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      Characteristics of gout patients according to the laterality of nephrolithiasis: A cross‐sectional study using helical computed tomography

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          Abstract

          Objective

          To clarify the clinical and laboratory characteristics of nephrolithiasis in gout by computed tomography (CT).

          Methods

          In 350 gout patients, unenhanced CT was performed at the 1st visit to hospital. Calculus density spots exceeding 1 mm in diameter with a CT value >120 Hounsfield units in the kidneys were defined as kidney stones. The association between laterality and the number of stones was investigated in each stone carrier. The 350 patients were classified into three groups (bilateral, unilateral and non‐stone carriers). Then serum urate (Sua), renal function, uric acid metabolism, and the prevalence of metabolic syndrome (Mets) were compared among these groups by the Tukey‐Kramer test or Fisher's exact test.

          Results

          Kidney stone(s) were detected in 108 (31%) of the 350 patients (bilateral in 58 and unilateral in 50). In 64 of the 108 patients (59%), there was no history of urolithiasis. Sua, serum creatinine and uric acid clearance were significantly higher ( P = 0.001, P < 0.001, P = 0.043, respectively), while the estimated glomerular filtration rate was significantly lower ( P = 0.039) in bilateral stone carriers than in non‐stone carriers. No significant differences of uric acid metabolism or the prevalence of Mets were noted among the three groups.

          Conclusions

          Approximately one‐third of gout patients had kidney stones and more than half of the patients with stones were bilateral and multiple stone carriers. Elevation of Sua might increase the stone burden in gout, leading to more severe renal dysfunction. An association between nephrolithiasis and Mets was not demonstrated in gout patients.

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          Most cited references 15

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          Preliminary criteria for the classification of the acute arthritis of primary gout.

          The American Rheumatism Association sub-committe on classification criteria for gout analyzed data from more than 700 patients with gout, pseudogout, rheumatoid arthritis, or septic arthritis. Criteria for classifying a patient as having gout were a) the presence of characteristic urate crystals in the joint fluid, and/or b) a topus proved to contain urate crystals by chemical or polarized light microscopic means, and/or c) the presence of six of the twelve clinical, laboratory, and X-ray phenomena listed in Table 5.
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            The metabolic syndrome and uric acid nephrolithiasis: novel features of renal manifestation of insulin resistance.

            Uric acid nephrolithiasis primarily results from low urinary pH, which increases the concentration of the insoluble undissociated uric acid, causing formation of both uric acid and mixed uric acid/calcium oxalate stones. These patients have recently been described as exhibiting features of insulin resistance. This study was designed to evaluate if insulin resistance is associated with excessively low urinary pH in overtly healthy volunteers (non-stone formers) and if insulin resistance may explain the excessively low urinary pH in patients with uric acid nephrolithiasis. Fifty-five healthy volunteers (non stone-formers) with a large range of body mass index and 13 patients with recurrent uric acid nephrolithiasis underwent hyperinsulinemic euglycemic clamp, 24-hour urinary studies, and anthropometric measurements of adiposity. A subgroup of 35 non-stone formers had 2-hour timed urinary collection before and during the hyperinsulinemic phase of the clamp studies. For the non-stone former population, low insulin sensitivity measured as glucose disposal rate significantly correlated with low 24-hour urinary pH (r= 0. 35; P= 0.01). In addition to the previously described acidic urine pH and hypouricosuria, patients with recurrent uric acid nephrolithiasis were found to be severely insulin resistant (glucose disposal rate: uric acid stone-formers vs. normals; 4.1 +/- 1.3 vs. 6.9 +/- 2.1 mg/min/kg of lean body mass, P= 0.008). Acute hyperinsulinemia was associated with higher urinary pH (6.1 +/- 0.7 at baseline to 6.8 +/- 0.7 during hyperinsulinemia; P < 0.0001), urinary ammonia excretion (2.7 +/- 1.6 mEq/2 hr at baseline and 4.0 +/- 2.6 mEq/2 hr P= 0.002) and urinary citrate excretion (48 +/- 33 mg/2 hr at baseline and 113 +/- 68 mg/2 hr P < 0.0001). We conclude that one renal manifestation of insulin resistance may be low urinary ammonium and pH. This defect can result in increased risk of uric acid precipitation despite normouricosuria.
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              Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography.

              To compare non-contrast-enhanced computed tomography (CT) and intravenous urography (IVU) in the evaluation of patients who present with acute flank pain and in whom ureteric obstruction is suspected. The findings at non-contrast-enhanced CT and IVU in 20 patients with acute flank pain were compared for the presence or absence of ureteric obstruction and delineation of ureteric stones. Twelve of the 20 patients had non-contrast-enhanced CT and IVU findings consistent with ureteric obstruction. Of these 12 patients, five had a ureteric stone that was demonstrated on both non-contrast-enhanced CT scans and IVU radiographs, six had a stone that was depicted on non-contrast-enhanced CT scans only, and in one patient a stone could not be delineated definitively on either non-contrast-enhanced CT scans or IVU radiographs. Eight patients had findings at non-contrast-enhanced CT and IVU consistent with the absence of obstruction. Non-contrast-enhanced CT is more effective than IVU in precisely identifying ureteric stones and is equally effective as IVU in the determination of the presence or absence of ureteric obstruction.
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                Author and article information

                Contributors
                shimizut@gold.ocn.ne.jp
                Journal
                Int J Rheum Dis
                Int J Rheum Dis
                10.1111/(ISSN)1756-185X
                APL
                International Journal of Rheumatic Diseases
                John Wiley and Sons Inc. (Hoboken )
                1756-1841
                1756-185X
                28 November 2018
                April 2019
                : 22
                : 4 ( doiID: 10.1111/apl.2019.22.issue-4 )
                : 567-573
                Affiliations
                [ 1 ] Department of Rheumatology Midorigaoka Hospital Takatsuki‐shi Japan
                [ 2 ] Department of Radiology Midorigaoka Hospital Takatsuki‐shi Japan
                [ 3 ] Safety Research Institute for Chemical Compounds Co., Ltd Tokyo Japan
                [ 4 ] Department of Internal Medicine Midorigaoka Hospital Takatsuki‐shi Japan
                Author notes
                [* ] Correspondence

                Toru Shimizu, Department of Rheumatology, Midorigaoka Hospital, Takatsuki‐shi, Japan.

                Email: shimizut@ 123456gold.ocn.ne.jp

                Article
                APL13443
                10.1111/1756-185X.13443
                6587737
                30485677
                © 2018 The Authors. International Journal of Rheumatic Diseases published by Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                Page count
                Figures: 3, Tables: 3, Pages: 7, Words: 4428
                Product
                Funding
                Funded by: Gout Research Foundation of Japan
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                apl13443
                April 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.4 mode:remove_FC converted:21.06.2019

                Rheumatology

                computed tomography, gout, nephrolithiasis, prevalence, renal failure, urolithiasis

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