Lessons Learned from Endoscopy
|
|
- Christian White
- 5 years ago
- Views:
Transcription
1 Mayo Clinic O Brien Urology Research Center Lessons Learned from Endoscopy August 22, 2015 Amy Krambeck, MD Mayo Clinic Department of Urology John C. Lieske, MD Fang Zhao, MD Mayo Clinic Division of Nephrology & Hypertension Nicholas Chia, PhD Department of Surgery
2 New Aims Specific Aim #1: Accurately map kidney stone location and precursor lesions after percutaneous nephrolithotomy in defined groups of patients Determine clinical and laboratory factors that predict the presence of plaque versus plug Correlate stone composition and stone precursor lesions with findings on dual energy CT scan using refined data analysis algorithms Hypothesis: Renal stone precursor lesions will differ in each group of patients, and within the CaOx group. Hypercalciuria will predict plaque coverage while urinary ph and CGI will predict plugs. Refined dual-energy CT technology will allow accurate classification of stone localization and composition.
3 New Aims Specific Aim #2: Define dual energy CT algorithms to predict stone fragility Hypothesis: Stone characteristics by DECT will allow prediction of stone susceptibility prior to intraoperative disruption. Specific Aim #3: Determine the gene expression profile of papillary tip biopsies with minimal and maximal plaque and plugs Hypothesis: Patients with extensive amounts of plaque will have different gene expression profiles from those with plugs, and both will differ from controls
4 New Aims Specific Aim #4: Characterize the microbiome of urine and kidney stones of patients with diverse types of stones. Hypothesis: The urinary and stone microbiome contributes to stone composition, growth upon plaque or plug, and will differ by stone type.
5 Mapping protocol 78 consecutive patients undergoing PCNL Stones were removed Analyzed using µ-ct and IR Each accessible calyx was endoscopically mapped using a flexible digital nephroscope Biopsies were acquired 24hr urine chemistries Supersaturations (EQUIL2) Crystal inhibition CaOx seeded crystal growth assay Kuo et al. J Urol, 170:2186, 2003
6 Randall s Plaque Summary 98.7% patients mapped had some RP 67.9% had plaque in all calyces Plaque SA covered a mean of 3.0% (±3.3%) 3.5 % (±4.6%) in CaOx 1.7 % (±1.6%) in UA No correlation between urinary analytes and amount of plaque Volume p= 0.20 ph p= 0.07 Calcium p= 0.72 Linnes et al: Kidney Int Oct;84(4):818-25
7 Ductal plugs are common in CaP stone formers Video Mapping Plug % CaOx CaOx -MAL CaPO4 Stone Type Other Struvite UricAcid Linnes et al: Kidney Int Oct;84(4):818-25
8 Urine Correlations with Tubular Plugging Plugging correlates with: High ph (p=0.02) Low Citrate (p=0.02) High Apatite & Br SS (p=0.007 & 0.005) Linnes et al: Kidney Int Oct;84(4):818-25
9 Further Plaque Evaluation 42 ICSF PCNL patients with urolithiasis 15 men and 27 women Mean age 62 years old 10 non-stone forming controls undergoing PCNL for other indications 8 men and 2 women Mean age 73 years old Wang X, et al. Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randall's Plaque. Clin J Am Soc Nephrol. 2014
10 Results 90% of controls and 75% stone formers had plaque coverage less than 5% (p=0.67) Upper 25% Lower 75% Controls ICSF
11 Clinical Characteristics ICSF with high plaque (n=10) ICSF with low plaque (n=32) P value Age ( yr) 61±7 62± Male 6(60%) 8(25%) BMI 27±2.5 31± BMI>30 1(10%) 16(50%) 0.03 History of stone events 10(100%) 21(66%) 0.04 Prior stone events 4 8(80%) 7(22%) History of UTI 0(0%) 11(34%) 0.04 Hypertension 4(40%) 13(42%) 0.92 DM 1(10%) 10(31%) 0.25
12 Urine Chemistry ICSF with high plaque (n=9) ICSF with low plaque (n=27) P value ph 6.3± ± Osmolality 444± ± Urine volume (l/24h) 2.5± ± Uric acid (mg/24h) 555± ± Sodium (mmol/24h) 170±97 134± Potassium (mmol /24h) 65±22 55± Calcium (mg/24h) 291±99 187± Phosphate (mg/24h ) 980± ± Magnesium (mg/24h) 112±32 91± Chloride (mmol/24h) 148±88 126± Creatinine ( mg/24h) 1369± ± Sulfate (mmol /24h) 21±11 15±5 0.04
13 Stone Culture 19% of low plaque ICSF had a + stone culture Diverse organisms: Corynebacterium (n=2), E. coli (n=1), enterococcus (n=1), Garnerella vaginalis (n=1), and Pseudomonas (n=1) None of high plaque group (P=0.059) Plaque coverage trended lower among low plaque ICSF with + stone culture 1.4% vs 4.0%, p=0.19
14 Stone morphology by micro CT Likely to arise upon a Randall s plaque Unlikely to arise upon a Randall s plaque 26% of low plaque ICSF had unlikely RP stones None of high plaque ICSF did (p=0.04)
15 Calcium Deposits by Yasue Staining Punctate Punctate Dense Fraction of ICSF, % Low plaque ICSF High plaque ICSF Low plaque ICSF tended to have lesser amounts of punctate and dense crystallization
16 Conclusion Low Plaque vs. High Plaque Stone formers with low amount of plaque had distinguishing characteristics Fewer prior stone events Lower urine calcium excretion Obese Past history of UTI and positive stone culture Stones often lack a calcium phosphate core Less punctate and dense crystallization
17 Gene Expression Studies Hypothesis ICSFs with low amount of plaque have a different gene expression profile than those with high amount of plaque
18 Methods RNA samples from papillary tip biopsies 3 low plaque ICSFs 2 high plaque ICSFs Next Generation Sequencing Platform Type: Illumina HiSeq 2000 Application Type: Transcriptome Secondary Analysis performed by Bio-Informatics Core LogFC 2 or - 2 was used as cut-off for differential expression analysis Validation study Real-time RT-PCR Control group: 8 samples high plaque group: 6 new samples low plaque group: 8 new samples
19 Results 61 differential expression (DE) genes between low and high plaque group 25 up-regulated DE genes in HP group 36 down-regulated DE genes in HP group
20 Selected genes for validation study Gene aka logfc Up-regulated in High Plaque group CHI3L1 Chitinase 3-Like 1 (Cartilage Glycoprotein-39) ALOX15B Arachidonate 15-Lipoxygenase, Type B ( 15-LOX-2) EPHA3 EPH Receptor A CRTAC1 Cartilage Acidic Protein ALB Albumin SMOC1 Secreted Modular Calcium-Binding Protein Down-regulated in High Plaques group MMP19 matrix metallopeptidase S100A8 S100 calcium-binding protein A SELE selectin E UPK3A Uroplakin-3a
21 Results of validation study: Genes Up-regulated in HP group CHI3L Normal LP HP ALOX15B Normal LP HP EPHA3 Normal LP HP 1.6 CRTAC ALB 16 SMOC Normal LP HP 0 Normal LP HP 0 Normal LP HP
22 Results of validation study: Genes Down-regulated in HP group 7 MMP S100A Normal LP HP 0 Normal LP HP 2.5 SELE 1.4 UPK3A Normal LP HP 0 Normal LP HP
23 Summary of biological function of confirmed DE genes Genes Up-regulated in High Plaques group CHI3L1 CHI3L1 is able to bind both proteins and carbohydrates that allows potential interactions with a variety of cell-surface and extracellularmatrix proteins EPHA3 Plays a role in cardiac cells migration and differentiation and regulates the formation of the atrioventricular canal and septum during development. CRTAC1 May be involved in cell-cell or cell-matrix interactions. ALB Serum albumin, the main protein of plasma, has a good binding capacity for water, Ca(2+), Na(+), K(+), fatty acids, hormones, bilirubin and drugs. Major zinc transporter in plasma, typically binds about 80% of all plasma zinc SMOC1 This gene encodes a multi-domain secreted protein that plays essential roles in both eye and limb development. Probable regulator of osteoblast differentiation
24 Summary of biological function of confirmed DE genes Genes Down-regulated in High Plaques group MMP19 Endopeptidase that degrades various components of the extracellular matrix May also play a role in neovascularization or angiogenesis. S100A8 Promote vascular calcification by providing necrotic bodies as calcification nidus UPK3A Encodes a member of the uroplakin family, a group of transmembrane proteins that form complexes on the apical surface of the bladder epithelium Contributes to the formation of urothelial glycocalyx which may play an important role in preventing bacterial adherence
25 Immunohistochemistry validation study SMOC1 NGS result: Up-regulated in high plaque group, logfc 2.05 RT-PCR validation result: Compared to controls, SMOC1 mrna expression level was 8.6- fold change in LP groups, and 10.9-fold change in HP groups Function: Encodes a multi-domain secreted protein that plays essential roles in both eye and limb development Probable regulator of osteoblast differentiation SMOC1 Normal LP HP
26 SMOC1 LC0001 LC0002 LC0003 LP: LS0021 LP: LS0072 LP: LS0088 HP: LS0040 HP: LS0010 HP: LS0049
27 UA Stones: often mixed
28 UA SF: Papillae similar to CaOx Non Stone Forming Control N = 19 CaOx N = 95 Uric Acid N = 23 p-value % Plaque SA 0.9 ( ) 2.0 ( ) 2.0 ( ) (median; IQR) % Plug SA 0.0 ( ) 0.0 ( ) 0.1 ( ) (median; IQR) # with plaque > 0 (%) 17 (90) 95 (100) 23 (100) # with plug > 0 (%) 2 (11) 43 (45) 13 (57) 0.006
29 UA vs CaOx Histology 100 * 90 % Patients with Histologic Feature Present UA CaOx 10 0 Punctate BM Calcifications Dense BM Calcifications Interstial Inflammation Intraluminal Crystals Polarizing Crystals
30 UA Histology by %CaOx % Patients with Histologic Feature Present Minority UA Mixed Majority UA 10 0 Punctate BM Calcifications Dense BM Calcifications Interstitial Inflammation Intraluminal Crystals Polarizing Crystals
31 Struvite SF: less plaque and similar plug Struvite CaOx P Control P Endoscopic map, N Plaque, N (%) 28 (97) 90 (100) 15 (88) Mean SA, % (SD) 1.5 (±1.4) 3.7 (±4.3) (±2.7) 0.76 Max SA, % (SD) 3.6 (±4.4) 8.4 (±11.2) (±4.1) 0.61 Plug, N (%) 9 (31) 40 (44) 2 (18) Mean SA, % (SD) 0.3 (±0.8) 0.8 (±2.8) (±0.1) 0.12 Max SA, % (SD) 0.8 (±1.8) 2.1 (±5.5) (±0.4) 0.14
32 Struvite histology: Prominent Inflammation
33 Current Enrollment Modifying factor Confirmed Stone category Number Mapping data Malabsorption Renal Tubular acidosis Hyperpara thyroidism Primary Hyperoxaluria Calcium oxalate Apatite Brushite Uric Acid Struvite/infection Other Control Total
34 N Age %F Weight Stone %DM CaOx (12) (21) 1 (0; 4) 23 CaOx MAL (9) (31) 1 (0, 4) 33 CaOx HPT (0, 40) 0 CaOx PH 3 40 (24) (13) 5 (5, 15) 0 HA (19) (13) 2 (0; 20) 14 HA MAL HA HPT BR (13) (25) 4.5 (2.5; 27) 0 BR MAL BR RTA 3 50 (16) (45) 30 (13; 60) 0 UA (12) (21) 1 (0, 3) 48 UA MAL ST (16) (27) 1 (0; 3) 26 OTHER* 6 49 (24) (28) 10 (3; 14) 0 CONTROL (19) (24) 0 6 *Cystine (3); DHA; Matrix; HA? Median (25:75)
35 Future Direction Differences between stone formers, high and low plaque Urine biomarkers Urine exosomes Micro RNA Characterization of icaox SF with plug
36 icaox with Plug Median Sodium, (U mmol/24hr) (IQR) Median Calcium, (U mg/24hr) (IQR) Median Urine ph (IQR) OH Apatite DG (IQR) plug <1% N= (100.5, 214.0) (137.0, 292.0) 6.0 (5.5, 6.4) 3.7 (1.6,4.9) plug >1% N= (98.5, 237.0) (142.5, 327.5) 6.5 (6.2, 6.7) 5.4 (3.9,5.7) p value icaox with plug 55 icaox without plug
37 Recent Project 2 publications 1: Viers BR, Lieske JC, Vrtiska TJ, Herrera Hernandez LP, Vaughan LE, Mehta RA, Bergstralh EJ, Rule AD, Holmes DR 3rd, Krambeck AE. Endoscopic and histologic findings in a cohort of uric acid and calcium oxalate stone formers. Urology Apr;85(4): doi: /j.urology Epub 2015 Feb 11. PubMed PMID: ; PubMed Central PMCID: PMC : de Cógáin MR, Lieske JC, Vrtiska TJ, Tosh PK, Krambeck AE. Secondarily infected nonstruvite urolithiasis: a prospective evaluation. Urology Dec;84(6): doi: /j.urology Epub 2014 Oct 11. PubMed PMID: ; PubMed Central PMCID: PMC : Wang X, Krambeck AE, Williams JC Jr, Tang X, Rule AD, Zhao F, Bergstralh E, Haskic Z, Edeh S, Holmes DR 3rd, Herrera Hernandez LP, Lieske JC. Distinguishing characteristics of idiopathic calcium oxalate kidney stone formers with low amounts of Randall's plaque. Clin J Am Soc Nephrol Oct 7;9(10): doi: /CJN Epub 2014 Aug 4. PubMed PMID: ; PubMed Central PMCID: PMC : Liu Y, Qu M, Carter RE, Leng S, Ramirez-Giraldo JC, Jaramillo G, Krambeck AE, Lieske JC, Vrtiska TJ, McCollough CH. Differentiating calcium oxalate and hydroxyapatite stones in vivo using dual-energy CT and urine supersaturation and ph values. Acad Radiol Dec;20(12): doi: /j.acra PubMed PMID: ; PubMed Central PMCID: PMC : Krambeck AE, Lieske JC, Li X, Bergstralh EJ, Rule AD, Holmes D 3rd, McCollough CM, Vrtiska TJ. Current computed tomography techniques can detect duct of Bellini plugging but not Randall's plaques. Urology Aug;82(2): doi: /j.urology Epub 2013 Jun 20. PubMed PMID: ; PubMed Central PMCID: PMC
38 Mayo Clinic O Brien Urology Research Center
RISK 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 informationSAT24 Supersaturation Profile, 24 Hour, Urine
1-800-533-1710 SAT24 Supersaturation Profile, 24 Hour, Urine Patient ID Patient Name SAMPLEREPORT, SAT24 NORMAL Birth Date 1976-05-13 Gender M Age 40 Order Number Client Order Number Ordering Physician
More informationRole of Interstitial Apatite Plaque in the Pathogenesis
Role of Interstitial Apatite Plaque in the Pathogenesis of the Common Calcium Oxalate Stone Andrew P. Evan, PhD,* James E. Lingeman, MD, Fredric L. Coe, MD, and Elaine M. Worcester, MD Summary: By using
More informationIntra-tubular deposits, urine and stone composition are divergent in patients with ileostomy
http://www.kidney-international.org & 2009 International Society of Nephrology original article Intra-tubular deposits, urine and stone composition are divergent in patients with ileostomy Andrew P. Evan
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 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 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 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 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 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 informationKidney stones are common after bariatric surgery
http://www.kidney-international.org & 214 International Society of Nephrology Kidney stones are common after bariatric surgery John C. Lieske 1,2, Ramila A. Mehta 3, Dawn S. Milliner 1, Andrew D. Rule
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 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 information24 HOUR URINARY METABOLIC PROFILE AFTER PERCUTANEOUS NEPHROLITHOTOMY
Original Article Urology 24 HOUR URINARY METABOLIC PROFILE AFTER PERCUTANEOUS NEPHROLITHOTOMY Sreedhar Dayapule 1, Suryaprakash Vaddi 1, Vijaya Bhaskar G 1, Ramamohan Pathapati 2 1 - Assistant Professor,
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 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 informationArticle. Stone Composition as a Function of Age and Sex
CJASN epress. Published on October 2, 2014 as doi: 10.2215/CJN.05660614 Article Stone Composition as a Function of Age and Sex John C. Lieske,* Andrew D. Rule,* Amy E. Krambeck, James C. Williams, Eric
More informationPatient Results Report
Sample Physician MD Sample Practice 2250 W. Campbell Park Dr. Chicago, IL 60612 Current Test Overview SAMPLE ID RESULTS TURNAROUND (IN DAYS) PATIENT COLLECTION LAB RECEIPT TEST COMPLETION S000000 2 08/03/2005
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 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 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 informationHHS Public Access Author manuscript J Nephrol. Author manuscript; available in PMC 2018 February 01.
Interpreting the results of chemical stone analysis in the era of modern stone analysis techniques Ron Gilad 1, James C. Williams Jr. 2, Kalba D. Usman 1, Ronen Holland 1, Shay Golan 1, Tor Ruth 3, and
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 informationMedical 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 informationRandall s plaque of patients with nephrolithiasis begins in basement membranes of thin loops of Henle
Randall s plaque of patients with nephrolithiasis begins in basement membranes of thin loops of Henle Andrew P. Evan,, Ramsay L. Kuo, Marc Grynpas J Clin Invest. 2003;111(5):607-616. https://doi.org/10.1172/jci17038.
More informationInborn errors of metabolism presenting with kidney stones: clinical aspects. Francesco Emma
Inborn errors of metabolism presenting with kidney stones: clinical aspects Francesco Emma Division of Nephrology and Dialysis Bambino Gesù Children s Hospital, IRCCS Rome, Italy September 6, 2016 Palazzo
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 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 informationIn vitro analysis of urinary stone composition in dual-energy computed tomography
DOI: https://doi.org/10.5114/pjr.2018.79588 Received: 8.04.2018 Accepted: 30.05.2018 Published: 10.09.2018 http://www.polradiol.com Original paper In vitro analysis of urinary stone composition in dual-energy
More informationSYSTEMIC IMPLICATIONS OF NEPHROLITHIASIS
SYSTEMIC IMPLICATIONS OF NEPHROLITHIASIS Marshall L. Stoller, M.D. Professor and Vice Chairman Department of Urology University of California San Francisco A STONE IS A STONE IS A STONE OR IS IT????? PATIENT
More informationUrinary Stones: Key Points
Urinary Stones: Key Points Don Griffith, MD Professor, Baylor; Dept of Urology Micheal E DeBakey VAMC, Houston USNR Flight Surgeon CVA-66 USS America Vietnam Era Both Stones are CaOx 1H20 Why Difference?
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 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 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 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 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 informationUpdate in rare and common causes of kidney stones
Update in rare and common causes of kidney stones John C. Lieske, MD, FACP, FASN SECOND INTERNATIONAL RENAL CONFERENCE BRUGGE 2018 March 16-17, 2018 2017 MFMER slide-1 Nephrologists and kidney stones Kidneys
More informationMetabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement
DOI 10.1007/s40620-016-0329-y POSITION PAPER AND GUIDELINES Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement Giovanni Gambaro
More informationA Prospective Study of Risk Factors for Nephrolithiasis After Roux-en-Y Gastric Bypass Surgery
A Prospective Study of Risk Factors for Nephrolithiasis After Roux-en-Y Gastric Bypass Surgery Alyssa M. Park,* Douglas W. Storm, Brant R. Fulmer, Christopher D. Still, G. Craig Wood and James E. Hartle,
More informationAllen Rodgers 1, Daniel Gauvin 2, Samuel Edeh 2, Shameez Allie-Hamdulay 1, Graham Jackson 1, John C. Lieske 2,3 * Abstract.
Sulfate but Not Thiosulfate Reduces Calculated and Measured Urinary Ionized Calcium and Supersaturation: Implications for the Treatment of Calcium Renal Stones Allen Rodgers 1, Daniel Gauvin 2, Samuel
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 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 informationRenal calculi formation and
Renal calculi formation and treatment : New insights David A. Lifshitz, M.D. Director of Minimally Invasive Urology Rabin Medical Center and Tel Aviv University School of Medicine, Israel Where is Israel
More informationDual Energy CT: a new tool in evaluation of the urinary tract stones composition in clinical practice - initial study
Dual Energy CT: a new tool in evaluation of the urinary tract stones composition in clinical practice - initial study Poster No.: C-2279 Congress: ECR 2013 Type: Scientific Exhibit Authors: M. Guzi#ski,
More informationCorrespondence between stone composition and urine supersaturation in nephrolithiasis
Kidney International, Vol. 51 (1997), pp. 894 900 Correspondence between stone composition and urine supersaturation in nephrolithiasis JOAN H. PARKS, MARK COWARD, and REDRIC L. COE Program in Nephrology,
More informationPHYSICAL CHARACTERISTICS, QUALITATIVE AND QUANTITATIVE ANALYSIS OF URINARY STONES (PATHARI)
Int. J. Chem. Sci.: 11(1), 2013, 457463 ISSN 0972768X www.sadgurupublications.com PHYSICAL CHARACTERISTICS, QUALITATIVE AND QUANTITATIVE ANALYSIS OF URINARY STONES (PATHARI) SUMAN PARIHAR a, PRASOON HADA
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 informationA Rare Cause of Renal Stone Formation in Two Siblings. Chris Stockdale
A Rare Cause of Renal Stone Formation in Two Siblings Chris Stockdale Index case-patient A Born 2000 Parents (first cousins) from Indian sub-continent Paternal Grandmother received dialysis for ESRF Possible
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 informationCombined Liver Kidney Transplantation for Primary Hyperoxaluria Type 2: A Case Report
American Journal of Transplantation 2018; 18: 253 257 Wiley Periodicals Inc. Case Report 2017 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/ajt.14418
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 informationNephrology - the study of the kidney. Urology - branch of medicine dealing with the male and female urinary systems and the male reproductive system
Urinary System Nephrology - the study of the kidney Urology - branch of medicine dealing with the male and female urinary systems and the male reproductive system Functions of the Urinary System 1. Regulation
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 informationPercutaneous Nephrolithotomy in a Patient with Mainz Pouch II Urinary Diversion: A Case Report
198) Prague Medical Report / Vol. 117 (2016) No. 4, p. 198 203 Percutaneous Nephrolithotomy in a Patient with Mainz Pouch II Urinary Diversion: A Case Report Stavros Sfoungaristos 1, Ioannis Mykoniatis
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 informationPediatric Nephrology Consult and Referral Guidelines
Pediatric Nephrology Consult and Referral Guidelines Introduction We see children and teens from birth to 21 years. The most common reasons patients are referred to pediatric nephrology services include:
More informationNATIONAL KIDNEY MONTH
NATIONAL KIDNEY MONTH According to the WebMD website, kidneys have several specific roles: Maintain your body s balance of water and concentration of minerals, such as sodium, potassium, magnesium and
More informationSerum zinc levels in children with and without nephrolithiasis.
Curr Pediatr Res 2017; 21 (4): 586-590 ISSN 0971-9032 www.currentpediatrics.com Serum zinc levels in children with and without nephrolithiasis. Parsa Yousefichaijan 1, Masoud Rezagholizamenjany 2, Fatemeh
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 informationEffect of being overweight on urinary metabolic risk factors for kidney stone formation
NDT Advance Access published October 31, 2014 Nephrol Dial Transplant (2014) 0: 1 7 doi: 10.1093/ndt/gfu350 Original Article Effect of being overweight on urinary metabolic risk factors for kidney stone
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 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 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 informationRandall plaque versus renal stone?
Commentary Randall plaque versus renal stone? Thomas Chi, Joe Miller, Marshall L. Stoller Department of Urology, University of California, San Francisco, USA Correspondence to: Thomas Chi, MD. Department
More informationCase Report Three-Dimensional Dual-Energy Computed Tomography for Enhancing Stone/Stent Contrasting and Stone Visualization in Urolithiasis
Case Reports in Urology Volume 2013, Article ID 646087, 4 pages http://dx.doi.org/10.1155/2013/646087 Case Report Three-Dimensional Dual-Energy Computed Tomography for Enhancing Stone/Stent Contrasting
More informationHHS Public Access Author manuscript AJR Am J Roentgenol. Author manuscript; available in PMC 2016 September 02.
Quantification of Urinary Stone Composition in Mixed Stones Using Dual-Energy CT: A Phantom Study Shuai Leng, PhD 1,*, Alice Huang, BS 1, Juan Montoya, BS 1, Xinhui Duan, PhD 1, James C. Williams, PhD
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 informationChallenges in Stone Management of Complex Patients
Challenges in Stone Management of Complex Patients Eugene Minevich, MD Professor, Division of Pediatric Urology Director, Stone Center Cincinnati Children s Hospital, Cincinnati, USA Financial and Other
More informationUrinary system. Urinary system
INTRODUCTION. Several organs system Produce urine and excrete it from the body Maintenance of homeostasis. Components. two kidneys, produce urine; two ureters, carry urine to single urinary bladder for
More informationTest Definition: SAT24 Supersaturation Profile, 24 Hour, Urine
Reporting Title: Supersaturation, U Performing Location: Rochester Specimen Requirements: Container/Tube: Plastic, 60-mL urine bottle Specimen Volume: 35 ml Collection Instructions: 1. Collect urine for
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 informationCase Presentation - Pediatric Endourology
Case Presentation - Pediatric Endourology PA N E L : E U G ENE M I N EV I C H, U S A J O NAT H A N G L A S S, UK R OY M O R AG, I S R A E L YO R A M M O R, I S R A E L P I N C H AS L I V N E, I S R A E
More informationAdams Memorial Hospital Decatur, Indiana EXPLANATION OF LABORATORY TESTS
Adams Memorial Hospital Decatur, Indiana EXPLANATION OF LABORATORY TESTS Your health is important to us! The test descriptions listed below are for educational purposes only. Laboratory test interpretation
More informationCase # 2 3/27/2017. Disclosure of Relevant Financial Relationships. Clinical history. Clinical history. Laboratory findings
Case # 2 Christopher Larsen, MD Arkana Laboratories Disclosure of Relevant Financial Relationships USCAP requires that all planners (Education Committee) in a position to influence or control the content
More informationTEPZZ _6 76A_T EP A1 (19) (11) EP A1. (12) EUROPEAN PATENT APPLICATION published in accordance with Art.
(19) TEPZZ _6 76A_T (11) EP 3 162 376 A1 (12) EUROPEAN PATENT APPLICATION published in accordance with Art. 13(4) EPC (43) Date of publication: 03.0.17 Bulletin 17/18 (21) Application number: 172173.0
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 informationG. Manish. et.al/ 1(4) pp
Fractions from Coconut water (Cocos nucifera) influencing in vitro calcium oxalate crystal growth Manish Gandhi * 1, Tandon Chanderdeep 2, Puri Sanjeev 3, Singla Surindar *1, *1 Department of Biochemistry,
More informationDual-Energy CT for Quantification of Urinary Stone Composition in Mixed Stones: A Phantom Study
Genitourinary Imaging Original Research Leng et al. Dual-Energy CT of Urinary Stones Genitourinary Imaging Original Research Shuai Leng 1 Alice Huang 1 Juan Montoya Cardona 1 Xinhui Duan 1,2 James C. Williams
More informationExploitation of Epigenetic Changes to Distinguish Benign from Malignant Prostate Biopsies
Exploitation of Epigenetic Changes to Distinguish Benign from Malignant Prostate Biopsies Disclosures MDxHealth Scientific Advisor 2 Case Study 54-year-old man referred for a PSA of 7 - Healthy, minimal
More informationHHS Public Access Author manuscript Abdom Imaging. Author manuscript; available in PMC 2017 June 27.
Motion Artifacts in Kidney Stone Imaging Using Single-Source and Dual-Source Dual-Energy CT Scanners. A Phantom Study El-Sayed H. Ibrahim 1,2,*, Joseph G. Cernigliaro 1, Robert A. Pooley 1, James C. Williams
More informationIraqi JMS. Pre and Post Extracorporeal Shock Wave Lithotripsy (ESWL) Urine Culture as A Guide for Antibiotics Management
Iraqi JMS Published by Al-Nahrain College of Medicine P-ISSN 1681-6579 E-ISSN 2224-4719 Email: iraqijms@colmed-alnahrain.edu.iq http://www.colmed-alnahrain.edu.iq http://www.iraqijms.net Pre and Post Extracorporeal
More informationOptimization of urinary dipstick ph: Are multiple dipstick ph readings reliably comparable to commercial 24-hour urinary ph?
Original Article - Basic and Translational Research https://doi.org/10.4111/icu.201.378 pissn 2466-0493 eissn 2466-054X Optimization of urinary dipstick ph: Are multiple dipstick ph readings reliably comparable
More informationDietary Protein and Potassium, Diet Dependent Net Acid Load, and Risk of Incident Kidney Stones
Article Dietary Protein and Potassium, Diet Dependent Net Acid Load, and Risk of Incident Kidney Stones Pietro Manuel Ferraro,* Ernest I. Mandel, Gary C. Curhan, Giovanni Gambaro,* and Eric N. Taylor Abstract
More informationTEST STATUS NOTIFICATION DATE: November 13, 2015 EFFECTIVE DATE: December 15, Test ID: SAT24
TEST STATUS NOTIFICATION DATE: vember 13, 2015 EFFECTIVE DATE: December 15, 2015 SUPERSATURATION PROFILE, 24 HOUR, URINE Test ID: SSAT EXPLANATION: The current profile is being replaced with a new one
More informationBlood containing water, toxins, salts and acids goes in
Page 1 Fact sheet What are kidney stones Your kidneys filter your blood and remove the extra waste and water as urine. Kidney stones form when some waste materials clump together to form a solid crystal.
More informationLisette Ramos-Voigt November 25, Kidney Stone Formation. substances found in the urine (Leslie & Swierzewski, 1998). There are various types of
Lisette Ramos-Voigt November 25, 2008 Kidney Stone Formation Kidney stones are hard solid pieces of material that form in the kidneys out of substances found in the urine (Leslie & Swierzewski, 1998).
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 informationUrinary. Smooth, collapsible, muscular sac stores urine. Figure Slide 15.21a
Urinary Smooth, collapsible, muscular sac stores urine Figure 15.6 Slide 15.21a Urinary Bladder Wall Walls are and folded in an empty bladder Bladder can significantly without increasing internal pressure
More informationInfluence of Urinary Stones on the Composition of a 24-Hour Urine Sample
Clinical Chemistry 49:2 281 285 (2003) General Clinical Chemistry Influence of Urinary Stones on the Composition of a 24-Hour Urine Sample Norbert Laube, 1* Michael Pullmann, 2 Stefan Hergarten, 2 and
More informationSometimes dogs need something a little extra!
Sometimes dogs need something a little extra! Hills a/d Used for pets recovering from serious illness/surgery. High protein/fat/omega- 3/carbohydrates/glutamine Aid in promoting wound healing, supports
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 informationAcute flank pain in children: Imaging considerations
Acute flank pain in children: Imaging considerations Carlos J. Sivit MD Rainbow Babies and Children s Hospital Case Western Reserve School of Medicine Flank pain Results from distention of ureter or renal
More informationPathogenesis of renal calculi
190 Türk Üroloji Dergisi - Turkish Journal of Urology 2010;36(2):190-199 Endourology / Endoüroloji Review / Derleme Pathogenesis of renal calculi Renal taş hastalığı patogenezi Ehud Gnessin 1, James E.
More informationDistal renal tubular acidosis: genetic and clinical spectrum
Distal renal tubular acidosis: genetic and clinical spectrum Sabrina Giglio Medical Genetics Unit, Meyer Children s University Hospital, University of Florence sabrina.giglio@meyer.it sabrinarita.giglio@unifi.it
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 informationCONTROLLING THE INTERNAL ENVIRONMENT
AP BIOLOGY ANIMAL FORM & FUNCTION ACTIVITY #5 NAME DATE HOUR CONTROLLING THE INTERNAL ENVIRONMENT KIDNEY AND NEPHRON NEPHRON FUNCTIONS Animal Form & Function Activity #5 page 1 NEPHRON STRUCTURE NEPHRON
More informationDependence of upper limit of metastability on supersaturation in
Kidney International, Vol. 52 (1997), pp. 162 168 CLINICAL NEPHROLOGY_- EPIDEMIOLOGY - CLINICAL TRIALS Dependence of upper limit of metastability on supersaturation in nephrolithiasis JOHN R. ASPLIN, JOAN
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 information