects 5% of US men and women Men twice as
More informationNEPHROLITHIASIS Etiology, stone composition, medical management, and prevention
NEPHROLITHIASIS Etiology, stone composition, medical management, and prevention Urology Division, Surgery Department Medical Faculty, University of Sumatera Utara Epidemiology Prevalence 2-3%, maybe in
More informationManagement of common uroliths through diet
Vet Times The website for the veterinary profession https://www.vettimes.co.uk Management of common uroliths through diet Author : Marge Chandler Categories : Canine, Companion animal, Feline, Vets Date
More informationMEDICAL STONE MANAGEMENT MADE EASY PRACTICAL ADVICE
MEDICAL STONE MANAGEMENT MADE EASY PRACTICAL ADVICE Comprehensive Kidney Stone Center at Duke University Medical Center Durham, North Carolina Glenn M. Preminger, M.D. UCLA State-of-the Art Urology 02
More information2015 OPSC Annual Convention. syllabus. February 4-8, 2015 Hyatt Regency Mission Bay San Diego, California
2015 OPSC Annual Convention syllabus February 4-8, 2015 Hyatt Regency Mission Bay San Diego, California FRIDAY, FEBRUARY 6, 2015: 4:00pm - 5:00pm Stone Disease^ Presented by John Grimaldi, DO ^ California
More informationMetabolic Stone Work-Up For Stone Prevention. Dr. Hazem Elmansy, MD, MSC, FRCSC Assistant Professor, NOSM, Urology Department
Metabolic Stone Work-Up For Stone Prevention Dr. Hazem Elmansy, MD, MSC, FRCSC Assistant Professor, NOSM, Urology Department Faculty/Presenter Disclosure Slide Faculty: Hazem Elmansy Relationships with
More informationEffective Health Care Program
Comparative Effectiveness Review Number 61 Effective Health Care Program Recurrent Nephrolithiasis in Adults: Comparative Effectiveness of Preventive Medical Strategies Executive Summary Introduction Nephrolithiasis
More informationGUIDELINES ON UROLITHIASIS
GUIDELINES ON UROLITHIASIS (Text updated May 2005) H.G. Tiselius (chairman), D. Ackermann, P. Alken, C. Buck, P. Conort, M. Gallucci, T. Knoll Eur Urol 2001;40:362-371 Introduction Urinary stone disease
More informationRISK FACTORS AND TREATMENT STRATEGIES FOR URINARY STONES Review of NASA s Evidence Reports on Human Health Risks
Mayo Clinic O Brien Urology Research Center RISK FACTORS AND TREATMENT STRATEGIES FOR URINARY STONES 2017 Review of NASA s Evidence Reports on Human Health Risks John C Lieske, MD July 27, 2017 What types
More informationThe Nuts and Bolts of Kidney Stones. Soha Zouwail Consultant Chemical Pathology UHW Renal Training Day 2019
The Nuts and Bolts of Kidney Stones Soha Zouwail Consultant Chemical Pathology UHW Renal Training Day 2019 Urinary Calculi Prevalence and incidence of kidney stones increasing across the world Environmental
More informationThe 82 nd UWI/BAMP CME Conference November 18, Jeetu Nebhnani MBBS D.M. Urology Consultant Urologist
The 82 nd UWI/BAMP CME Conference November 18, 2017 Jeetu Nebhnani MBBS D.M. Urology Consultant Urologist Disclosures Outline Index case Introduction Etiology Risk factors Acute stone event Conservative
More informationDiet and fluid prescription in stone disease
http://www.kidney-international.org & 2006 International Society of Nephrology mini review Diet and fluid prescription in stone disease EN Taylor 1 and GC Curhan 1,2 1 Renal Division, Department of Medicine,
More informationGuideline of guidelines: kidney stones
Justin B. Ziemba and Brian R. Matlaga* Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, and *James Buchanan Brady Urological
More informationApproach to the Patient with Nephrolithiasis; The Stone Quiz. Farahnak Assadi* 1, MD
Education Article Iran J Ped Sep 2007; Vol 17 (No 3), Pp:283-292 Approach to the Patient with Nephrolithiasis; The Stone Quiz Farahnak Assadi* 1, MD 1. Pediatric Nephrologist, Rush University Medical Center,
More informationEvaluation of the Recurrent Stone Former
Urol Clin N Am 34 (2007) 315 322 Evaluation of the Recurrent Stone Former Paramjit S. Chandhoke, MD, PhD* Department of Urology, Northwest Permanente, Portland, OR, USA At one time, metabolic kidney stone
More informationQuaseem et coll. Ann Intern Med 2014
Dietary and Pharmacologic Management to prevent Recurrent Nephrolithiasis in Adults A Clinical Practice Guideline From the American College of Physicians Introduction Approximately 80% of adults with kidney
More informationIdentification and qualitative Analysis. of Renal Calculi
Identification and qualitative Analysis of Renal Calculi 1 -Renal Calculi: Kidney stones, renal calculi or renal lithiasis (stone formation) are small, hard deposits that form inside your kidneys. The
More informationUrologic Stone Disease. Urologic Stone Disease. Urologic Stone Disease. Urologic Stone Disease. Urologic Stone Disease 5/7/2010
Diagnosis and Treatment Stephen E. Strup MD William Farish Professor and Chief of Urology Director of Minimally Invasive Urologic Surgery University of Kentucky I will not cut, even for the stone, but
More informationNomogram to predict uric acid kidney stones based on patient s age, BMI and 24-hour urine profiles: A multicentre validation
ORIGINAL RESEARCH Nomogram to predict uric acid kidney stones based on patient s age, BMI and 24-hour urine profiles: A multicentre validation Fabio Cesar Miranda Torricelli, MD; * Robert Brown, MD; Fernanda
More informationThis is the written version of our Hot Topic video presentation available at: MayoMedicalLaboratories.com/hot-topics
This is the written version of our Hot Topic video presentation available at: MayoMedicalLaboratories.com/hot-topics Welcome to Mayo Medical Laboratories Hot Topics. These presentations provide short discussion
More informationAssociation of serum biochemical metabolic panel with stone composition
bs_bs_banner International Journal of Urology (2015) 22, 195 199 doi: 10.1111/iju.12632 Original Article: Clinical Investigation Association of serum biochemical metabolic panel with stone composition
More informationAlkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy
Clinical Urology Alkaline citrate and stone recurrence International Braz J Urol Vol. 37 (5): 611-616, September - October, 2011 Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy
More informationUrinary Calculus Disease. Urinary Stones: Simplified Metabolic Evaluation. Urinary Calculus Disease. Urinary Calculus Disease 2/8/2008
Urinary Stones: Simplified Metabolic Evaluation Marshall L. Stoller, M.D. Professor and Vice Chairman Department of Urology University of California San Francisco Incidence: 7-21/10,000 3 men: 1 woman
More informationGUIDELINES ON UROLITHIASIS
18 H.G. Tiselius (chairman), D. Ackermann, P. Alken, C. Buck, P. Conort, M. Gallucci Eur Urol 2001;40:362-371 Introduction Urinary stone disease continues to occupy an important place in everyday urological
More informationKidney Stone Update. Epidemiology of Kidney Stones. Lifetime Risk of Kidney Stone
Kidney Stone Update Michael Emmett MD Baylor University Medical Center Dallas, Texas Epidemiology of Kidney Stones Incidence About 0.3% Prevalence 10% Men 12% Women 8% Hospitalization Peak Age Stone Composition
More informationEURACARE Multi-Specialist Hospital
EURACARE Multi-Specialist Hospital PATIENT INFORMATION FORM MEDICAL MANAGEMENT OF URINARY STONE DISEASE Kidney & Urinary Stones Kidney stones, one of the most painful of the urologic disorders, have beset
More informationJ of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 4/ Issue 15/Feb 19, 2015 Page 2499
ROLE OF DEFLAZACORT AND TAMSULOSIN IN MEDICAL EXPULSIVE THERAPY FOR SYMPTOMATIC LOWER URETERIC STONES K. Sitharamaiah 1, G. Chalapathi 2, S. Abdul Samad 3, C. Surya Prakash Reddy 4 HOW TO CITE THIS ARTICLE:
More informationNIH Public Access Author Manuscript Expert Opin Pharmacother. Author manuscript; available in PMC 2013 September 13.
NIH Public Access Author Manuscript Published in final edited form as: Expert Opin Pharmacother. 2013 March ; 14(4): 435 447. doi:10.1517/14656566.2013.775250. KIDNEY STONES: AN UPDATE ON CURRENT PHARMACOLOGICAL
More informationReviews in Clinical Medicine
Mashhad University of Medical Sciences (MUMS) Reviews in Clinical Medicine Clinical Research Development Center Ghaem Hospital Evaluation of the effects of magnesium supplement in primary and secondary
More informationShlomi Albert, M.D., Inc Warner Avenue, Suite 423 Fountain Valley, Ca Tel (714) Fax (714) Kidney Stone Disease in Adults
Shlomi Albert, M.D., Inc. 11160 Warner Avenue, Suite 423 Fountain Valley, Ca 92708 Tel (714)549-3333 Fax (714)549-3334 Kidney Stone Disease in Adults Overview Kidney stones are one of the most painful
More informationKidney Stones EDITING FILE. Biochemistry Team 437 "الل ھ م لا س ھ ل إ لا ما ج ع ل ت ھ س ھ لا وأن ت ت ج ع ل الح ز ن إذ ا ش ي ت س ھ لا " Renal block
"الل ھ م لا س ھ ل إ لا ما ج ع ل ت ھ س ھ لا وأن ت ت ج ع ل الح ز ن إذ ا ش ي ت س ھ لا " Kidney Stones Biochemistry Team 437 Color index: Doctors slides Doctor s notes Extra information Highlights Renal block
More informationDepartment of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
A survey of patient preferences regarding medical expulsive therapy following the SUSPEND trial John Roger Bell, MD, 1 Kristina L. Penniston, PhD, 1 Sara L. Best, MD, 1 Stephen Y. Nakada, MD 1-3 1 Department
More informationAlterations of Renal and Urinary Tract Function
Alterations of Renal and Urinary Tract Function Chapter 29 Urinary Tract Obstruction Urinary tract obstruction is an interference with the flow of urine at any site along the urinary tract The obstruction
More informationNICE guideline Published: 8 January 2019 nice.org.uk/guidance/ng118
Renal and ureteric stones: assessment and management NICE guideline Published: 8 January 2019 nice.org.uk/guidance/ng118 NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationDietary Management of Nephrolithiasis. Sarah Yttri, NP Duke University Duke Comprehensive Kidney Stone Center
Dietary Management of Nephrolithiasis Sarah Yttri, NP Duke University Duke Comprehensive Kidney Stone Center None Disclosures Prevalence 1 in 11 individuals in the US 10.6% of men, 7.1% of women 70% increase
More informationPart I: On-line web-based survey of Dalmatian owners GENERAL INFORMATION
Dr. Bartges' final report on the Dal stone survey: Commissioned by the Dalmatian Club of America Foundation (DCAF) Published in the DCA magazine, The Spotter, Summer 2006 Part I: On-line web-based survey
More informationWorkshop : Managing Urinary Stones and BPH
Workshop : Managing Urinary Stones and BPH How common are they? lifetime risk 15% men, 6% women Dr John Tuckey Urologist Auckland 105 new stones /100,000 peak age incidence 30-50 males 2.3:1 How common
More informationEfficacy of Three Different Alpha 1-Adrenergic Blockers and Hyoscine N-Butylbromide for Distal Ureteral Stones
Clinical Urology Alpha-1 Blockers and Hyoscine for Ureteral Stones International Braz J Urol Vol. 37 (2): 195-202, March - April, 2011 doi: 10.1590/S1677-55382011000200006 Efficacy of Three Different Alpha
More informationGuideline Renal and ureteric stones: assessment and management
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Guideline Renal and ureteric stones: assessment and management Draft for consultation, July 0 This guideline covers assessing and managing renal and ureteric
More informationApril 08, biology 2201 ch 11.3 excretion.notebook. Biology The Excretory System. Apr 13 9:14 PM EXCRETORY SYSTEM.
Biology 2201 11.3 The Excretory System EXCRETORY SYSTEM 1 Excretory System How does the excretory system maintain homeostasis? It regulates heat, water, salt, acid base concentrations and metabolite concentrations
More informationPrevention of recurrent calcium stones in adults
Official reprint from UpToDate www.uptodate.com Print Back Prevention of recurrent calcium stones in adults Author Gary C Curhan, MD, ScD Section Editor Stanley Goldfarb, MD Deputy Editor Theodore W Post,
More informationKidney Stone Clinic Dr. Raymond Ko MB BS (Hons 1) FRACS (Urology) General Information about Kidney Stones
Why do kidney stones form? General Information about Kidney Stones Kidney stones form from minerals and salts in the urine that clump together when the urine becomes highly concentrated. Normally these
More informationUrinary Stones. Urinary Stones. Published on: 1 Jul What are the parts of the urinary system?
Published on: 1 Jul 2016 Urinary Stones Urinary Stones What are the parts of the urinary system? The urinary system consists of the kidneys, ureters, urinary bladder, and urethra. What are the functions
More informationMODULE 6: KIDNEY STONES
MODULE 6: KIDNEY STONES KEYWORDS: Nephrolithiasis, Urinary Stones, Urolithiasis, Hypercalciuria, Hyperoxaluria, Hypocitraturia, Hyperuricosuria, Cystinuria LEARNING OBJECTIVES At the end of this clerkship,
More informationTreatment of Kidney and Ureteral Stones
Patient Information English 3 Treatment of Kidney and Ureteral Stones The underlined terms are listed in the glossary. You have been diagnosed with a kidney or ureteral stone. This leaflet describes the
More informationAlpha blockers have no role in renal colic
Alpha blockers have no role in renal colic HARRY WINKLER Director, section of Endourology Kidney stone center Dept.of Urology Sheba Medical Center Financial and Other Disclosures Off-label use of drugs,
More informationDietary and medical management of recurrent nephrolithiasis
REVIEW EDUCATIONAL OBJECTIVE: Readers will apply interventions to reduce the risk of recurrent nephrolithiasis SILVI SHAH, MD Department of Nephrology, University of Alabama at Birmingham JUAN CAMILO CALLE,
More informationEQUILIBRIUM VERSUS SUPERSATURATED URINE HYPOTHESIS IN CALCIUM SALT UROLITHIASIS: A NEW THEORETICAL AND PRACTICAL APPROACH TO A CLINICAL PROBLEM
Scanning Microscopy Vol. 13, No. 2-3, 1999 (Pages 261-265) 0891-7035/99$5.00+.25 Scanning Microscopy International, Chicago Equilibrium (AMF O Hare), model for IL calcium 60666 USA salt urolithiasis EQUILIBRIUM
More informationExcretory System. Biology 2201
Excretory System Biology 2201 Excretory System How does the excretory system maintain homeostasis? It regulates: Body heat Water-salt concentrations Acid-base concentrations Metabolite concentrations ORGANS
More informationExcretory System. Excretory System
Excretory System Biology 2201 Excretory System How does the excretory system maintain homeostasis? It regulates: Body heat Water-salt concentrations Acid-base concentrations Metabolite concentrations 1
More informationEffect of Potassium Magnesium Citrate and Vitamin B-6 Prophylaxis for Recurrent and Multiple Calcium Oxalate and Phosphate Urolithiasis
www.kjurology.org http://dx.doi.org/10.4111/kju.2014.55.6.411 Original Article - Endourology/Urolithiasis http://crossmark.crossref.org/dialog/?doi=10.4111/kju.2014.55.6.411&domain=pdf&date_stamp=2014-06-16
More informationNephrolithiasis Outline Epidemiology
Nephrolithiasis Brian Duty, M.D. Assistant Professor Department of Urology Oregon Health & Sciences University Outline Epidemiology Pathophysiology Clinical Presentation Diagnosis Management Medical Surgical
More informationNon-protein nitrogenous substances (NPN)
Non-protein nitrogenous substances (NPN) A simple, inexpensive screening test a routine urinalysis is often the first test conducted if kidney problems are suspected. A small, randomly collected urine
More informationCalcium Oxalate Urolithiasis
Customer Name, Street Address, City, State, Zip code Phone number, Alt. phone number, Fax number, e-mail address, web site Calcium Oxalate Urolithiasis (Calcium Oxalate Stones in the Urinary Tract) Basics
More informationORIGINAL ARTICLE ALPHA 1 BLOCKERS IN COMBINATION WITH OTHER DRUGS FOR MEDICAL TREATMENT OF URETERIC CALCULI
ALPHA 1 BLOCKERS IN COMBINATION WITH OTHER DRUGS FOR MEDICAL TREATMENT OF URETERIC CALCULI Brijendra Nigam 1, Renu Ranwaka 2, Manisha Nigam 3, T.P. Devpura 4 HOW TO CITE THIS ARTICLE: Brijendra Nigam,
More informationCalcium Nephrolithiasis and Bone Health. Noah S. Schenkman, MD
Calcium Nephrolithiasis and Bone Health Noah S. Schenkman, MD Associate Professor of Urology and Residency Program Director, University of Virginia Health System; Charlottesville, Virginia Objectives:
More informationT H E K I D N E Y F O U N D A T I O N O F C A N A D A
Kidney stones T H E K I D N E Y F O U N D A T I O N O F C A N A D A 1 Kidney stones What are the kidneys? The kidneys are the master chemists of the body. Normally, there are two of them, one on either
More information24-h uric acid excretion and the risk of kidney stones
http://www.kidney-international.org & 2008 International Society of Nephrology original article 24-h uric acid excretion and the risk of kidney stones GC Curhan 1,2,3 and EN Taylor 1,2 1 Department of
More informationAUA Guidelines. Medical Management of Kidney Stones: AUA Guideline
AUA Guidelines Medical Management of Kidney Stones: AUA Guideline Margaret S. Pearle, David S. Goldfarb, Dean G. Assimos, Gary Curhan, Cynthia J. Denu-Ciocca, Brian R. Matlaga, Manoj Monga, Kristina L.
More informationThe role of corticosteroids in the management of kidney stones disease: a systematic review
The role of corticosteroids in the management of kidney stones disease: a systematic review Background: Therapy for kidney stones disease has undergone many changes in the last decades. Medical expulsive
More information(Would you like to include: <5mm, 5-10mm?)
1. Why the guideline is needed: Current practice (line 30) The measurements provided are examples states: Ongoing treatment of renal stone disease is only, do you agree with the range of renal dependent
More informationEffects of dietary interventions on 24-hour urine parameters in patients with idiopathic recurrent calcium oxalate stones
Kaohsiung Journal of Medical Sciences (2013) 29, 88e92 Available online at www.sciencedirect.com journal homepage: http://www.kjms-online.com ORIGINAL ARTICLE Effects of dietary interventions on 24-hour
More informationUrinary System. Analyze the Anatomy and Physiology of the urinary system
Urinary System Analyze the Anatomy and Physiology of the urinary system Kidney Bean-shaped Located between peritoneum and the back muscles (retroperitoneal) Renal pelvis funnelshaped structure at the beginning
More informationMedical Expulsive Therapy
Medical Expulsive Therapy Samuel P. Sterrett, DO, and Stephen Y. Nakada, MD Summary: Minimally invasive therapies for urolithiasis including extracorporeal shock wave lithotripsy, ureteroscopy, and percutaneous
More informationA&P of the Urinary System
A&P of the Urinary System Week 44 1 Objectives Identify the organs of the urinary system, from a Identify the parts of the nephron (the functional unit List the characteristics of a normal urine specimen.
More informationUrine Stone Screen requirements
Urine Stone Screen requirements Unique Identifying Index Number LP/PA/CB/CBSP030 Version number 4 Issue Date (this version) 03.08.15 Document Type Accreditation or Licensing Standard to which this applies
More informationRecent advances in endourologic techniques have created new therapeutic challenges, particularly
JOURNAL OF ENDOUROLOGY Volume 2, Number 2, 1988 Mary Ann Liebert, Inc., Publishers Broad-Beam Ultrasound for Acceleration of Struvite Calculi Dissolution Using Citric Acid-Based Chemolytic Agents GEORGE
More informationRecurrent stone formers-metabolic evaluation: a must investigation
International Surgery Journal Bhangu GS et al. Int Surg J. 2017 Jan;4(1):86-90 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Original Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20163972
More informationRenal Stone Disease 1
Renal Stone Disease 1 What is a Stone? A Precipitation of secretions within an excretory organ Four sites: Renal, Prostatic, Biliary, Salivary Stone Formation needs Supersaturation of urine with solute
More informationUrinary Calculus Disease
SYSTEMIC AND METABOLIC CONSIDERATION OF NEPHROLITHIASIS Marshall L. Stoller, M.D. Professor and Vice Chairman Department of Urology University of California San Francisco Urinary Calculus Disease Incidence:
More informationThe Effect of Terpene Combination on Ureter Calculus Expulsion After Extracorporeal Shock Wave Lithotripsy
www.kjurology.org http://dx.doi.org/10.4111/kju.2014.55.1.36 Original Article - Urolithiasis http://crossmark.crossref.org/dialog/?doi=10.4111/kju.2014.55.1.36&domain=pdf&date_stamp=2014-1-17 The Effect
More informationNephrolithiasis cases
Nephrolithiasis cases Primary Care Internal Medicine October 2015 Brian Eisner MD Co-director, Kidney Stone Program Massachusetts General Hospital, Harvard Medical School CASE 1 45 year old male, otherwise
More informationOutcome of ureteric stone treatment with tamsulocin. Janaki Medical College Teaching Hospital, Ramdaiya ABSTRACT
DOI: https://doi.org/10.3126/jmcjms.v6i02.22058 Research Article JMCJMS Outcome of ureteric stone treatment with tamsulocin Rakesh Kumar Pandit 1*, Uma Shankar Gupta 2, Subash Thapa Magar 3, Vinay Kumar
More informationCYSTIC DISEASES of THE KIDNEY. Dr. Nisreen Abu Shahin
CYSTIC DISEASES of THE KIDNEY Dr. Nisreen Abu Shahin 1 Types of cysts 1-Simple Cysts 2-Dialysis-associated acquired cysts 3-Autosomal Dominant (Adult) Polycystic Kidney Disease 4-Autosomal Recessive (Childhood)
More informationMetabolic Abnormalities Associated With Renal Calculi in Patients with Horseshoe Kidneys
JOURNAL OF ENDOUROLOGY Volume 18, Number 2, March 2004 Mary Ann Liebert, Inc. Metabolic Abnormalities Associated With Renal Calculi in Patients with Horseshoe Kidneys GANESH V. RAJ, M.D., 1 BRIAN K. AUGE,
More informationAP2, Lab 7 - THE URINARY SYSTEM
AP2, Lab 7 - THE URINARY SYSTEM I. SYSTEM COMPONENTS (Figs. 25.1 25.4) KIDNEYS Each kidney contains approx. 1,000,000 tubular NEPHRONS which produce FILTRATE from the plasma and then add to or take from
More informationEvaluation of different urinary constituent ratios in renal stone formers
Available online at www.scholarsresearchlibrary.com Annals of Biological Research, 2010, 1 (3) : 50-55 (http://scholarsresearchlibrary.com/archive.html) ISSN 0976-1233 CODEN (USA): ABRNBW Evaluation of
More informationPRODUCT INFORMATION UROCIT -K. Wax matrix tablets
PRODUCT INFORMATION UROCIT -K Wax matrix tablets NAME OF DRUG Potassium Citrate CAS number- 6100-05-6 The empirical formula of potassium citrate is K 3 C 6 H 5 0 7.H 2 O, and its structural formula is:
More informationCitation 泌尿器科紀要 (2004), 50(7):
TitleRole of the urinary calcium in the Author(s) Murayama, Tetsuo; Sakai, Naoki; Tak Tetsuo Citation 泌尿器科紀要 (24), 5(7): 451-455 Issue Date 24-7 URL http://hdl.handle.net/2433/113414 Right Type Departmental
More informationCase studies. Stephen Mark Rob Walker
Case studies Stephen Mark Rob Walker Case 1 31 yr old woman with 3 rd UTI. E coli Frequency and dysuria Asymptomatic after treatment Recurrent UTI Lower tract symptoms Coliforms Asymptomatic after treatment
More informationEfficacy of Tamsulosin in the Medical Management of Juxtavesical Ureteral Stones: A Randomized Control Trial
Bangladesh Med Res Counc Bull 2016; 42:78-83 Efficacy of Tamsulosin in the Medical Management of Juxtavesical Ureteral Stones: A Randomized Control Trial Abstract Mustafa ASMF 1, Islam MS 2, Mamun AA 3,
More informationMarc Richards MD South Florida Kidney Disease and Hypertension Specialists BRRH Grand Rounds October 13 th, 2015
Marc Richards MD South Florida Kidney Disease and Hypertension Specialists BRRH Grand Rounds October 13 th, 2015 None Epidemiology Acute Renal Colic Types of Stones Risk factors for Stone Formation Treatment
More informationAcute Kidney Injury (AKI)
(Last Updated: 08/22/2018) Created by: Socco, Samantha Acute Kidney Injury (AKI) Thambi, M. (2017). Acute Kidney Injury. Lecture presented at PHAR 503 Lecture in UIC College of Pharmacy, Chicago. AKI This
More informationPractical Approach to Metabolic Evaluation and Treatment of the Recurrent Stone Patient
Practical Approach to Metabolic Evaluation and Treatment of the Recurrent Stone Patient Gaurav Bandi, MD; Stephen Y. Nakada, MD; Kristina L. Penniston, PhD, RD Abstract Although significant progress has
More informationQuality of life and urolithiasis: the patient - reported outcomes measurement information system (PROMIS)
ORIGINAL ARTICLE Vol. 43 (5): 880-886, September - October, 2017 doi: 10.1590/S1677-5538.IBJU.2016.0649 Quality of life and urolithiasis: the patient - reported outcomes measurement information system
More informationHydronephrosis. What is hydronephrosis?
What is hydronephrosis? Hydronephrosis Hydronephrosis describes the situation where the urine collecting system of the kidney is dilated. This may be a normal variant or it may be due to an underlying
More informationChapter 20 Diseases of the kidney:
Chapter 20 Diseases of the kidney: 1. Which of the following is seen in Nephrotic syndrome (2000, 2004) (a) Albumin is lost in the urine, while other globulins are unaffected (b) Early hypertension (c)
More informationUse the following diagram to answer the next question. 1. In the diagram above, pressure filtration occurs in a. W b. X c. Y d. Z
Part A: Multiple Choice Questions Value: 32 Marks Suggested time: 40 minutes Instructions: For each question select the best answer and record your choice on the Scantron card provided. Using an HB pencil,
More informationRETROGRADE URETEROSCOPIC HOLMIUM: YAG LASER LITHOTRIPSY FOR URETERAL AND RENAL STONES
1110-5712 Vol. 20, No. 3, 2014 Egyptian Journal of Urology 121-125 RETROGRADE URETEROSCOPIC HOLMIUM: YAG LASER LITHOTRIPSY FOR URETERAL AND RENAL STONES AHMED EL-FEEL, AHMED SAMIR, HESHAM FATHY, OMAR M
More informationSchedule of taking calcium supplement and the risk of nephrolithiasis
Kidney International, Vol. 65 (2004), pp. 1835 1841 Schedule of taking calcium supplement and the risk of nephrolithiasis SOMNUEK DOMRONGKITCHAIPORN,WICHAI SOPASSATHIT, WASANA STITCHANTRAKUL, SURASING
More informationw This information leaflet contains basic information Basic Information on Kidney and Ureteral Stones What is a stone? Patient Information Go Online
Patient Information English Basic Information on Kidney and Ureteral Stones The underlined terms are listed in the glossary. What is a stone? right kidney left kidney A stone is a hard, solid mass that
More informationCost-Effectiveness of Medical Expulsive Therapy Using Alpha-Blockers for the Treatment of Distal Ureteral Stones
european urology 53 (2008) 411 419 available at www.sciencedirect.com journal homepage: www.europeanurology.com Stone Disease Cost-Effectiveness of Medical Expulsive Therapy Using Alpha-Blockers for the
More informationThe Effectiveness of Lemon Solution versus Potassium Citrate in the Management of Hypocitraturic Calcium Kidney Stones: A Systematic Review
Title of the Systematic Review: The Effectiveness of Lemon Solution versus Potassium Citrate in the Management of Hypocitraturic Calcium Kidney Stones: A Systematic Review Student Name: Pei-Ling Yang (Peggy)
More informationPHYSICAL PROPERTIES AND DETECTION OF NORMAL CONSTITUENTS OF URINE
PHYSICAL PROPERTIES AND DETECTION OF NORMAL CONSTITUENTS OF URINE - OBJECTIVES: 1- The simple examination of urine. 2- To detect some of the normal organic constituents of urine. 3- To detect some of the
More informationJ of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 3/ Issue 42/Sep 08, 2014 Page 10564
MANAGING LARGE COMPLICATED BILATERAL STAGHORN, URETERIC AND VESICAL CALCULI: IMAGES AND DILEMMAS Ranjith Chaudhary 1, Kulwant Singh 2, Chirag Shanthi Dausage 3, Nidhi Jain 4 HOW TO CITE THIS ARTICLE: Ranjith
More informationUrinary stone disease is a significant
Medical Management of Common Urinary Calculi PAUL K. PIETROW, M.D., and MICHAEL E. KARELLAS, M.D. University of Kansas Medical Center, Kansas City, Kansas Nephrolithiasis is a common condition affecting
More informationRenal and ureteric stones: assessment and management
National Institute for Health and Care Excellence Consultation Renal and ureteric stones: assessment and management NICE guideline Intervention evidence review July 2018 Consultation This evidence review
More information