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      Effect of Renal Insufficiency on Stone Recurrence in Patients with Urolithiasis

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          Abstract

          The study was designed to assess the relationship between glomerular filtration rate (GFR) and urinary stone-forming constituents, and to assess the effect of renal insufficiency on stone recurrence risk in first stone formers (SF). Baseline serum creatinine levels were obtained, and renal insufficiency was defined as creatinine clearance ≤60 mL/min (Cockroft-Gault). This retrospective case-control study consists of 342 first SF; 171 SF with normal renal function were selected with 1:1 propensity scores matched to 171 SF with renal insufficiency. Urinary metabolic evaluation was compared to renal function. GFR was positively correlated with urinary calcium, uric acid, and citrate excretion. Subjects with renal insufficiency had significantly lower urinary calcium, uric acid, and citrate excretion than those with normal renal function, but not urine volume. With regard to urinary metabolic abnormalities, similar results were obtained. SF with renal insufficiency had lower calcium oxalate supersaturation indexes and stone recurrence rates than SF with normal renal function. Kaplan-Meier curves showed similar results. In conclusion, GFR correlates positively with urinary excretion of stone-forming constituents in SF. This finding implies that renal insufficiency is not a risk factor for stone recurrence.

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          Prediction of creatinine clearance from serum creatinine.

          A formula has been developed to predict creatinine clearance (Ccr) from serum creatinine (Scr) in adult males: (see article)(15% less in females). Derivation included the relationship found between age and 24-hour creatinine excretion/kg in 249 patients aged 18-92. Values for Ccr were predicted by this formula and four other methods and the results compared with the means of two 24-hour Ccr's measured in 236 patients. The above formula gave a correlation coefficient between predicted and mean measured Ccr's of 0.83; on average, the difference predicted and mean measured values was no greater than that between paired clearances. Factors for age and body weight must be included for reasonable prediction.
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            Urolithiasis through the ages: data on more than 200,000 urinary stone analyses.

            The incidence and prevalence of urolithiasis are increasing but clinicians also have the impression that gender and age distributions of stone formers are changing. Moreover, regional differences in stone occurrence and composition have been observed. We analyzed such trends based on a large series of urinary stone analyses. A total of 224,085 urinary stone analyses from 22 German centers were evaluated to determine the incidence of stone composition and identify age and gender distributions from 1977 to 2006. A subset of 58,682 stone analyses from 1993 to 2006 was available to identify regional differences in stone composition in Germany. Calcium containing calculi were most common in each gender. The overall male-to-female ratio of 2.4:1 increased from 1977 (1.86:1) to 2006 (2.7:1). The predominance of male calcium stone formers was even higher among elderly patients with a 3.13:1 ratio at ages 60 to 69. Since 1997, we observed a tendency toward an increasing incidence in middle-aged patients at ages 40 to 49 years. While the rate of infection stones constantly decreased, the incidence of uric acid calculi remained stable with an overall rate of 11.7% in males and 7.0% in females with a peak at higher ages. Cystine stones remained rare at 0.4% in males and 0.7% in females. In terms of regional analyses we noted great variation in stone composition in the 2 genders. Uric acid stones were more common in the eastern and southern regions but infection stones were mostly seen in eastern regions. In what is to our knowledge the largest series of stone analysis reported to date we identified an age and gender relationship of stone formation and composition. Regional variations are common and underline the influence of living habits, diet and standard of medical care on urinary stone formation. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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              Economics and cost of care of stone disease.

              Yair Lotan (2008)
              Nephrolithiasis is associated with a high cost to society because of the high prevalence of disease and high recurrence rates. The total annual medical expenditures for urolithiasis in the United States were estimated at $2.1 billion in 2000. The cost of stone disease reflects the cost of health care services required to manage stone disease and the rate of utilization. Although the care of individuals with urolithiasis has shifted from the inpatient to the outpatient setting and the hospital length of stay has decreased, costs continue to rise because of increases in the prevalence of kidney stones. There are 2 potential areas that would allow for a decrease in stone disease-related costs, lower health care-related costs, and decreased prevalence of stone disease. Reducing treatment-related costs are unlikely to provide a solution to the high cost of caring for stone disease because physician-fee reductions did not result in a significant reduction in costs. Furthermore, there are no significant advancements in surgical technique or technologies in the horizon. One area of cost savings could be to develop better guidelines for acute management, optimizing timing for surgery in acute settings and increasing the practice of medical expulsive therapy. Another area with potential to reduce costs is the reduction of overall stone burden through the prevention of new stones or recurrences. Strategies for primary prevention in high-risk populations have not been studied and represent an area for future research. More efforts should be made to improve medical management of stone formers. These efforts include improving dietary recommendations, identifying barriers to evaluations and treatment of recurrent stone formers, improving patient compliance with recommendations, and development of new medications.
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                Author and article information

                Journal
                J Korean Med Sci
                J. Korean Med. Sci
                JKMS
                Journal of Korean Medical Science
                The Korean Academy of Medical Sciences
                1011-8934
                1598-6357
                August 2014
                30 July 2014
                : 29
                : 8
                : 1132-1137
                Affiliations
                Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea.
                Author notes
                Address for Correspondence: Sang-Cheol Lee, MD. Department of Urology, Chungbuk National University College of Medicine and Institute for Tumor Research, 776 1Sunhwan-ro, Heungdeok-gu, Cheongju 361-763, Korea. Tel: +82.43-269-6371, Fax: +82.43-269-6144, lscuro@ 123456chungbuk.ac.kr
                Author information
                http://orcid.org/0000-0002-8164-4427
                http://orcid.org/0000-0001-6179-7031
                http://orcid.org/0000-0002-7482-4550
                http://orcid.org/0000-0001-7638-7174
                http://orcid.org/0000-0001-7737-4746
                http://orcid.org/0000-0002-4163-2210
                http://orcid.org/0000-0002-8060-8926
                Article
                10.3346/jkms.2014.29.8.1132
                4129207
                05771ea9-b7a0-490f-b1ad-0a14e53a9316
                © 2014 The Korean Academy of Medical Sciences.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 04 January 2014
                : 07 May 2014
                Funding
                Funded by: National Research Foundation of Korea
                Award ID: 2008-0062611
                Award ID: 2013R1A1A2004740
                Funded by: Rural Development Administration
                Award ID: PJ009621
                Categories
                Original Article
                Urology

                Medicine
                urinary calculi,recurrence,renal insufficiency,creatinine
                Medicine
                urinary calculi, recurrence, renal insufficiency, creatinine

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