An Epidemiological Study of Kidney Calculi in Western Guangdong

Objective: To investigate the risk factors of kidney calculi in its high prevalence areas of western Guangdong, and provide the proper prevention measures. Methods: A cross-sectional survey was conducted among individuals in Maoming, western Guangdong. Univariate and Poisson regression analyses were applied to investigate the influence of the epidemiology, lifestyle, and environmental factors on renal calculi. Risk ratios with 95% confidence interval were used to estimate the association between the investigated factors and the prevalence of renal calculi. Results: 500 questionnaires were sent out and 481 valid questionnaires were recycled. Among 481 respondents, 84 had renal calculi with a prevalence rate of 17.46%. Univariate regression analysis showed statistically significant differences in the prevalence of renal calculi among different groups of sex, ages, family history of kidney calculi, diet and drinking habit. Poisson regression analysis showed that daily water intake and drinking boiled water were protective factors, while male, family history of kidney calculi, diet high in protein, sugar, vitamin C and calcium were risk factors. Additionally, high sugar diet was not statistically significantly associated with the occurrence of renal calculi. Conclusion: The occurrence of kidney calculi in western Guangdong is closely related to demographic characteristics of individuals, living and dietary habits of the resident populations.

Perioperative Outcomes of Percutaneous Nephrolithotomy in Septuagenarians and Beyond

Background: Life expectancy has continuously risen worldwide. Because the elderly may tolerate complications poorly, the risks and benefits of percutaneous nephrolithotomy (PCNL) in those patients should be discussed thoroughly. Objective: To analyze utility and operative outcomes of PCNL with respect to age. Materials and Methods: A retrospective study of PCNL was performed at Ramathibodi Hospital between 2011 and 2020. The patients were divided into two age groups, 1) below 70 years old and 2) 70 years old and above. Comparison of demographics, operative data, and postoperative outcomes were analyzed. Results: Of the 253 patients, the overall stone-free rate (SFR) was 59.7%. The SFR in younger groups and older groups were 59.4% (126/212) and 61.0% (25/41), respectively, which was not significantly different (p=0.999). There was a similar in-stone burden between the two groups (p=0.573). Patients in the older group had worse renal function, higher American Society of Anesthesiologists score, and more comorbidities, including hypertension and ischemic heart disease. However, estimated blood loss, length of hospital stay, operative time, percent change in eGFR, and complications were comparable between the groups. Conclusion: PCNL is a safe and effective treatment of kidney calculi in septuagenarians and older patients, even with the risk of higher comorbidities and poorer renal function than in younger patients. Keywords: Percutaneous nephrolithotomy; Renal calculus; Stone-free status; Septuagenarians

MEDICAL ERROR, PERSISTENT VEGETATIVE STATE AND OVER NINETEEN LONG YEARS OF MEDICAL CARE

A medical error is a preventable adverse effect of medical care. Errors can happen in the hospital at the doctor’s office, at the pharmacy, laboratory and ward. These can also occur at home by the patient or the attendant. These errors may lead to death or major/minor injuries or can also be harmless. However these should be recorded, analysed and remedial measures implemented to reduce the risk of being committed in the future. We are reporting the medical care of our patient in persistent vegetative state over nineteen years due to medical error at our hospital resulting in brain anoxia. The key issues faced during the care were recurrent respiratory and urinary tract infections and in last one year kidney calculi leading to chronic kidney disease and its complications. There are no contractures or thrombo-embolic events and above all no bed sore over this period.

Prevalence of Renal Colic in the Emergency Departments: A Multi-center Study

Background: Kidney calculi are the most common cause of kidney failure. Objectives: This study aimed to investigate the prevalence of renal colic and its risk factors in the patients referred to two emergency departments during a year. Methods: This was a descriptive cross-sectional study conducted in two hospitals in Kerman city, south-east of Iran, for one year from March 2019 to March 2020. All the archives of the two emergency departments were reviewed, and the required information was recorded in a checklist. The data was analyzed in SPSS 20 software. Results: A total of 504 patients were included in the study. The prevalence of renal colic was 0.5%. Most of the patients (58.5%) had an age between 19 and 39 years, and the majority (60.1%) were males and had a body mass index (BMI) above 25. A family history of renal colic was reported in 68.7% of the patients, and 63.9% had either hypertension or diabetes. Most of the patients consumed less than 3 liters of water per day. The highest referrals were seen in autumn (31.5%) and summer (27.4%). Conclusion: Considering the relationship between renal colic and age, sex, BMI, occupation, a family history of the disease, the presence of underlying diseases, the amount and type of drinking water, and the season of referral, it is recommended to control these risk factors to reduce the incidence of the disease.

Lithotriptic Effects of Phyllanthus fraternus Methanol Leaf Extract on Ethylene Glycol-induced Kidney Calculi in Albino Rats

This study was designed to evaluate the Lithotriptic potentials of Phyllantus fraternus methanol leaf extract on ethylene glycol-induced kidney calculi in albino rats. Ethylene glycol (1% v/v) was administered in their drinking water for a period of 28 days. The Treatment was done with the extract at 200 mg/kg, 400 mg/kg and 600 mg/kg body weights. Cystone® at 500 mg/kg body weight was also given for a period of 21 days to the standard control group. The serum parameters such as calcium, phosphates, magnesium and albumin were measured and evaluated. The results for the Lithotriptic activity, where the kidney homogenates were analyzed are described as thus, the phosphate concentrations when compared were significant (p<0.05) between the groups’ 600 mg/kg body weight (9.61 ± 1.17) and the normal control (5.67 ± 0.70). Significant differences (p<0.05) for phosphates were also observed between 600 mg/kg (9.61 ± 1.17) and 200 mg/kg body weights (12.06 ± 0.51); 400 mg/kg (7.64 ± 0.44) and 200 mg/kg body weights (12.06 ± 0.51) and the 200 mg/kg and standard control groups Cystone® (7.96 ± 0.56) respectively. Significant differences (p<0.05) were also observed for phosphates concentration, when the normal control (5.67 ± 0.70) was compared to the 400 mg/kg body weight (7.64 ± 0.44) and the standard control group Cystone® (7.96 ± 0.56). From this study, it can be deduced that, the presented data indicated that, the administration of Phyllanthus fraternus methanol leaf extract to rats with ethylene glycol-induced kidney calculi, reduced and prevented the growth of kidney calculi, supporting the folklore claim regarding its Lithotriptic activity.

Percutaneous Nephrolithotomy in Patients With Solitary Kidney

Introduction: The aim of this study was to evaluate percutaneous nephrolithotomy (PCNL) in the patients with solitary kidneys. Materials and Methods: Between 1995 and 2005, we had 11 patients with a solitary kidney and kidney calculi who underwent PCNL at our center. Tubeless and standard PCNLs were performed in 3 and 7 patients. In 1 patient, we could not achieve access to the system due to the stricture of the infundibulum. Results: The calculi were extracted or fragmented successfully in 10 patients. In 2 patients with residual calculi, a double-J catheter was inserted and extracorporeal shock wave lithotripsy (SWL) was performed. Retroperitoneal hematoma was detected in 3 cases by ultrasonography 1 week after the procedure, which was treated conservatively. Also, fever occurred in 3 patients after the procedure which was treated successfully. The patients were discharged on the 3rd and 4th postoperative days. Conclusion: Although PCNL is accompanied by the risk of complications such as severe bleeding that may result in kidney loss in patients with a solitary kidney, the rate of success and complications seem to be similar to the other patients if careful operation and correct selection of candidates are done. Therefore, we recommend cautious performance of PCNL in patients with solitary kidneys.

Results of extracorporeal shock wave lithotripsy in patients with high density kidney calculi

A study of the efficacy of extracorporeal shock wave lithotripsy (ESWL) in patients with urolithiasis with renal calculi of high-density (1000 HU) and size less than 20 mm was carried out. A total of 18 patients underwent 54 ESWL sessions. The tolerability of the treatment was satisfactory. The best results were obtained in patients with structural heterogeneity of calculi with a difference in the density of different sections of the calculus according to multi-slice computer tomography data of more than 500 HU. Such calculi disintegrated more easily during ESWL.

Bioinformatic gene analysis for potential biomarkers and therapeutic targets of kidney calculi-related renal cell carcinoma

Kidney calculi (KC) is considered to be a potential cause of renal cell carcinoma（RCC）due to urinary retention, hydronephrosis, pyelonephritis, and carcinoma of renal pelvis. We searched co-expressed genes in order to explore the relationships between kidney calculi (KC) and renal cell carcinoma（RCC） and reveal potential biomarkers and therapeutic targets of kidney calculi-related renal cell carcinoma.KC-related differentially expressed genes (DEGs) were identified via bioinformatic analysis Gene Expression Omnibus (GEO) datasets GSE73680 and GSE117518. Simultaneously, RCC-related DEGs were also identified via bioinformatic analysis GEO datasets GSE14994 and GSE40435. Subsequently, co-DEGs of KC-related RCC were found, and extensive target prediction and network analyses methods were used to assess protein–protein interaction (PPI) networks, Gene Ontology (GO) terms and pathway enrichment for DEGs, and co-expressed DEGs coupled with corresponding predicted miRNAs involved in KC and RCC were assessed as well.We identified 832 DEGs in KC and RCC samples. The co-DEGs of VIM，DCN，WNK1 and PXDN coupled with corresponding predicted miRNAs, especially miR-181c-5p and miR-181d-5p may be significantly associated with KC-related RCC. The Co-DEGs of VIM，DCN，WNK1 and PXDN link KC and RCC. Finally, the top 5 miRNAs for each Co-DEGs may be potential signaling pathways for KC-relate RCC, especially miR-181c-5p and miR-181d-5p. Therefore, there is an association between KC and RCC and expression of VIM，DCN，WNK1 and PXDN genes may favor KC-related RCC.