struvite and Acidosis--Renal-Tubular

Topics: Acidosis, Renal Tubular; Calcium; Calcium Oxalate; Citric Acid; Cysteine; Humans; Kidney Calculi; Magnesium Compounds; Phosphates; Struvite; Uric Acid

Advances in renal lithiasis research have contributed to a better understanding of the many varied factors that contribute to renal calculus formation. Utilizing the newer techniques of ambulatory metabolic evaluation, we can establish a specific diagnosis in 95% of recurrent stone-formers. Since a significant percentage of initial stone-formers will never have a second episode, it is essential to establish the natural history of the patient's stone disease prior to initiating potentially life-long medical therapy. The majority of initial stone-formers can be managed with education concerning modest dietary restrictions and increased fluid intake. For the recurrent stone-former with metabolically active stone disease, it is probably best to design medical therapy to treat the specific urinary chemical abnormality or disease process.

Topics: Acidosis, Renal Tubular; Bacterial Infections; Calcium; Crystallography; Cystinuria; Diuresis; Fluid Therapy; Humans; Intestinal Absorption; Kidney; Kidney Calculi; Magnesium; Magnesium Compounds; Oxalates; Patient Education as Topic; Phosphates; Recurrence; Risk; Struvite; Uric Acid; Urography

Topics: Acidosis, Renal Tubular; Calcium; Cystinuria; Humans; Hydrogen-Ion Concentration; Hyperparathyroidism; Kidney Calculi; Magnesium; Magnesium Compounds; Phosphates; Proteus Infections; Struvite; Urine

Topics: Acidosis, Renal Tubular; Allopurinol; Benzothiadiazines; Calcium; Calcium, Dietary; Cystinuria; Diuretics; Humans; Hyperparathyroidism; Kidney Calculi; Magnesium; Magnesium Compounds; Oxalates; Penicillamine; Phosphates; Quaternary Ammonium Compounds; Sodium Chloride Symporter Inhibitors; Struvite; Uric Acid

Topics: Acidosis, Renal Tubular; Antirheumatic Agents; Female; Humans; Middle Aged; Obesity; Recurrence; Rituximab; Sjogren's Syndrome; Staghorn Calculi; Struvite

We investigated contents and classes of urinary and stone matrix lipids, and evaluated their clinical relevance in nephrolithiasis patients. Lithogenic role of major lipid classes was explored. Urine (24 h) and stone samples were collected from 47 patients with nephrolithiasis. Control urines were obtained from 29 healthy subjects. Urinary 8-hydroxy-deoxyguanosine (8-OHdG), malondialdehyde (MDA), N-acetyl-β-glucosaminidase (NAG) activity and total proteins were measured. Total lipids were extracted from centrifuged urines (10,000 rpm, 30 min) and stones by chloroform/methanol method. Major classes of lipids were identified using multi-one-dimensional thin-layer chromatography (MOD-TLC). Influence of each lipid class purified from stone matrices on stone formation was evaluated using crystallization and crystal aggregation assays. Urinary NAG activity and 8-OHdG were significantly elevated in nephrolithiasis patients. Total lipids in centrifuged urines of the patients were not significantly different from that of controls. In nephrolithiasis, urinary excretion of total lipids was linearly correlated to urinary MDA, 8-OHdG, NAG activity and total proteins. Lipid contents in stone matrices varied among stone types. Uric acid stone contained lower amount of total lipids than calcium oxalate and magnesium ammonium phosphate stones. MOD-TLC lipid chromatograms of healthy urines, nephrolithiasis urines and stone matrices were obviously different. Triacylglyceride was abundant in urines, but scarcely found in stone matrices. Stone matrices were rich in glycolipids and high-polar lipids (phospholipids/gangliosides). Partially purified glycolipids significantly induced crystal aggregation while cholesterol was a significant inducer of both crystal formation and agglomeration. In conclusion, total lipids in centrifuged urines did not differ between nephrolithiasis and healthy subjects. Our finding suggests that the significant sources of lipids in patients' urine may be large lipids-containing particles, which are removed in centrifuged urines. However, urinary lipid excretion in nephrolithiasis patients was associated with the extent of oxidative stress and renal tubular injury. Triacylglyceride was abundant in urines, but rarely incorporated into stones. Glycolipids were principal lipid constituents in stone matrices and functioned as crystal aggregator. Cholesterol purified from stone matrices bared crystal nucleating and aggregating activities.

Topics: Acidosis, Renal Tubular; Adult; Calcium Oxalate; Chromatography, Thin Layer; Deoxyguanosine; Female; Humans; Lipids; Magnesium Compounds; Male; Malondialdehyde; Middle Aged; Nephrolithiasis; Oxidative Stress; Phosphates; Struvite; Uric Acid; Urinalysis

Comprehensive metabolic evaluation has become an important aspect of the management of recurrent nephrolithiasis, yet the role of stone analysis is often neglected or perhaps underestimated. The purpose of this study was to determine the role of stone analysis in medical decision making in patients with recurrent nephrolithiasis.. We evaluated 100 consecutive stone-forming patients who had undergone compositional stone analysis as well as comprehensive metabolic evaluation at our institution. An analysis of stone composition in relation to metabolic disturbances was performed. Patients were stratified into two groups: calcium and non-calcium stone formers.. Patients having non-calcium stones were found to have a metabolic analysis reflecting specific metabolic disorders. Alternatively, patients with calcium stones were heterogeneous with regard to metabolic disorders, but there was a significant likelihood of renal tubular acidosis in those patients with calcium phosphate calculi. On the basis of these results, a simplified metabolic evaluation and nonselective medical therapy based on stone composition was formulated to facilitate assessment, management, and monitoring of stone disease.. Compositional stone analysis should be an integral part of the metabolic evaluation of patients with nephrolithiasis. Moreover, stone analysis alone may provide guidance for therapeutic treatment and obviate a formal metabolic evaluation.

Topics: Acidosis, Renal Tubular; Calcium; Calcium Phosphates; Cystine; Female; Humans; Kidney Calculi; Magnesium Compounds; Male; Metabolic Diseases; Phosphates; Struvite; Uric Acid

Distal RTA is characterized by decreased distal renal tubular hydrogen ion secretion, decreased ability to acidify urine, hypercalciuria, hyperphosphaturia, hypocitraturia, and metabolic acidosis. Because of the resulting alterations in urine composition and pH, patients with distal RTA are predisposed to urolithiasis and renal calcification. Diagnosis of distal RTA is important because it is a potentially reversible disorder that, left untreated, may cause nephrocalcinosis, recurrent urolith formation, moderate to severe metabolic acidosis, and renal failure.

Topics: Acidosis, Renal Tubular; Animals; Calcium Phosphates; Dog Diseases; Dogs; Magnesium; Magnesium Compounds; Phosphates; Struvite; Urinary Calculi