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PubMed1984

Chloride and phosphate as impediments to silica urinary calculi in rats fed tetraethylorthosilicate.

Rats fed a dextrose-casein type of diet adequate for normal growth and containing 2% of tetraethylorthosilicate (TES) were used to study the effect of NaCl and Na2SO4 drinking waters, and dietary additions of chloride, sulfate and phosphate on formation of silica urinary calculi. In experiment 1, rats fed the basal-TES diet had a 53% incidence of silica urinary calculi. NaCl or Na2SO4 (0.07 N) drinking waters each increased (P less than 0.01) water intake and urine volume, whereas only NaCl reduced (P less than 0.05) the incidence of silica urinary calculi. The incidence of calculi in the rats treated with NaCl and Na2SO4 was 15 and 55%, respectively. The saline waters had similar effects on urine pH, silica, phosphorus, magnesium and calcium, as well as blood plasma magnesium and calcium. Plasma phosphorus tended to be higher (P = 0.08) in the NaCl-treated rats. In experiment 2, 50% of rats fed the basal-TES diet developed silica urinary calculi. Addition of 0.2 eq/kg diet of chloride, sulfate or phosphate as sodium salts (phosphate was an equal molar mixture of mono- and dibasic sodium phosphates) resulted in a reduction in silica urinary calculi (P less than 0.05) by dietary chloride (15% incidence) and phosphate (5% incidence) but not by sulfate (35% incidence). Water intake and urine volumes did not differ, urine calcium was increased (P less than 0.05) by sulfate, and urine phosphorus was increased (P less than 0.05) by phosphate. Blood plasma concentrations of calcium and magnesium did not differ, but plasma phosphorus was higher for animals fed the additional phosphate (P less than 0.1) or chloride (P less than 0.05) in the 2% TES diet.

Administration, Oral↗
PubMed2003

Endotoxin content in renal calculi.

PURPOSE: Manipulation of infection calculi (struvite and calcium apatite) can cause the sepsis syndrome due to endotoxemia or bacteremia. We sought to determine whether concentrations of endotoxin sufficient to produce the sepsis syndrome could be embedded in renal infection stones. MATERIALS AND METHODS: Fragments of infection and noninfection renal calculi were processed and assayed for endotoxin concentration. Endotoxin concentrations, recorded as endotoxin units per gm. calculus, were converted to ng. (10 endotoxin units = 1 ng.). Urine culture results were available for some patients with infection stones. RESULTS: A total of 34 renal calculi (16 infection and 18 noninfection) were evaluated. The composition of 62.5% of the infection stones was struvite, whereas 50% of the noninfection stones were calcium oxalate monohydrate. Mean endotoxin concentration in infection calculi was 12,223 ng./gm. stone (range 0.6 to 50,000), compared to 340.3 ng./gm. stone (range 0 to 3,490) in noninfection calculi. The endotoxin content difference was significant (p = 0.001). Urine culture results available from 9 patients with infection stones did not correlate with endotoxin concentrations. CONCLUSIONS: Large endotoxin concentrations can be found in renal infection calculi. Noninfection stones can contain endotoxin but in much lower amounts. Massive endotoxin release could occur with infection stone manipulation, possibly producing increased serum endotoxin concentrations similar to those seen in gram-negative sepsis. Anti-endotoxin strategies may be beneficial in preventing and treating stone induced endotoxemia and the sepsis syndrome.

Endotoxins↗
PubMed1996

Pancreatic calculi superimposed upon slow growing pancreatic cancer.

We report on a 59 year old male patient with cancer of the head of the pancreas, upon which pancreatic calculi were superimposed during the 3 year clinical course. Pancreatic calculi were noted in the main pancreatic duct (MPD) on both computed tomographic scans and ultrasonographs of the abdomen approximately 10 months after the recognizable dilatation of the MPD. Existence of the calculi was confirmed by autopsy. Elemental analysis and infrared spectrophotometry of the calculi demonstrated that the main constituent of the calculi was calcium carbonate. Histopathological examination showed that the pancreatic cancer was moderately differentiated adenocarcinoma. Immunohistochemical studies revealed that pancreatic stone protein (lithostathine) was present in the cytoplasm of tumour cells. In this case, pancreatic cancer progressed to obstruct the MPD unusually slowly, resulting in stagnation of pancreatic secretion and subsequent formation of the calculi.

Adenocarcinoma↗
PubMed2004

Renal silica calculi in an infant.

We report on a rare case of urinary silica calculi in a 10-month-old boy. The boy showed acute pyelonephritis with left hydronephrosis. Ultrasonography and computed tomography revealed a calculus at the left ureteropelvic junction and three additional calculi in the left renal pelvis. Because his acute pyelonephritis was refractory to conventional chemotherapy, the patient underwent successful left percutaneous nephrostomy followed by percutaneous nephrolithotripsy for the renal calculi. All stones disappeared and his postoperative course was uneventful. On infrared spectrophotometry, the wavelength pattern of the stones exhibited two peaks at 1100 and 1650 cm(-1), consistent with the determination that the calculi consisted of a mixture of silicate (78%) and calcium oxalate (22%). We consider that the etiology of the calculi in this child can be ascribed to the silicate-rich water used to dilute milk. In Japan, 46 adult patients with urinary silicate calculi have been reported in the literature; however, there is no report of the disease in an infant in Japan.

Combined Modality Therapy↗
PubMed2004

Preventing reservoir calculi after augmentation cystoplasty and continent urinary diversion: the influence of an irrigation protocol.

OBJECTIVE: To evaluate the influence of an irrigation protocol in preventing reservoir calculi forming after augmentation cystoplasty and continent urinary diversion. PATIENTS AND METHODS: Between 1985 and 1995, 91 patients had an augmentation cystoplasty and/or continent urinary diversion (group 1; 54 females and 37 males, mean age 11.1 years, range 1-31); these patients were not routinely instructed to use irrigation after surgery. The segments used included ileum (44), colon (36), stomach (eight) and ureter (three). Between 1995 and 2000, 42 patients (group 2) underwent urinary reconstruction (22 females and 20 males, mean age 14.8 years, range 4-27), the segment used being ileum (30), colon (five), ureter (five) and stomach (two) but in contrast to group 1 they then were placed on a standard prophylactic irrigation protocol. The occurrence of stones in the reservoir was then assessed. RESULTS: Thirty-nine of the 91 patients (42.8%) in group 1 presented with reservoir calculi after reconstruction and 22 had several episodes. The mean time to presentation was 30 months. The incidence of stone formation by underlying diagnosis included: myelomeningocele, 32/48 (66%), exstrophy five/25 (25%), posterior urethral valves two/20 (10%) and rhabdomyosarcoma, none of three. Fifty of the 91 patients had an abdominal stoma, with stone formation in 33 (66%), while 41 used the native urethra, with stone formation in six (15%). Three (7%) of the 42 patients in group 2 developed reservoir calculi after reconstruction, two in patients with myelomeningocele and one in a trauma patient who had residual bone spicules in the bladder; the mean time to presentation was 26.5 months. CONCLUSIONS: These data suggest that the irrigation protocol used in group 2 significantly reduced the number of reservoir calculi after urinary tract reconstruction when bowel was used as part of the reconstruction (43% vs. 7%). The most calculi in both groups were in immobile patients with sensory impairment. Also, patients with an abdominal stoma had a greater risk of reservoir calculi (66%) than those using the native urethra (15%).

Adolescent↗
PubMed1978

Ultrastructure of salivary calculi.

Twenty-one submandibular salivary calculi from 19 patients were examined with the light and electron microscope. Adjacent to the peripheral parts of the calculi metaplastic squamous epithelium or connective tissue was seen in close contact to the mineralized matrix. Disintegrated cellular substances from these tissue components were in some cases found to condense in a peripherally located zone of the salivary calculi. The morphology of the examined salivary calculi varied extensively not only within each calculus but also from one calculus to another. High and low incidence of crystals gave rise to the lamellated pattern. In some cases the crystals were so abundant as to five a dense homogeneous appearance. In the central parts of the calculi spheroid bodies of very low electron density with a size ranging from 1 to 100micrometer were found in an amorphous matrix. The origin of these structures is discussed. In the peripheral parts of some calculi osmiophilic spherical bodies with an electron microscopical appearance similar to lipid granules as well as bacteria of cocci or coliform type were found. Degenerated bacteria might in some cases contribute in forming part of the peripheral organic matrix.

Humans↗
PubMedDate not supplied

Silica-containing urinary calculi in dogs (1981-1993).

Silica-containing urinary calculi obtained from 773 dogs and submitted by veterinarians throughout the United States were analyzed by quantitative crystallographic analysis to determine mineral composition. Specimens were composed of either multiple mineral layers (535 specimens) or 1 mineral layer (238 specimens). Most multiple-layer calculi were composed of 80% or greater silica (300 of 535, 56%) or 20% to 79% silica (184 of 535, 34%) in any mineral layer. Most 1-layer calculi were composed of 100% silica (212 of 238, 89%). Most dogs forming silica-containing calculi were of male gender (679 of 773, 88%). Bacterial cultures of calculus or urine or both were performed on 49% (376 of 773) of the specimens, and bacterial growth was obtained from 37% (139 of 376) of samples cultured. The prevalence of calculus-associated urinary tract infection was 35% (113 of 321) in males and 47% (26 of 55) in females. The gender prevalence for infection with Staphylococcus species was 16% (51 of 321) in males and 33% (18 of 55) in females. The breed and gender of dogs that formed calculi (silica population) were compared with the hospital population (Veterinary Medical Teaching Hospital [VMTH] population) and with a population of calculus-forming dogs (Stonelab population) to determine risk factors for silica calculus formation. For all breeds compared, the ratio of males to females was higher in the silica population. The German Shepherd Dog and Old English Sheepdog were significantly overrepresented when the silica population was compared with either the VMTH population or the Stonelab population. We conclude that male German Shepherd Dogs and Old English Sheepdogs are at increased risk for formation of silica-containing urinary calculi.

Animals↗
PubMedDate not supplied

Changes in proportion of canine urinary calculi composed of calcium oxalate or struvite in specimens analyzed from 1981 through 2001.

The objective of this report was to characterize 20-year changes in proportion of calcium oxalate (CaOx) calculi and struvite calculi in dogs, and associations with breed, age, and sex. In this retrospective study, results of analysis of urinary calculi from dogs were reviewed for specimens received between July 1, 1981, and December 31, 2001. Breed, sex, age, year of submission of the specimen, and mineral type(s) were analyzed statistically. CaOx or Struvite or both were contained in 18,966 of 20,884 (91%) specimens. For both sexes, a 20-year statistically significant increase was observed in the proportion of calculus specimens that contained CaOx. The increase in this proportion was greater in females (1% to 31%) than in males (18% to 82%). From 1998 to 2001, when proportions may have plateaued, the odds of specimens containing CaOx were markedly higher in 18 breeds, markedly lower in 5 breeds, and not significantly different in 13 breeds compared with crossbreds. For both sexes, a 20-year statistically significant decrease was observed in the proportion of calculus specimens that contained struvite. This decrease in proportion was greater for males (79-16%) than for females (97-68%). From 1998 to 2001, when proportions plateaued, the odds of calculi containing struvite were markedly lower in 20 breeds, markedly higher in 1 breed, and not significantly different in 15 breeds when compared with crossbreds. Breed, age, and sex were associated statistically with CaOx or struvite urolithiasis. In conclusion, there appears to have been a long-term increase in the proportion of specimens of canine urinary calculi that contain CaOx as well as a long-term decrease in the proportion of specimens of calculi that contain struvite for both male and female dogs. The rate of change appeared to begin leveling off in the period 1998 to 2001. The recent proportion of dogs with either CaOx- or struvite-associated urolithiasis may depend on breed, age, and sex, and on interactions among these 3 factors.

Age Factors↗
PubMed2002

Conspicuity of renal calculi at unenhanced CT: effects of calculus composition and size and CT technique.

PURPOSE: To determine the effects of calculus size, composition, and technique (kilovolt and milliampere settings) on the conspicuity of renal calculi at unenhanced helical computed tomography (CT). MATERIALS AND METHODS: The authors performed unenhanced CT of a phantom containing 188 renal calculi of varying size and chemical composition (brushite, cystine, struvite, weddellite, whewellite, and uric acid) at 24 combinations of four kilovolt (80-140 kV) and six milliampere (200-300 mA) levels. Two radiologists, who were unaware of the location and number of calculi, reviewed the CT images and recorded where stones were detected. These observations were compared with the known positions of calculi to generate true-positive and false-positive rates. Logistic regression analysis was performed to investigate the effects of stone size, composition, and technique and to generate probability estimates of detection. Interobserver agreement was estimated with kappa statistics. RESULTS: Interobserver agreement was high: the mean kappa value for the two observers was 0.86. The conspicuity of stone fragments increased with increasing kilovolt and milliampere levels for all stone types. At the highest settings (140 kV and 300 mA), the detection threshold size (ie, the size of calculus that had a 50% probability of being detected) ranged from 0.81 mm + 0.03 (weddellite) to 1.3 mm + 0.1 (uric acid). Detection threshold size for each type of calculus increased up to 1.17-fold at lower kilovolt settings and up to 1.08-fold at lower milliampere settings. CONCLUSION: The conspicuity of small renal calculi at CT increases with higher kilovolt and milliampere settings, with higher kilovolts being particularly important. Small uric acid calculi may be imperceptible, even with maximal CT technique.

Humans↗
PubMed2001

Investigation of upper tracts after resolution of symptoms due to ureteric calculi.

OBJECTIVE: To determine whether patients with proven ureteric calculi on IVU require repeat IVU after resolution of symptoms and passage of calculus on plain X-ray. METHODOLOGY: IVU reports for a 12-month period were obtained and notes and X-rays of those patients with ureteric calculi were reviewed. Presentation, management and subsequent imaging after resolution of symptoms were determined for each patient. All X-rays were reviewed by a uroradiologist. RESULTS: Fifty-eight patients were investigated for the study. All initial IVUs showed upper tract dilation or obstruction. Forty-three eventually passed their calculi spontaneously and of these, 18 had KUB, all of which showed passage of the calculus and 25 had repeat IVU, 22 of which were normal. The 3 abnormal IVUs showed persisting calculi which were visible on the plain film. Fifteen patients required surgical intervention and all had repeat IVU, of which 5 were abnormal. CONCLUSION: This study suggests that following resolution of symptoms due to ureteric colic, patients who pass their calculi spontaneously can be followed up by KUB. Only those with persistent calculi on KUB or those who have had surgical intervention require repeat IVU.

Follow-Up Studies↗
PubMed1989

Amyloid urinary-tract calculi in patients on chronic dialysis.

Urinary calculi found in 4 patients on chronic hemodialysis or continuous ambulatory peritoneal dialysis (CAPD) were identified as protein calculi by infrared spectroscopic analysis. Positive Congo red staining and immunological assessment revealed that the calculi were composed of amyloid protein derived from beta 2-microglobulin. A comparison of the patients who excreted calculi with 10 patients on chronic dialysis without urinary calculi showed no significant differences in the urinary and serum levels of beta 2-microglobulin. The mechanism of amyloid calculus formation may involve factors independent of the concentration of beta 2-microglobulin in urine or serum. Urinary calculi found in patients on chronic hemodialysis or CAPD were composed of amyloid protein derived from beta 2-microglobulin.

Amyloid↗
PubMed1992

Primary extracorporeal shock wave lithotripsy of staghorn renal calculi.

186 patients with partial and 55 patients with complete renal staghorn calculi were treated with primary extracorporeal shock wave lithotripsy (ESWL) at the Department of Urology, University of Würzburg Medical School. Partial staghorn calculi required an average of 1.4, complete staghorn calculi an average of 2.2 treatment sessions using the Dornier HM 3 lithotriptor. 55% of all patients and 46% of the patients with complete staghorn calculi were rendered stone-free within 1 year after ESWL. Pretreatment urinary tract infections present in 50.6% of all patients could be reduced to 22.5% 1 year after ESWL. The most frequent complications after ESWL were ureteral obstruction caused by 'steinstrasse' (41.4%), fever (38.4%), and renal colics (29.4%). Severe complications needing open operative procedures or blood transfusions did not occur. 50% of all patients underwent auxiliary procedures (e.g. insertion of indwelling ureteral stents: 25.3%, percutaneous nephrostomy: 20.3%, percutaneous nephrolithotripsy: 2.9%). Pretreatment insertion of an indwelling ureteral stent was found to reduce posttreatment complications as well as the need for percutaneous nephrostomy only in patients with partial staghorn calculi. The data presented in this study demonstrate that primary ESWL therapy can be safely and successfully performed in the majority of patients with renal staghorn calculi. In patients requiring complete removal of all stone fragments, a percutaneous lithotripsy can be performed following ESWL.

Adult↗
PubMed1994

Extracorporeal shock wave lithotripsy monotherapy for staghorn calculi.

Forty-eight patients with large renal staghorn calculi of more than 35 mm in maximum length on plain X-rays were treated by extracorporeal shock wave lithotripsy (ESWL) monotherapy for a period of 2 years. Thirty patients, with a follow-up of more than 6 months after the last treatment, were included in this study. The surface area of the calculi was 1,290 mm2 on average. Based on plain X-rays, 9 cases (30%) became free of calculi while 12 patients (40%) had a small amount of residual fragments (less than 100 mm2 in area). Adding these cases to those in which all the residual calculi were eliminated, the total turned out to be 21 cases (70%) and the treatment of staghorn calculi with ESWL was thus considered to have been fairly effective in the present series. The remaining 9 cases (30%) contained a considerable amount of residuals (more than 100 mm2). The present study in the ESWL of large staghorn calculi revealed no clear relationship between the surface area of the stones and evacuation of the fragments. The amount of the residual fragments was significantly small when either the renal collecting system was less than 2,000 mm2 in area (p < 0.05), or when the ureteropelvic junction (UPJ) was equal or greater than 5 mm in diameter (p < 0.02) according to intravenous pyelography (IVP) before treatment. The complications associated with this treatment were minimal, with a high fever in only 3 patients that were treated easily by antibiotic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMedDate not supplied

Inheritance of urinary calculi in the Dalmatian.

Dalmatians are unique among dogs in that they excrete uric acid in their urine as the end product of purine metabolism rather than allantoin as do other breeds of dogs. Urinary calculi form from urate (salts of uric acid) and can cause urethral obstruction in male Dalmatians. Although all Dalmatians have the primary defect, only a subset develops clinical disease. We postulated that calculi formation might have a genetic component that segregates within the breed, causing some animals to form calculi and others to never form calculi despite excreting uric acid in their urine. We used a survey to ascertain the urinary calculi status based on clinical signs of adult Dalmatians aged 6 years or older, and we used pedigrees from these same animals to estimate the heritability of the clinical manifestation of urate calculi within the breed to be .87 (.75-.96). The prevalence of the disease was 34% (24.99-43.70%) among male Dalmatians in our survey. The high heritability of the disease makes it possible for breeders to effectively select against the disease.

Animals↗
PubMed1984

Computed tomographic analysis of renal calculi.

An in vitro study sought to determine the feasibility of using computed tomography (CT) to analyze the chemical composition of renal calculi and thus aid in selecting the best treatment method. Sixty-three coded calculi were scanned in a water bath. Region-of-interest measurements provided the mean, standard deviation, and minimum and maximum pixel values for each stone. These parameters were correlated with aspects of the stones' chemical composition. A multivariate analysis showed that the mean and standard deviation of the stones' pixel values were the best CT parameters for differentiating types of renal calculi. By using computerized mapping techniques, uric acid calculi could be perfectly differentiated from struvite and calcium oxalate calculi. The latter two types also were differentiable, but to a lesser extent. CT has a potential role as an adjunct to clinical and laboratory methods for determining the chemical composition of renal calculi in an effort to select optimal treatment.

Calcium Oxalate↗
PubMed2005

Clinical, clinicopathologic, radiographic, and ultrasonographic abnormalities in cats with ureteral calculi: 163 cases (1984-2002).

OBJECTIVE: To determine clinical, clinicopathologic, radiographic, and ultrasonographic abnormalities in cats with ureteral calculi. DESIGN: Retrospective study. ANIMALS: 163 client-owned cats. PROCEDURE: Medical records were reviewed, and information on signalment, history, clinical signs, and results of clinicopathologic testing and diagnostic imaging was obtained. RESULTS: The number of cats in which ureterolithiasis was diagnosed each year increased progressively during the study period. Clinical signs tended to be non-specific and included inappetence, vomiting, lethargy, and weight loss. A combination of survey radiography and abdominal ultrasonography revealed ureteral calculi in 66 of 73 (90%) cats in which the diagnosis was confirmed at surgery or necropsy. Ultrasonography revealed that ureteral calculi were causing ureteral obstruction in 143 of 155 (92%) cats. One hundred thirty-four of 162 (83%) cats had azotemia, 84 of 156 (54%) had hyperphosphatemia, and 22 of 152 (14%) had hypercalcemia. Urinary tract infection was documented in 10 of 119 (8%). Fifty-eight of 76 (76%) cats with unilateral ureterolithiasis had azotemia and 33 (43%) had hyperphosphatemia, indicating impairment of renal function in the contralateral kidney or prerenal azotemia. Ultrasonographic imaging of the contralateral kidney in cats with unilateral ureteral calculi suggested that preexisting renal parenchymal disease was common in cats with ureterolithiasis. Ninety-one of 93 (98%) ureteral calculi contained calcium oxalate. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that abdominal imaging should be performed in all cats with chronic nonspecific signs or with acute or chronic renal failure to rule out ureterolithiasis. Preexisting renal disease may be common in cats with ureteral calculi.

Animals↗
PubMed1991

Observations of vaginal calculi in dolphins.

Vaginal calculi have been described from the common (Delphinus delphis), Pacific white-sided (Lagenorhynchus obliquidens) and spotted (Stenella attenuata) dolphins. We describe additional calculi found in six sexually mature D. delphis from southern California. Three calculi were large (ca. 7 x 5 cm), exhibited concentric layer crystallization, and were unique from previously published descriptions. One calculus described previously and one in our sample appeared to be a fetal skeleton and skull respectively. Using CAT scans of a first trimester northern right whale dolphin (Lissodelphis borealis) and of a near term Delphinus delphis, we discuss the potential origin and development of vaginal calculi through analysis of ossification in embryonic delphinids. We hypothesize that the calculi represented spontaneous incomplete abortion with retention of part or all of the fetus in the distal reproductive tract. The form of the calculus relates to the degree of skeletal development at the time of fetal death. Calculi from a pregnant dolphin provided one measure of residence time.

Abortion, Veterinary↗
PubMed1993

Treatment of ureteral calculi with an 8.3F disposable shaft rigid ureteroscope.

Seventy-one adult patients underwent ureteroscopy for treatment of ureteral calculi using the disposable shaft semirigid mini-ureteroscope. The ureteroscope has an 8.3F outer diameter with a fiber optic core that allows some flexibility of the shaft. It has a 4.0F working channel that allows simultaneous use of 3F instruments and irrigation. Twenty-three patients had upper ureteral calculi and 48 patients had lower ureteral calculi. Thirty-six patients did not require ureteral dilation and the remainder had minimal dilation to 10-12F. Fifty-one patients underwent laser lithotripsy, 14 patients underwent basket extraction, and six patients had both. Five patients required use of a second flexible ureteroscope. Seventy-seven percent of the patients went home the day of the procedure, 16% stayed one night in the hospital, and the remaining 7% had longer hospital stays. No major complications or infections were noted. Only 11% of the patients required IV or IM narcotics for pain management post-operatively. The stone-free results at 1 month were 96% for lower ureteral calculi and 91% for upper ureteral calculi. We have found this ureteroscope to be similar to other rigid mini-ureteroscopes with some additional advantages. A larger working channel, increased flexibility/steerability, and improved optics make it useful for treating ureteral calculi in the lower ureter in men and the entire ureter in women.

Adult↗