Urolithiasis最新文献

The global rise in urolithiasis poses significant health risks. However, the formation mechanisms and environmental influences of kidney stones remain poorly understood. Investigating the elemental composition of kidney stones provides a critical approach to exploring these factors. This study analyzed kidney stones from Yunnan Province, a region with high nephrolithiasis prevalence, classifying them into three types: calcium oxalate (CO), uric acid (UA), and mixed CO and carbonate apatite (CA) stones. The long-term accumulation of calcium salts results in significantly higher concentrations of Ca, Zn, and Se in calcium stones compared to the crustal average. The concentrations of most elements in UA stones are generally lower than those in calcium stones. Mg, Zn, and Sr show significant correlations with multiple elements and inhibit stone crystallization, whereas Cu and Se appear to act only in apatite-containing stones. Additionally, the heavy metal characteristics of kidney stones exhibit notable regional differences. Kidney stones from Yunnan show significantly lower Zn and Sr levels than those from other regions, displaying unique geochemical features influenced by regional environmental and dietary factors. The heavy metal characteristics of kidney stones in Yunnan elucidate the mechanistic roles of individual elements and their associated environmental influences.

Urolithiasis is a common condition worldwide, marked by significant variations in lifetime risk across different regions, genders, and socioeconomic backgrounds. Understanding these disparities is crucial for developing effective public health strategies. This study aims to analyze these risks from 1990 to 2021 and project future trends in the incidence and mortality of urolithiasis. Data were obtained from the Global Burden of Disease (GBD) 2021 study, which provides comprehensive estimates on urolithiasis incidence, prevalence, and mortality across various demographics. Analyses were stratified by gender, age, Sociodemographic Index (SDI), and geographic regions, and included assessments of temporal trends and concentration indices (CIs). Additionally, AutoRegressive Integrated Moving Average (ARIMA) models were employed to project future trends regarding the lifetime risk of developing urolithiasis.The global lifetime risk of developing urolithiasis in 2021 was estimated at 62.95%, with the highest risks observed in Eastern Europe (89.20%), Southern Latin America (80.34%), and Central Asia (75.75%). Men exhibited a higher risk than women (70.40% vs. 50.34%). The global mortality risk from urolithiasis remained low at 0.03%, with the highest rates found in High-income Asia Pacific (0.07%) and Eastern Europe (0.06%). Notably, the lifetime risk of developing urolithiasis declined with advancing age, particularly after 40. ARIMA projections suggest a moderate increase in lifetime risk, potentially reaching nearly 70% by 2050, especially among females. Urolithiasis demonstrates significant global and regional disparities influenced by socioeconomic, environmental, and demographic factors. Comprehensive strategies that address these disparities will be essential for enhancing public health outcomes and reducing the incidence of urolithiasis worldwide.

Up to 40% of all kidney stone disease may have an underlying genetic contribution. Brushite stone formers are known to have high rates of stone recurrence and urine chemistry abnormalities, suggesting a possible intrinsic kidney abnormality which may contribute to brushite stone formation. In this study, we sought to determine the burden of genetic variants amongst brushite stone formers. An IRB approved prospective study of brushite stone formers was conducted. Patients with any brushite on stone analysis were eligible for enrollment. Genetic testing was done on peripheral blood derived DNA and assessed using a clinically available nephrolithiasis gene panel. Primary analysis assessed rates of genetic variants amongst brushite stone formers. Secondary analysis assessed for distinct patterns in urine chemistries in different genotypes. 15 patients (8 males) with a median age of 32 years (range 22-69) underwent genetic testing. 12 patients (80%) were reported to have a genetic variant, with 6 (40%) having multiple variants. Two patients had a heterozygous pathogenic or likely pathogenic variant in a gene that causes autosomal recessive disease. 9 (60%) patients had a variant of unknown significance. 10 (67%) patients had genetic variants associated with hypophosphatemic rickets. Genetic variants of unknown significance are common in brushite stone formers. Further work is needed to assess the significance of these variants and their role in the lithogenic process.

Retrograde intrarenal surgery (RIRS) is commonly performed with a ureteral access sheath (UAS). Our objective was to evaluate the impact of UAS use in patients undergoing RIRS for renal stones. We conducted a retrospective, multicenter cohort study of all patients who underwent RIRS for kidney stones between January 2017 and December 2018 at six academic medical centers. Patients were stratified according to UAS use. To adjust for baseline differences, we applied inverse probability of treatment weighting (IPTW), a propensity score-based method that balances covariates between groups. A total of 1,177 patients were included: 740 (62.8%) underwent RIRS with a UAS and 437 (37.2%) without. After adjustment, adequate balance was achieved between groups. In IPTW analysis, the stone-free rate (SFR) at three months was comparable between groups (OR = 0.75; 95% CI [0.53-1.08]; p = 0.12). UAS use was associated with longer operative time (estimate = 3.71 min; 95% CI [1.08-7.32]; p = 0.04), lower probability of outpatient procedure (OR = 0.67; 95% CI [0.49-0.91]; p = 0.01), and higher likelihood of postoperative stenting (OR = 3.61; 95% CI [2.72-4.78]; p < 0.001). There were no significant differences in overall complications (OR = 1.16; 95% CI [0.68-1.99]; p = 0.57) or major complications (OR = 1.07; 95% CI [0.45-2.57]; p = 0.86). In this large multicenter retrospective study, UAS use during RIRS was associated with a similar stone-free rate but increased perioperative morbidity. These real-world findings suggest that routine UAS use may not always be necessary, although randomized controlled trials are required to define its role more definitively.