RESUMEN

INTRODUCTION: Pediatricians, surgeons and subspecialties as pediatric urology and nephrology are involved in the diagnosis and treatment of pediatric renal stone disease (RSD). The aim of this study was to determine diagnostic and treatment approaches, of different disciplines, and to assess differences in their routine diagnostic and treatment protocols. POPULATION AND METHODS: A questionnaire was designed and administered to the participants of the RSD sessions in national congresses of all disciplines in 2017 to evaluate the diagnostic and treatment routines of specialties (surgeons and pediatricians) and subspecialties (pediatric nephrologists and pediatric urologists) for RSD. RESULTS: A total, of 324 questionnaires were analyzed, from 88 pediatricians (27 %), 121 urologists (37 %), 23 pediatric surgeons (7 %), 54 pediatric nephrologists (17 %), and 38 pediatric urologists (12 %). Both groups agreed on the necessity of metabolic evaluation. For distal ureter stones that were ≥ 6 mm; surgeons preferred ureteroscopy (URS), pediatricians preferred shock wave lithotripsy (SWL) (p < 0.001) and subspecialties preferred URS for the treatment (p = 0.636). For lower calix stones less than 1 cm surgeons and subspecialists preferred SWL, while pediatricians preferred hydration (p < 0.001, p = 0.371). For the stone between 1.1 and 2 cm, surgeons preferred intrarenal surgery (RIRS) and SWL, pediatricians preferred SWL (p = 0.001). For larger stones, surgeons and subspecialists preferred percutaneous nephrolithotomy (PCNL), and pediatricians preferred SWL (p = 0.458 p = 0.001). Pediatric urologist chose low-dose computerized tomography as a diagnostic radiologic evaluation (p = 0.029). CONCLUSION: There are differences between the disciplines who take an active role in diagnosis and treatment of RSD.

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Introducción. Los pediatras, cirujanos y subespecialistas, como urólogos y nefrólogos pediátricos, participan en el diagnóstico y tratamiento de la nefrolitiasis pediátrica. El objetivo fue determinar los enfoques de distintas disciplinas y evaluar las diferencias en sus protocolos de diagnóstico y tratamiento habituales. Población y métodos. Cuestionario administrado a participantes de sesiones sobre nefrolitiasis en congresos nacionales en 2017 para evaluar las rutinas de diagnóstico y tratamiento de la nefrolitiasis entre distintas especialidades (cirujanos y pediatras) y subespecialidades (nefrólogos pediátricos y urólogos pediátricos). Resultados. Se analizaron 324 cuestionarios de 88 pediatras, 121 urólogos, 23 cirujanos pediátricos, 54 nefrólogos pediátricos y 38 urólogos pediátricos. Ambos grupos coincidieron en la necesidad de una evaluación metabólica. Para los cálculos ureterales distales ≥6 mm, los cirujanos preferían una ureteroscopía; los pediatras, una litotricia por ondas de choque (LOC) (p < 0,001); y los subespecialistas, una ureteroscopía (p = 0,636). Para los cálculos en la parte inferior de los cálices renales < 1 cm, los cirujanos y los subespecialistas preferían la LOC y los pediatras, la hidratación (p < 0,001; p = 0,371). Para los cálculos de entre 1,1 cm y 2 cm, los cirujanos preferían la cirugía retrógrada intrarrenal (CRIR) y la LOC, y los pediatras, la LOC (p = 0,001). Para los cálculos más grandes, los cirujanos y subespecialistas preferían la nefrolitotomía percutánea (NLP) y los pediatras, la LOC (p = 0,458; p = 0,001). Conclusión. Existen diferencias entre las disciplinas que participan activamente en el diagnóstico y tratamiento de la nefrolitiasis.

Asunto(s)

Cálculos Renales , Litotricia , Médicos , Niño , Humanos , Cálculos Renales/diagnóstico , Cálculos Renales/terapia , Encuestas y Cuestionarios , Resultado del Tratamiento , Ureteroscopía

RESUMEN

INTRODUCTION: Ceftriaxone is a wide-spectrum antibiotic frequently used in pediatrics. Biliary pseudolithiasis is a well-known side-effect occurring in 15-57% of cases. However, nephrolithiasis is extremely infrequent, with very few related publications. CASE REPORT: We present the case of a 9-year-old patient with ceftriaxone-treated complicated acute appendicitis who developed biliary pseudolithiasis and nephrolithiasis. During hospitalization, the patient presented with pseudolithiasis complications such as mild pancreatitis and bilateral ureterohydronephrosis with acute renal failure. REMARKS: Suspecting ceftriaxone-associated biliary pseudolithiasis and/or nephrolithiasis is key to achieve an early diagnosis and prevent complications such as those reported in this patient. Early discontinuation is essential as an initial treatment measure.

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INTRODUCCION: La ceftriaxona es un antibiótico de amplio espectro frecuentemente utilizado en pediatría. La pseudolitiasis vesicular es un efecto adverso bien conocido, que se presenta en un 15 a 57% de los casos. En cambio la litiasis renal es extremadamente infrecuente con muy pocas publicaciones al respecto. CASO CLINICO: Se presenta el caso de un paciente de 9 años que, durante tratamiento con ceftriaxona por una apendicitis aguda complicada, desarrolla pseudolitiasis vesicular y urinaria. Durante la misma internación el paciente presenta una pancreatitis leve y una ureterohidronefrosis bilateral, con insuficiencia renal aguda, como complicaciones de las pseudolitiasis. COMENTARIOS: La sospecha de la formación de litiasis renal y/o vesicular asociada al uso de ceftriaxona es fundamental para un diagnóstico temprano y prevención de complicaciones como las reportadas en este paciente, siendo fundamental la suspensión precoz del fármaco como inicio del tratamiento.

Asunto(s)

Antibacterianos/efectos adversos , Ceftriaxona/efectos adversos , Cálculos Renales/inducido químicamente , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , Antibacterianos/administración & dosificación , Apendicitis/tratamiento farmacológico , Ceftriaxona/administración & dosificación , Niño , Humanos , Cálculos Renales/diagnóstico , Masculino , Pancreatitis/diagnóstico , Pancreatitis/etiología

RESUMEN

The Spanish version of the Wisconsin Stone Quality of Life (WISQOL) questionnaire was developed and validated. A double-back translation of the WISQOL was conducted and syntactic amendments were made, resulting in the Spanish version of the WISQOL (S-WISQOL) which then went through a readability analysis. Stone formers from two hospitals in Mexico (Merida and Monterrey) filled in the S-WISQOL and the Short Form 36 (SF36). Convergent validity was assessed by the correlation of both questionnaires. Internal consistency was evaluated by Cronbach's α, and external validity by comparing between centers. The impact of clinical settings on patients' health-related quality of life (HRQOL) scores was tested. Each hospital's institutional review board approved the project and informed consent was obtained from all participants. A total of 87 Spanish-speakers patients completed the S-WISQOL and SF36 and a good correlation was found between both (r = 0.75, p < 0.001). S-WISQOL readability was rated as "easy". Patients from Merida had longer median duration (years) with stones, more stone-related procedures, and hospitalizations, and scored lower on WISQOL (p = 0.006). Internal consistency was good as Cronbach's α coefficients ranged between acceptable and excellent. Stone-related admissions and duration of stones were inversely correlated with S-WISQOL score (- 0.254 and - 0.283, respectively; p < 0.005) but not to SF36. The S-WISQOL is an internally consistent, reliable, and valid instrument to assess HRQOL in Spanish-speaking patients with kidney stones. The S-WISQOL is generalizable as demonstrated by good external validity among centers. S-WISQOL scores can be added as an outcome for kidney stone treatments.

Asunto(s)

Cálculos Renales , Calidad de Vida , Autoinforme , Adulto , Femenino , Humanos , Cálculos Renales/diagnóstico , Masculino , Persona de Mediana Edad , Traducciones

RESUMEN

Kidney stones are a common disorder, with an annual incidence of eight cases per 1,000 adults. During an episode of renal colic, the first priority is to rule out conditions requiring immediate referral to an emergency department, then to alleviate pain, preferably with a nonsteroidal anti-inflammatory drug. The diagnostic workup consists of urinalysis, urine culture, and imaging to confirm the diagnosis and assess for conditions requiring active stone removal, such as urinary infection or a stone larger than 10 mm. Conservative management consists of pain control, medical expulsive therapy with an alpha blocker, and follow-up imaging within 14 days to monitor stone position and assess for hydronephrosis. Asymptomatic kidney stones should be followed with serial imaging, and should be removed in case of growth, symptoms, urinary obstruction, recurrent infections, or lack of access to health care. All patients with kidney stones should be screened for risk of stone recurrence with medical history, basic laboratory evaluation, and imaging. Lifestyle modifications such as increased fluid intake should be recommended for all patients, and thiazide diuretics, allopurinol, or citrates should be prescribed for patients with recurrent calcium stones. Patients at high risk of stone recurrence should be referred for additional metabolic assessment, which can serve as a basis for tailored preventive measures.

Asunto(s)

Cálculos Renales , Adulto , Tratamiento Conservador/métodos , Humanos , Cálculos Renales/diagnóstico , Cálculos Renales/prevención & control , Cálculos Renales/terapia , Conducta de Reducción del Riesgo , Prevención Secundaria/métodos

RESUMEN

La cistinuria es una enfermedad genética que se engloba dentro de alteraciones congénitas del transporte de aminoácidos con formación de cálculos en las vías urinarias, si bien es poco frecuente se caracteriza por su elevada recurrencia. En este trabajo presentamos el caso de una paciente de 34 años, con antecedentes de haber perdido un riñón por episodios anteriores de litiasis y con múltiples recidivas que es diagnosticada mediante la detección de cistina por espectroscopía infrarroja como componente único de 96 fragmentos de cálculos removidos mediante nefrolitotomía percutánea. La paciente fue evaluada laboratorialmente mediante el perfil metabólico y la cristaluria. Las indicaciones de tratamiento específicas incluyeron la administración de agentes alcalinizantes, régimen nutricional, y entrenamiento para control de pH urinario. Es importante señalar la agresividad de la litiasis de cistina con las consecuencias que puede tener la calidad de vida del paciente, y por tanto la importancia de contar con capacidades instaladas a nivel país para el diagnóstico y seguimiento de litiasis genéticas como la causada por la cistinuria(AU)

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Cystinuria is a genetic disease that is included among congenital defects of renal amino acids transport that causes urinary stone formation. Although it is rare, it is characterized by its high recurrence. We present the case of a 34-year-old patient that lost one of her kidney because of recurrent episodes of lithiasis, and that was diagnosed by the detection of cystine with infrared spectroscopy as the sole component of 96 stone fragments removed by percutaneous nephrolithotomy. The patient was evaluated by metabolic profile and crystalluria. The specific treatment indications included the administration of alkalinizing agents, nutritional regimen, and training for personal measurement of urinary pH. This case highlights the aggressiveness of cystine stones with the consequences that may have on the quality of the patient life, and therefore the importance of having installed proper diagnostic capacities at national level to detect and monitor treatment efficacy in genetic lithiasis such as cystinuria(AU)

Asunto(s)

Humanos , Femenino , Adulto , Cistinuria/diagnóstico , Espectrofotometría Infrarroja , Cálculos Renales/diagnóstico , Cálculos Renales/química , Cistinuria/complicaciones , Cistinuria/terapia , Nefrolitiasis/diagnóstico , Nefrolitiasis/etiología , Nefrolitiasis/terapia

RESUMEN

INTRODUCTION: Currently, there is a paucity of data evaluating the outcomes of supine percutaneous nephrolithotomy (PCNL) in septuagenarian and octogenarian patients. In this study we aim to compare the outcomes of supine PCNL in elderly patients with those of younger population. MATERIAL AND METHODS: A matched case-control study was performed from January 2009 through December 2015 using our prospectively collected kidney stone database. Case group was composed of patients with age greater than 70 years. Control group included patients with less than 70 years old. Patients were randomly matched based on Guy's Stone Score as a surrogate of case complexity. RESULTS: Fifty-four patients were enrolled in this study, 18 cases and 36 controls. There were no significant differences in gender and body mass index between groups. There were significantly more ASA 3 patients in septuagenarian and octogenarian patients (p = 0.012). Mean Charlson comorbidity index was significantly higher in septuagenarian and octogenarian patients (p = 0.041). Regarding PCNL technique, there were no differences in number of accesses, number of supra-costal accesses, and operative time. There was no significant difference in stone-free rate, nephrostomy tube time, complication rate, mean decrease in hemoglobin level, and need of blood transfusion. Hospital stay time (days) was longer in case group (4.0 +/- 1.7 versus 2.4 +/- 1.1 days; p = 0.002). CONCLUSION: Septuagenarian and octogenarian patients have similar complication and stone-free rates compared to younger patients, although they demand a longer length of hospital stay.

Asunto(s)

Cálculos Renales/cirugía , Nefrostomía Percutánea/métodos , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Femenino , Evaluación Geriátrica , Humanos , Cálculos Renales/diagnóstico , Tiempo de Internación , Litotricia/métodos , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Nefrostomía Percutánea/efectos adversos , Tempo Operativo , Posicionamiento del Paciente , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Posición Supina , Resultado del Tratamiento

Asunto(s)

Cálculos Renales/diagnóstico , Cálculos Renales/terapia , Impresión Tridimensional , Riñón/anatomía & histología , Modelos Anatómicos

Asunto(s)

Cálculos Renales , Riñón/anatomía & histología , Impresión Tridimensional , Cálculos Renales/diagnóstico , Cálculos Renales/terapia , Modelos Anatómicos

RESUMEN

Esta guía aborda aspectos relacionados con el tratamiento y la prevención secundaria de la nefrolitiasis en el adulto

Asunto(s)

Humanos , Adulto , Cálculos Renales , Cálculos Renales/diagnóstico , Cálculos Renales/terapia , Nefrolitiasis , Urolitiasis , Prevención Secundaria

Asunto(s)

Humanos , Atención Primaria de Salud/normas , Cálculos Renales/diagnóstico , Cálculos Renales/terapia , Nefrolitiasis/diagnóstico , Protocolos Clínicos/normas , Atención Secundaria de Salud/normas , Hidronefrosis

RESUMEN

Calcium renal lithiasis is a frequent condition that affects the worldwide population and has a high recurrence rate. Different metabolic changes may trigger the onset of calcium stone disorders, such as hypercalciuria, hyperoxaluria, hyperuricosuria, hypocitraturia and others. There are also other very prevalent disorders that are associated with calcium calculi, such as arterial hypertension, obesity and loss of bone mineral density. A correct diagnosis needs to be obtained through examining the serum and urinary parameters of mineral metabolism in order to carry out adequate prevention and treatment of this condition. Once the metabolic diagnosis is known, it is possible to establish dietary and pharmacological treatment that may enable monitoring of the disease and prevent recurrence of stone formation. Some advances in treating this pathological condition have been made, and these include use of sodium alendronate in patients with calcium renal lithiasis and osteopenia/osteoporosis, or use of a combination of a thiazide with a bisphosphonate. In summary, calcium renal lithiasis often requires multidrug treatment with strict control and follow-up of patients.

Asunto(s)

Calcio , Cálculos Renales/química , Calcio/sangre , Calcio/orina , Humanos , Cálculos Renales/diagnóstico , Cálculos Renales/terapia

RESUMEN

Calcium renal lithiasis is a frequent condition that affects the worldwide population and has a high recurrence rate. Different metabolic changes may trigger the onset of calcium stone disorders, such as hypercalciuria, hyperoxaluria, hyperuricosuria, hypocitraturia and others. There are also other very prevalent disorders that are associated with calcium calculi, such as arterial hypertension, obesity and loss of bone mineral density. A correct diagnosis needs to be obtained through examining the serum and urinary parameters of mineral metabolism in order to carry out adequate prevention and treatment of this condition. Once the metabolic diagnosis is known, it is possible to establish dietary and pharmacological treatment that may enable monitoring of the disease and prevent recurrence of stone formation. Some advances in treating this pathological condition have been made, and these include use of sodium alendronate in patients with calcium renal lithiasis and osteopenia/osteoporosis, or use of a combination of a thiazide with a bisphosphonate. In summary, calcium renal lithiasis often requires multidrug treatment with strict control and follow-up of patients.

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Litíase renal cálcica é uma doença comum que afeta a população no mundo todo e tem alta taxa de recorrência. Diferentes alterações metabólicas podem desencadear o aparecimento de distúrbios de pedras de cálcio, como hipercalciúria, hiperoxalúria, hiperuricosúria, hipocitratúria e outros. Existem também doenças altamente prevalentes associadas à doença de cálculo de cálcio, como hipertensão, obesidade e perda de densidade óssea mineral. Para realizar prevenção e tratamento adequados, é necessário diagnóstico correto, examinando o metabolismo mineral sérico e urinário. Depois de conhecer o diagnóstico metabólico, é possível estabelecer um tratamento dietético e farmacológico que permita controlar a doença e prevenir a recorrência de cálculos biliares. Há alguns avanços no tratamento dessa doença e incluem o uso de alendronato de sódio em pacientes com nefrolitíase de cálcio e osteopenia/osteoporose, ou a combinação de um tiazídico com um bifosfonato. Em resumo, litíase renal cálcica exige, muitas vezes, um tratamento multidroga com rigorosos controle e acompanhamento de pacientes.

Asunto(s)

Humanos , Calcio , Cálculos Renales/química , Calcio/sangre , Calcio/orina , Cálculos Renales/diagnóstico , Cálculos Renales/terapia

RESUMEN

OBJECTIVE: To describe the characteristics of normocalcemic primary hyperparathyroidism (NPHPT) in patients seen for osteoporosis evaluation. PATIENTS AND METHODS: We examined the records of 156 women who came to the hospital to be screened for osteoporosis. Measurements of total calcium, PTH, 25-hydroxy vitamin D, and ß-C-telopeptide were recorded. Bone mineral density and T-scores were evaluated by densitometry of the lumbar spine, femoral neck and distal one-third of the radius. The latter was only measured in patients with primary hyperparathyroidism. Nephrolithiasis and bone fractures were documented by a review of the medical records. RESULTS: We identified 14 patients with NPHPT, accounting for 8.9% of the population studied. In the medical records, the occurrence of kidney stones was reported in 28.6% of the patients with NPHPT, in contrast with only 0.7% of the noncarriers. Regarding the presence of general fractures, 21.4% of the patients with NPHPT were affected versus 16.2% of noncarriers. CONCLUSION: Data from our study suggest that NPHPT has a diverse phenotypic presentation, implying that this may not be an "indolent" disease.

Asunto(s)

Densidad Ósea/fisiología , Calcio/sangre , Hiperparatiroidismo Primario/sangre , Osteoporosis/diagnóstico , Hormona Paratiroidea/sangre , Adulto , Biomarcadores , Brasil/epidemiología , Colágeno Tipo I/sangre , Femenino , Fracturas Óseas/diagnóstico , Fracturas Óseas/epidemiología , Humanos , Hiperparatiroidismo Primario/epidemiología , Cálculos Renales/diagnóstico , Cálculos Renales/epidemiología , Persona de Mediana Edad , Osteoporosis/epidemiología , Péptidos/sangre , Vitamina D/análogos & derivados , Vitamina D/sangre

RESUMEN

OBJECTIVE: To describe the characteristics of normocalcemic primary hyperparathyroidism (NPHPT) in patients seen for osteoporosis evaluation. PATIENTS AND METHODS: We examined the records of 156 women who came to the hospital to be screened for osteoporosis. Measurements of total calcium, PTH, 25-hydroxy vitamin D, and β-C-telopeptide were recorded. Bone mineral density and T-scores were evaluated by densitometry of the lumbar spine, femoral neck and distal one-third of the radius. The latter was only measured in patients with primary hyperparathyroidism. Nephrolithiasis and bone fractures were documented by a review of the medical records. RESULTS: We identified 14 patients with NPHPT, accounting for 8.9 percent of the population studied. In the medical records, the occurrence of kidney stones was reported in 28.6 percent of the patients with NPHPT, in contrast with only 0.7 percent of the noncarriers. Regarding the presence of general fractures, 21.4 percent of the patients with NPHPT were affected versus 16.2 percent of noncarriers. CONCLUSION: Data from our study suggest that NPHPT has a diverse phenotypic presentation, implying that this may not be an "indolent" disease.

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OBJETIVO: Avaliar as características do hiperparatireoidismo primário normocalcêmico (HPTPN) em pacientes atendidos para avaliação de osteoporose. PACIENTES E MÉTODOS: Foi realizada análise de um banco de dados de 156 mulheres que procuraram atendimento para avaliação de osteoporose. Todas apresentavam dosagem de cálcio sérico, PTH, 25-hidroxi-vitamina D e C-telopeptídeo. A densidade mineral óssea e escore-T foram avaliados por meio de densitometria óssea de coluna lombar, colo do fêmur e rádio distal, este último apenas em pacientes com hiperparatireoidismo renal primário. Nefrolitíase e fraturas ósseas foram documentadas pela revisão dos prontuários. RESULTADOS: Foram identificadas 14 pacientes com HPTPN, correspondendo a 8,9 por cento da população estudada. Nos registros médicos, o relato da existência de litíase renal ocorreu em 28,6 por cento dos portadores de HPTN em contraste com apenas 0,7 por cento nas mulheres não portadoras, com um p < 0,001. CONCLUSÃO: Os dados do estudo sugerem que HPTPN tem uma apresentação fenotípica variada, podendo não ser uma patologia "indolente".

Asunto(s)

Adulto , Femenino , Humanos , Persona de Mediana Edad , Densidad Ósea/fisiología , Calcio/sangre , Hiperparatiroidismo Primario/sangre , Osteoporosis/diagnóstico , Hormona Paratiroidea/sangre , Biomarcadores , Brasil/epidemiología , Colágeno Tipo I/sangre , Fracturas Óseas/diagnóstico , Fracturas Óseas/epidemiología , Hiperparatiroidismo Primario/epidemiología , Cálculos Renales/diagnóstico , Cálculos Renales/epidemiología , Osteoporosis/epidemiología , Péptidos/sangre , Vitamina D/análogos & derivados , Vitamina D/sangre

RESUMEN

PURPOSE: To compare chemical to morphological kidney stone composition analysis based on a sample of 50 stones retrieved from patients at a nephrology service. METHODS: The chemical analysis was performed with a Bioclin® kit, while a 10-mm magnifying glass (10x; Prolabo, Paris, France) was employed in the morphological analysis. Findings obtained with the two methods were compared and classified as concordant (100 percent agreement), partly concordant (concordant for major components, discordant for minor components) or discordant (discordant for major components). RESULTS: In the chemical analysis, the most commonly observed major component was calcium (70 percent), followed by oxalate (66 percent), ammonium (56 percent), urate (28 percent) and carbonate (24 percent). In the morphological analysis, the most commonly observed major components were calcium phosphate and magnesium (32 percent each), followed by calcium oxalate monohydrate (24 percent), uric acid and urates (20 percent each), calcium oxalate dihydrate (18 percent) and cystine (6 percent). Infectious kidney stones were identified in 34 percent and 24 percent of cases by morphological and chemical analysis, respectively. Thirty-eight percent of the samples were classified as concordant, 52 percent were partly concordant and 10 percent were discordant. CONCLUSION: We suggest kidney stones be routinely submitted to both types of analysis for a better understanding of the mechanisms involved in lithogenesis.(AU)

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OBJETIVO: Comparar a análise química com a análise morfológica de 50 cálculos urinários provenientes de pacientes em um serviço de nefrologia. MÉTODOS: A análise química foi realizada utilizando o kit da Bioclin®, enquanto que a morfológica foi realizada com auxílio de uma lupa de 10mm (Prolabo, Paris, France). A comparação entre as técnicas foi classificada em concordante (100 por cento de concordância), parcialmente concordante (componentes majoritários concordantes e minoritários discordantes) e discordante (discordância nos componentes majoritários). RESULTADOS: Na análise química os principais componentes majoritários foram cálcio (70 por cento), oxalato (66 por cento), amônio (56 por cento), urato (28 por cento) e carbonato (24 por cento). Na análise morfológica os principais componentes majoritários foram fosfato cálcico (PCa) e magnesiano-PCa (32 por cento), oxalato de cálcio monohidratado (24 por cento), ácido úrico e uratos (20 por cento), oxalato de cálcio dihidratado (18 por cento) e cistina (6 por cento). Cálculos de infecção foram identificados em 34 por cento e 24 por cento casos pela análise morfológica e química, respectivamente. Concordância total foi observada em 38 por cento, concordância parcial em 52 por cento e discordância em 10 por cento. CONCLUSÃO: Sugere-se a utilização simultânea das duas técnicas para melhor compreensão dos mecanismos litogênicos.(AU)

Asunto(s)

Cálculos de la Vejiga Urinaria/diagnóstico , Cálculos de la Vejiga Urinaria/ultraestructura , Cálculos Renales/diagnóstico , Cálculos Renales/ultraestructura , Cálculos Urinarios/diagnóstico , Cálculos Urinarios/ultraestructura , Método Doble Ciego

RESUMEN

Los pacientes con litiasis renal requieren de investigaciones para identificar las condiciones médicas subyacentes y otras anomalías metabólicas predisponentes. Los resultados de estas investigaciones se utilizan para guiar el tratamiento preventivo. La profundidad del estudio necesario depende de varios factores, incluyendo la edad, la historia clínica de la persona y el número y la frecuencia de los cálculos. Una variedad de factores dietéticos y metabólicos pueden contribuir o causar la formación de litiasis renal. Los factores dietéticos incluyen una alta ingesta de proteínas animales, oxalato y sodio, y una baja ingesta de líquidos y de productos cítricos que contienen potasio. Las alteraciones metabólicas más frecuentemente asociadas a litiasis son la hipercalciuria, la hipocitraturia, la gota, la hiperoxaluria y la hiperuricosuria. Las modificaciones en la dieta deben aplicarse en todos los pacientes con litiasis renal, y consisten en una elevada ingesta de líquidos, la restricción de oxalato y sodio, una dieta balanceada en proteínas animalesy complementadas por una ingesta adecuada de frutas y verduras. Cuando las modificaciones en la dieta no son suficientes en prevenir la formación de litiasis o en la presencia de alteraciones metabólicas importantes, es necesaria una intervención farmacológica especifica.

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People who form kidney stones require investigations to identify underlying medical conditions and to detect other predisposing metabolic abnormalities. The results of these investigations can also be used to help guide therapy to prevent future stone formation. The extent of testing required dependson several factors including age and medical history of the person and the number and frequency of stones. A variety of dietary and metabolic factors may contribute or cause stone formation in nephrolithiasis. Dietary factors include a high intake of animal proteins, oxalate and sodium, and a low intake of fluids and potassium containing citrus products. Some of the metabolic causes of stones are hypercalciuria, hypocitraturia, gout, hyperoxaluria, and hyperuricosuria. Dietary modification, to be applied in all patients with stones includes a high fluid intake, restriction of oxalate and sodium, and balanced diet with animal proteins complemented by adequate intake of fruits and vegetables. When dietary modification is ineffective in controlling stone formation or in the presence of severe metabolic derangements, a pharmacologic intervention may be necessary.

Asunto(s)

Humanos , Estado Nutricional , Nefrolitiasis/diagnóstico , Nefrolitiasis/metabolismo , Nefrolitiasis/terapia , Cálculos Renales/diagnóstico , Cálculos Renales/metabolismo , Cálculos Renales/terapia , Factores de Riesgo

RESUMEN

INTRODUCTION: The most frequent urine metabolic risk factor in adults is idiopathic hypercalciuria while in children is hypocitraturia. If there is really a change of metabolic abnormalities with age it would be interesting to study risk factors in the intermediate population: young adults. OBJECTIVE: We evaluated metabolic risk factors, clinical presentation and family history of stone formers between 17 and 27 years old. METHODS: A total of 160 patients (87 males and 73 females) were studied with a standard protocol. RESULTS: A single urine metabolic risk factor was present in 64% of the patients, and multiple risk factors were present in 27% of them. No metabolic abnormalities were found in the remaining 9%. The most common urine risk factor was idiopathic hypercalciuria (alone or in combination), which was identified in 42.5% followed by hypocitraturia (alone or in combination) found in 32.9% of the patients. In the subgroup of patients of 17-20 years (n = 75; mean age of 18.8 + or - 1.0 years), hypocitraturia (alone or in combination) was as frequent as idiopathic hypercalciuria (alone or in combination), which was identified in 38% (n = 30) and 36.7% (n = 29), respectively. The most frequent form of presentation was renal colic (72%). A positive family history of stone disease in first degree and second-degree relatives was found in 32.9 and 34.1%, respectively. CONCLUSIONS: Metabolic abnormalities were found in 91% of young adults with renal lithiasis, similar to our adult series. Hypercalciuria was the most frequent metabolic abnormality found. Yet, hypocitraturia (alone or in combination) was very frequent, and in the subgroup of patients of 17-20 years, it was as frequent as idiopathic hypercalciuria, similar to what we found in children.

Asunto(s)

Cálculos Renales/diagnóstico , Cálculos Renales/metabolismo , Adolescente , Adulto , Femenino , Humanos , Cálculos Renales/epidemiología , Masculino , Medición de Riesgo , Factores de Riesgo , Adulto Joven

RESUMEN

Pocos estudios han evaluado el tratamiento a largo plazo con citrato de potasio en pacientes con nefrolitiasis por oxalato de calcio o ácido úrico cuyos factores de riesgo metabólico urinario son hipocitraturia o diátesis gotosa. Nosotros evaluamos retrospectivamente las historias clínicas de 92 pacientes adultos con litiasis renal recurrente cuyos factores de riesgo metabólico eran hipocitraturia aislada o diátesis gotosa que fueron tratados con citrato de potasio 30 a 60 meq/día, una a dos veces por día, por más de 3 meses.... Concluimos que el tratamiento con citrato de potasio efectivamente corrige los trastornos metabólicos en pacientes con hipocitraturia y diátesis gotosa con una disminución asociada en el calcio urinario y que estos efectos son sostenidos en el tiempo.

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Few studies have evaluated the long term treatmente with potassium citrate in patients with calcium oxalate o uric acid nephrolithiasis whose urine metabolic risk factores were hypocitraturia or gouty diathesis. We retrospectively reviewed the charts of 92 adult patients with recurrent renal stones whose urine metabolic risk factores were either hypocitraturia or gouty diathesis who were treated with potassium citrate 30 at 60 meq/d one or two times daily, for more than 3 months... We conclude that potassium citrate effectively corrects metabolic derangements in patients with hypocitraturia and couty diathesis with an associated decrease in urinary calcium and these effects were sustained in time.

Asunto(s)

Humanos , Adulto , Acidosis Tubular Renal/patología , Oxalato de Calcio , Cálculos Renales/diagnóstico , Citrato de Potasio/uso terapéutico , Nefrolitiasis/patología , Cuidados a Largo Plazo , Estudios Retrospectivos

RESUMEN

Artigos de emergência em Medicina sugerem que 90 por cento dos cálculos menores do que 5mm e 15 por cento dos cálculos com 5mm a 8 mm são eliminados espontaneamente com quatro semanas, enquanto 95 por cento daqueles maiores de 8mm requerem intervenção urológica. Pesquisas recentes mostram que a terapia médico-expulsiva pode aumentar a taxa de eliminação para cálculos de 10mm, reduzir a perda de dias de trabalho, visitas médicas e evitar procedimentos para a sua remoção.

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Text the emergency medicina suggests that 90 percent of stones less than 5mm and 15 percent of stones between 5mm and 8mm will pass spontaneously within 4 weeks. while 95 percent of those larger than 8mm will require urological intervention. Recent research shows that medical expulsive therapy can increase the expulsion rate for stones up to 10mm and decrease the expulsion time there by reducing lost workdays, medical visits and avoidable stone removal procedures.

Asunto(s)

Humanos , Cálculos Renales/complicaciones , Cálculos Renales/diagnóstico , Cálculos Renales/terapia , Cólico/etiología , Litotricia/tendencias , Litotricia , Litiasis/cirugía , Riñón/patología

RESUMEN

El diagnóstico de la litiasis renal mediante el microsistema de orejas se realizó a través de un estudio observacional, analítico y transversal en 60 pacientes de 20 a 80 años de edad, de ambos sexos, con edades entre 20 y 80 años, que acudieron a la consulta de Urología del Policlínico de Especialidades del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba, durante los meses de octubre y noviembre del 2006, con signos y síntomas de litiasis renal. Al grupo de estudio se le estableció el diagnóstico de la enfermedad por el microsistema de orejas y luego se le indicó el ultrasonido como prueba de oro para ratificar o no el hallazgo. Cuando el resultado ultrasonográfico fue positivo de litiasis renal, en la oreja derecha aparecieron gránulos, manchas y pápulas; pero cuando resultó negativo, solo se observaron manchas rojizas en la región del riñón en ambas orejas, lo cual permitió concluir que el microsistema de orejas constituye un mecanismo útil para diagnosticar la presencia de litiasis renal en un elevado porcentaje de afectados

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The diagnosis of the renal lithiasis by means of the ears microsystem was carried out through an observational, analytic and cross-sectional study in 60 patients between 20 to 80 years of age, of both sexes, that went to the Urology consulting room in the Specialties Polyclínic of the Saturnino Lora Teaching Provincial Hospital from Santiago de Cuba, during the months of October and November, 2006, with signs and symptoms of renal lithiasis. The study group was diagnosed the disease by the ears microsystem and then the ultrasound as definite examination was suggested to ratify or not the finding. When the ultrasonographic result was renal lithiasis positive, in the right ear appeared granules, stains and papules; but when it was negative, only reddish stains were observed in the earflap of both ears, which allowed to conclude that the ears microsystem constitutes an useful mechanism to diagnose the presence of renal lithiasis in a high percentage of persons with this condition

Asunto(s)

Humanos , Masculino , Femenino , Cálculos Renales/diagnóstico , Cálculos Renales , Oído Externo , Medicina Tradicional