Treatment of Kidney Stones by Percutaneous Nephrolithotomy: Evaluation of the Results of the First Series of Our Experience in the Urology Department of the Idrissa Pouye General Hospital in Dakar

The principle of PCNL is the extraction through a nephrostomy channel of kidney stones which are defined as the presence of crystalline concretions in the kidneys. Objectives: The objective of this work was to study the epidemiological, clinical and paraclinical aspects of patients with renal lithiasis treated by PCNL and on the other hand the different technical aspects of PCNL. Materials and Methods: This was a retrospective descriptive study, conducted in the urology department of HOGIP, covering the period from January 2015 to January 2019. We studied the demographic and clinical aspects of patients presenting renal lithiasis;we also studied the technical aspects and treatment outcomes. Statistical significance was set for α = 0.05. Results: Our series covered 82 PCNLs performed during the study period. The average age was 45.95 years, the age group [40 - 49 years] was more affected. Our study involved 44 men and 38 women, a sex ratio of 1.15. At the clinic, atypical lumbar pain was more frequent in 45.83% of cases. On URO-CT, the calculations were located more at the pyelic level (31.2%) and lower caliceal (27.2%). The size of stones measured between 15 and 20 mm in 30.52%. The stone density was between 500 and 1000 HU in 47.54% of cases. Intraoperatively, the patients were placed in lateral decubitus in 41.46% of cases. Only one access to the kidney was necessary in 87.8% of cases. The lithoclast was used in 65.85% of cases. The overall success rate (stone free) in our series was 96%. The majority of cases, 41.44%, drainage were done by natural means (totally tubeless). The average duration was 92 minutes. The complications encountered in our experience concerned 10 cases, a rate of 12.19%. Conclusion: Urinary lithiasis is more and more frequent in our regions. The development of Endo-urology offers several therapeutic options. Thus, PCNL occupies an important place in the management of kidney stones.

Kidney stone matrix proteins:Role in stone formation

Stone formation is induced by an increased level of urine crystallization promoters and reduced levels of its inhibitors.Crystallization inhibitors include citrate,magnesium,zinc,and organic compounds such as glycosaminoglycans.In the urine,there are various proteins,such as uromodulin(Tamm-Horsfall protein),calgranulin,osteopontin,bikunin,and nephrocalcin,that are present in the stone matrix.The presence of several carboxyl groups in these macromolecules reduces calcium oxalate monohydrate crystal adhesion to the urinary epithelium and could potentially protect against lithiasis.Proteins are the most abundant component of kidney stone matrix,and their presence may reflect the process of stone formation.Many recent studies have explored the proteomics of urinary stones.Among the stone matrix proteins,the most frequently identified were uromodulin,S100 proteins(calgranulins A and B),osteopontin,and several other proteins typically engaged in inflammation and immune response.The normal level and structure of these macromolecules may constitute protection against calcium salt formation.Paradoxically,most of them may act as both promoters and inhibitors depending on circumstances.Many of these proteins have other functions in modulating oxidative stress,immune function,and inflammation that could also influence stone formation.Yet,the role of these kidney stone matrix proteins needs to be established through more studies comparing urinary stone proteomics between stone formers and non-stone formers.

An Optimized Transfer Learning Model Based Kidney Stone Classification

The kidney is an important organ of humans to purify the blood.The healthy function of the kidney is always essential to balance the salt,potassium and pH levels in the blood.Recently,the failure of kidneys happens easily to human beings due to their lifestyle,eating habits and diabetes diseases.Early pre-diction of kidney stones is compulsory for timely treatment.Image processing-based diagnosis approaches provide a greater success rate than other detection approaches.In this work,proposed a kidney stone classification method based on optimized Transfer Learning(TL).The Deep Convolutional Neural Network(DCNN)models of DenseNet169,MobileNetv2 and GoogleNet applied for clas-sification.The combined classification results are processed by ensemble learning to increase classification performance.The hyperparameters of the DCNN model are adjusted by the metaheuristic algorithm of Gorilla Troops Optimizer(GTO).The proposed TL model outperforms in terms of all the parameters compared to other DCNN models.

Tea Consumption is Associated with Increased Risk of Kidney Stones in Northern Chinese： A Cross-sectional Study

Kidney stones are a common urinary system condition that can progress to kidney disease.Previous studies on the association between tea consumption and kidney stones are inconsistent.A cross‐sectional study to investigate the association between tea consumption and kidney stones was conducted from 2013 to 2014 and recruited 9,078northern Chinese adults.A total of 8,807participants were included in the final analysis.

Impact of the adherence to medical treatment on the main urinary metabolic disorders in patients with kidney stones

Objective:To assess the effect of the adherence to medical treatment on urinary parameters in the 24-h metabolic study of patients with kidney stones.Methods:A retrospective,longitudinal,descriptive,and observational study was carried out by reviewing the hospital electronic medical record from 2014 to 2018.The adherence to drug treatment was measured 6 months after its initiation,and the numerical values of the metabolic studies were compared.Wilcoxon tests were performed to compare the difference before and after treatment.Results:Ninety patients were evaluated,with 73.3% of adherence.The 180-day overall adherence rate was 61.2% in patients treated with a single drug and 85.4% in patients treated with multiple drugs.There is a statistically significant increase in citrate levels in patients with good adherence in comparison with non-adherent patients(p=0.031 vs.p=0.528).Conclusions:Medical treatment and dietary measures in patients with kidney stones have an initial impact at 6 months on the values of the main urinary metabolic alterations that predispose to calculi formation;the most significant is seen in those patients with adherence to medical treatment for hypocitraturia.

Effectiveness of Using Renalof®in the Elimination of Kidney Stones under 10 mm Located in the Renal-Ureteral Tract

Background: In view of the high recurrence of kidney stones in patients, the search for less aggressive, preventive treatments has become increasingly essential. Renalof® offers a phytotherapy alternative. Due to its diuretic and kidney stone demineralisation properties, it has been widely used in this patient population, disintegrating and eliminating calcium oxalate and struvite kidney stones painlessly in the genitourinary system. Methods: A Phase II, randomised, prospective, observational, single-blind study with two treatment arms was conducted in order to determine the efficacy of this alternative therapy: a total of 155 patients were enrolled, 120 were assigned to a Renalof® treatment group and 35 to the placebo group. All were over 18 years of age, of both genders, diagnosed with kidney stones of under 10 mm in diameter, present along the entire renal-ureteral-vesicular tract, diagnosed by ultrasound and renal CAT scan. Divided into two study arms, 120 were administered a dosage of a single 325 mg capsule of the Renalof® product half an hour before the two main meals for 3 months. The presence of kidney stones in any part of the renal-ureteral tract was assessed at monthly consultations using one of the above-mentioned diagnostic tools. Results: Study results show a high rate of effectiveness with Renalof®, finding up to a 65% expulsion rate (78 patients) in the first 8 weeks of treatment, compared to 11.4% (4 patients) in the placebo control group, P < 0.001. It is likely a longer follow-up period would be necessary in patients with kidney stones of 10 mm in diameter or larger than the period applied in the study. Discussion: We strongly recommend the inclusion of this product in kidney stone disease management protocols, especially for patients with kidney stones under 10 mm in diameter, where high response and effectiveness have been observed. Thus, it should be evaluated to reduce surgical treatment costs, as well as those for possible colic episodes and other associated complications.

A Review on Kidney Stone and Its Herbal Treatment

Medicinal plants have been valued for millennia as a rich source of therapeutic compounds for the prevention of various ailments all throughout the world.Kidney stones and urinary calculi affect a huge percentage of the population nowadays.Stone sickness has become more prevalent as a result of changes in living conditions,such as industrialization and hunger.The most common stone recorded in India is calcium oxalate kidney stones.Changes in prevalence and incidence,the occurrence of stone kinds and stone position,and stone removal treatment are all discussed.Medicinal herbs have been utilised for centuries because they are safer,more effective,culturally acceptable,and have less adverse effects than manufactured medications.Patients are advised to consume a low-fat diet,as well as fibres from naturally occurring plants and herbal treatments.The current article discusses the steps that should be taken to maximise the potential of medicinal plants for stone dissolving action.Combining herbal remedies with allopathic treatment is an excellent way to eliminate all issues associated with kidney stones.The purpose of this article is to emphasise the use of herbs as a treatment for urinary stones.

Comparative Analysis of Kidney Stone Composition in Patients from Ghana and South Africa: Case Study of Kidney Stones from Accra and Cape Town

Background: Kidney stone disease, also termed nephrolithiasis is associated with significant morbidities such as severe colicky flank pain, haematuria, urinary tract infection and kidney failure. Kidney stone disease was perceived as uncommon in developing countries;however, the global prevalence has been rising over the past two decades due to lifestyle changes. There is very limited literature on kidney stone composition in Africa, including Ghana and South Africa. It was based on this evidence that this study was undertaken. Aim: The primary aim of this study was to describe and compare the composition of kidney stone in patients receiving treatment at the Korle-Bu Teaching Hospital (KBTH), Accra (Ghana) and Groote Schuur Hospital (GSH), Cape Town (South Africa). Methods: The study was a retrospective folder review of patients treated for nephrolithiasis at the Korle-Bu Teaching Hospital in Accra (Ghana) and Groote Schuur Hospital in Cape Town (South Africa). Patients who were treated for kidney stone disease between 1st June 2016 and 31st May 2018 were recruited, and their folder numbers were retrieved from theatre logbooks. A total of hundred and sixty-three (n = 163) folders (n = 30 KBTH;n = 133 GSH) were subsequently retrieved from the two facilities’ records department. Demographic data and kidney stone analysis results were analyzed using the R statistical software. Results: The age of KBTH patients ranged from 24 to 75 years and age of 45 years, while that of GSH ranged 19 to 77 years and median age 48 years respectively. Males were the majority stone formers for both hospitals [56.7% KBTH;59.4% GSH]. There was no statistical difference in gender (p = 0.9447) and age (p = 0.2612) between the two groups. Calcium oxalate (86.7%) and uric acid (90.0%) were the commonest components of the kidney stones analyzed from the KBTH. Calcium oxalate (66.2%) and carbonate apatite (40.6%) were the most common components stones from GSH. Brushite (3.0%), cystine (3.8%) and struvite (19.6%) stones were only found in GSH patients. All kidney stones from the KBTH were mixed stones. Pure kidney stones were only found among the GSH dataset constituting 48.9%, also female patients from GSH formed more mixed stones than their male counterparts (M:F = 40.5%:66.67%) and infection kidney stones were also predominantly found among female patients. Conclusion: The findings indicate that the two facilities’ participants are not different in terms of gender and age. However, the composition of stones was found to be different between participants from both hospitals. This suggests that kidney stone composition may be influenced by patients’ geographical location and or cultural background.

The Influence of Kidney Stones and Salivary Uric Acid on Dental Calculus Formation and Periodontal Status among Some Saudi Patients Aged 25 - 70 Years

Background: The formation of kidney stones is considered a complicated process. Consequently, there are many questions about the link between kidney stones formation and level of salivary uric acid and calculus formation on the teeth surfaces. Objectives: To evaluate the correlation between the level of salivary uric acid and kidney stones formation and their influence on dental calculus and periodontal status among Saudi patients aged 25 - 70 years. Materials and Methods: 120 Saudi male patients were examined (60 of Kidney stones patients and 60 patients of non-kidney stones patients) for clinical evaluation of plaque index (PLI), gingival index (GI), calculus index of oral hygiene (CI) and clinical attachment loss (CAL). Moreover, lab assessment of uric acid level in the collected salivary samples was done. The findings were analyzed using of ANOVA test and Tukey’s test. Results: There were statistically significant differences in clinical parameters among kidney stones patients and non-kidney stones patients (p < 0.05), but these differences were highly statistically significant in the correlation between calculus index (CI), plaque index (PLI) and gingival index (GI) among kidney stone patients in group II, moreover, PLI and clinical attachment loss (CAL) among kidney stone patients in group III (p < 0.001). The statistical analyses revealed statistically significant differences in the level of salivary uric acid (mg/dl) in the comparison between kidney stones patients and non-kidney stones patients in group I and group III, whereas there were highly statistically significant in the comparison between kidney stones patients and non-kidney stones patients in group III. Conclusion: At the end of this study, we concluded that there was a relationship between dental calculus formation, kidney stones formation, and an increase in the level of salivary uric acid.

Kidney Stones in Transfusion-Dependent Thalassemia: Prevalence and Risk Factors

Purpose: As patients with transfusion-dependent thalassemia (TDT) are living longer, novel morbidities are being recognized. The purpose of this review is to summarize the current knowledge regarding the prevalence and risk factors of nephrolithiasis in patients with TDT. Methods: A non-systematic, narrative review of the current literature published up to August 2021 was conducted. Results: Nephrolithiasis has been reported in 18% - 59% of patients with TDT, which is at least twice the prevalence in the general US population. The risk factors for nephrolithiasis can be classified into behavioral (dietary and lifestyle), environmental, metabolic, disease-specific, and genetic factors. While clarifying the true prevalence of nephrolithiasis in different age groups and diagnostic categories of TDT requires further research, prevention, and management of nephrolithiasis is a growing clinical concern. Physicians should be aware of the potential increased risk of stone disease in splenectomized and diabetic patients as well as those treated with certain chelation regimens. Conclusions: The etiology of nephrolithiasis and potential TDT-specific risk factors that may put patients at greater risk are highlighted. There is insufficient evidence at this time to recommend universal screening for nephrolithiasis using ultrasound. Evidence-based recommendations on monitoring, prevention, and management of nephrolithiasis in TDT are provided.

Beyond kidney stones:Why pediatricians should worry about hypercalciuria

The incidence of urolithiasis(UL)is increasing,and it has become more common in children and adolescents over the past few decades.Hypercalciuria is the leading metabolic risk factor of pediatric UL,and it has high morbidity,with or without lithiasis as hematuria and impairment of bone mass.The reduction in bone mineral density has already been described in pediatric idiopathic hypercalciuria(IH),and the precise mechanisms of bone loss or failure to achieve adequate bone mass gain remain unknown.A current understanding is that hypercalciuria throughout life can be considered a risk of change in bone structure and low bone mass throughout life.However,it is still not entirely known whether hypercalciuria throughout life can compromise the quality of the mass.The peak bone mass is achieved by late adolescence,peaking at the end of the second decade of life.This accumulation should occur without interference in order to achieve the peak of optimal bone mass.The bone mass acquired during childhood and adolescence is a major determinant of adult bone health,and its accumulation should occur without interference.This raises the critical question of whether adult osteoporosis and the risk of fractures are initiated during childhood.Pediatricians should be aware of this pediatric problem and investigate their patients.They should have the knowledge and ability to diagnose and initially manage patients with IH,with or without UL.

The Intake of Vitamin C Increases the Risk of Kidney Stone:A review

Vitamin C is an essential vitamin for people,but it possibly linked to an increased risk of kidney stones.This view is controversial.The purpose of this assess was to illuminate the relationship between vitamin C intake and kidney stones.This paper reviewed relevant articles in the past 40 years from pubmed,analyzed the correlation between vitamin C intake and kidney stones,and pointed out the problems in the research process,which is of great reference significance.

Development of Segmentation and Classification Algorithms for Computed Tomography Images of Human Kidney Stone

Computed tomography(CT)scan diagnostics procedures adopt the use of image infbnnation retrieval system with the help of radiographer's expertise.However,this technique is prone to errors,Significant height of accuracy is required in healthcare decision support,as 20%of CT scans are associated with error.The application of artificial intelligence(Al)can improve performance level,mitigate human error,and enhance clinical decision support in the context of time and accuracy.The study introduced machine learning algorithm to analyze stream of anonymous CT scans of kidney.The research adopted deep learning approach for segmentation and classification of kidney stone(renal calculi)images in Python(with Keras and TensorFlow)environment.A control volume of data along with 336 kidney stone images were used to train the deep learning network with 10 testing images.The training images were divided into two sets(folders)as follows;one was labeled as STONE(containing 167 images)and the other as NO-STONE(containing 169 images);10 iterations were performed for model training.The network layers were structured as input layer in the following with 2-D convolutional neural network machine learning(CNN-ML),ReLU activation,Maxpooling,and fully connected(dense)layer including the sigmoid activation layer.The training adopted a batch size of 8 with 10%validation.The output result,upon testing the model,has an accuracy of 90%,sensitivity value of 80%and effectiveness of 89%.The segmentation and classification algorithm model could be embedded in future CT diagnostic procedure to enhance medical decision support and accuracy.

Effect of Humanistic Nursing Care on Health Knowledge Mastery and Nursing Satisfaction Among Patients Undergoing Kidney Stone Surgery

Objective:To deeply understand the influence of humanistic nursing care on the health knowledge mastery and nursing satisfaction among patients undergoing kidney stone surgery.Methods:Sixty patients with kidney stone who underwent surgical treatment in our hospital from June 2019 to June 2020 were randomly divided into reference group and experimental group by random number table method.There were 30 patients in each group.The patients of reference group were given routine nursing care,and the patients of experimental groups were given humanistic nursing care.The mastery score of various health knowledge,nursing satisfaction and postoperative complications were compared between the two groups.Results:The scores of health knowledge mastery among the patients in experimental group who were treated with humanistic nursing care were much higher than those in reference group who were treated with routine nursing care.The nursing satisfaction of patients in experimental group(96.67%)was significantly higher than that in reference group(80.00%),and the incidence of complications after kidney stone surgery in the experimental group(6.67%)was higher than that in the reference group(26.67%)(P<0.05).Conclusion:Humanistic nursing care is greatly conducive to the mastery of health knowledge in patients undergoing kidney stone surgery,and this nursing mode can meet the needs for nursing work and potentially minimize postoperative complications.

Kidney Stones Are Prevalent in Individuals with Pseudoxanthoma Elasticum, a Genetic Ectopic Mineralization Disorder

Objective:Pseudoxanthoma elasticum(PXE)is a rare genetic disorder caused by loss-of-function mutations in the ABCC6 gene.While PXE is characterized by ectopic mineralization of connective tissues clinically affecting the skin,eyes,and cardiovascular system,kidney stones were reported in some individuals with PXE.The aim of this study is to determine whether kidney stones are an incidental finding or a frequent manifestation of PXE.Methods:We first investigated the genetic basis of two siblings diagnosed with PXE.The younger patient presented with recurrent kidney stones since 8 years old.Secondly,to address whether kidney stones are associated with PXE,the prevalence of kidney stones in a survey cohort of 563 respondents with PXE was compared to that of a general U.S.population survey,National Health and Nutrition Examination Survey,with 28,629 participants.Results:Genetic analysis in both patients identified compound heterozygous mutations in ABCC6,c.2787+1G>T,and c.3774_3775insC.The analysis of participants 20 years old and older revealed that 23.4%of PXE patients had previously had a kidney stone,a significant increase compared to 9.2%in the general population(P<0.01).In addition,17.8%of PXE patients reported their first kidney stone episode before age of 18 years old.Conclusions:PXE correlates with an increased risk of developing kidney stones with considerable morbidity and health-care cost.

Proposal for pathogenesis-based treatment options to reduce calcium oxalate stone recurrence

Objective:Prevalence of kidney stone disease continues to increase globally with recurrence rates between 30%and 50%despite technological and scientific advances.Reduction in recurrence would improve patient outcomes and reduce cost and stone morbidities.Our objective was to review results of experimental studies performed to determine the efficacy of readily available compounds that can be used to prevent recurrence.Methods: All relevant literature up to October 2020,listed in PubMed is reviewed.Results: Clinical guidelines endorse the use of evidence-based medications,such as alkaline agents and thiazides,to reduce urinary mineral supersaturation and recurrence.However,there may be additional steps during stone pathogenesis where medications could moderate stone risk.Idiopathic calcium oxalate stones grow attached to Randall’s plaques or plugs.Results of clinical and experimental studies suggest involvement of reactive oxygen species and oxidative stress in the formation of both the plaques and plugs.The renin-angiotensin-aldosterone system(RAAS),nicotinamide adenine dinucleotide phosphate(NADPH)oxidase,mitochondria,and NOD-like receptor pyrin domain containing-3(NLRP3)inflammasome have all been implicated at specific steps during stone pathogenesis in animal models.Conclusion: In addition to supersaturation-reducing therapies,the use of anti-oxidants,free radical scavengers,and inhibitors of NADPH oxidase,NLRP3 inflammasome,and RAAS may prove beneficial for stone prevention.Compounds such as statins and angiotensin converting enzyme inhibitors are already in use as therapeutics for hypertension and cardio-vascular disease and have previously shown to reduce calcium oxalate nephrolithiasis in rats.Although clinical evidence for their use in stone prevention in humans is limited,experimental data support they be considered along with standard evidence-based medications and clinical expertise when patients are being counselled for stone prevention.

Modulatory effects of Lactiplantibacillus plantarum on chronic metabolic diseases

The increased global incidence of chronic metabolic diseases,a vital threat to human health and a burden on our healthcare systems,includes a series of clinical metabolic syndromes such as obesity,diabetes,hypertension,and dyslipidemia.One of the well-known probiotic microorganisms,Lactiplantibacillus plantarum plays an important role in promoting human health,including inhibiting the occurrence and development of a variety of chronic metabolic diseases.The present study provides an overview of the preventive and therapeutic effects of L.plantarum on diabetes,obesity,non-alcoholic fatty liver disease,kidney stone disease,and cardiovascular diseases in animal models and human clinical trials.Ingesting L.plantarum demonstrated its ability to reduce inflammatory and oxidative stress levels by regulating the production of cytokines and short-chain fatty acids(SCFAs),the activity of antioxidant enzymes,and the balance of intestinal microbial communities to alleviate the symptoms of chronic metabolic diseases.Furthermore,updated applications and technologies of L.plantarum in food and biopharmaceutical industries are also discussed.Understanding the characteristics and functions of L.plantarum will guide the development of related probiotic products and explore the modulatory benefit of L.plantarum supplementations on the prevention and treatment of multiple chronic metabolic diseases.

Renal calcification in children with renal tubular acidosis:What a paediatrician should know

Renal tubular acidosis(RTA)can lead to renal calcification in children,which can cause various complications and impair renal function.This review provides pediatricians with a comprehensive understanding of the relationship between RTA and renal calcification,highlighting essential aspects for clinical manage-ment.The article analyzed relevant studies to explore the prevalence,risk factors,underlying mechanisms,and clinical implications of renal calcification in children with RTA.Results show that distal RTA(type 1)is particularly associated with nephrocalcinosis,which presents a higher risk of renal calcification.However,there are limitations to the existing literature,including a small number of studies,heterogeneity in methodologies,and potential publication bias.Longitudinal data and control groups are also lacking,which limits our understanding of longterm outcomes and optimal management strategies for children with RTA and renal calcification.Pediatricians play a crucial role in the early diagnosis and management of RTA to mitigate the risk of renal calcification and associated complications.In addition,alkaline therapy remains a cornerstone in the treatment of RTA,aimed at correcting the acid-base imbalance and reducing the formation of kidney stones.Therefore,early diagnosis and appropriate therapeutic interventions are paramount in preventing and managing renal calcification to preserve renal function and improve long-term outcomes for affected children.Further research with larger sample sizes and rigorous methodologies is needed to optimize the clinical approach to renal calcification in the context of RTA in the pediatric population.

The influence of metabolic syndrome and its components on the development of nephrolithiasis

The prevalence of kidney stone disease is increasing,afflicting 7%-11% of the United States population.Multiple systemic conditions,including obesity and diabetes,are also on the rise.Further,the literature has demonstrated a strong association between metabolic syndrome,its components,and kidney stone disease.In this article,we aim to review the associations of metabolic syndrome and nephrolithiasis,discussing the pathophysiology,urinary parameters,and clinical presentations.With this knowledge,urologists will have a more comprehensive understanding of this complex population of metabolic stone formers enabling improved patient management and treatment of stone disease.

Medical therapy for nephrolithiasis:State of the art

The prevalence of nephrolithiasis is increasing worldwide.Understanding and implementing medical therapies for kidney stone prevention are critical to prevent recurrences and decrease the economic burden of this condition.Dietary and pharmacologic therapies require understanding on the part of the patient and the prescribing practitioner in order to promote compliance.Insights into occupational exposures and antibiotic use may help uncover individual risk factors.Follow-up is essential to assess response to treatment and to modify treatment plans to maximize therapeutic benefit.