Sakip Erturhan

Renal tubular injury induced by hyperoxaluria: evaluation of apoptotic changes.

Abstract In order to evaluate the injurious effect of hyperoxaluria on renal tubular epithelium, as judged by apoptotic changes in the renal parenchyma, we performed an experimental study in 20 rabbits. In the experimental group animals (n=10) severe hyperoxaluria was induced by continuous ethylene glycol (EG; 0.75%). Histologic alterations, including crystal formation, together with apoptotic changes were evaluated after 7 and 28 days. Control group animals (n=10) received normal distilled drinking water. Following 7- and 28-day periods, tissue sections obtained from kidneys were examined histopathologically under light microscopy for the presence and the degree of crystal deposition in the tubular lumen. Apoptotic changes in renal tubular cells were examined using the terminal deoxynucleotidyl transferase (TdT)-mediated dUTP in situ nick and labeling (TUNEL) method during the same follow-up period. Crystal deposition was evident in the tubular lumen of tissue sections obtained during the 7-day examination period. During the 28-day examination period, however, these findings were found to be either limited or to have disappeared. In relation to apoptotic changes, the percentage of positive nuclei stained using the TUNEL method was from 11 to 20% in the experimental group and 5.6% in the control group. Our findings indicate that both calcium oxalate (CaOx) crystals and hyperoxaluria itself may be injurious to renal tubular cells, as indicated by apoptotic changes. These changes may be responsible for the pathologic course of urolithiasis.

Effect of Being Overweight on Stone-Forming Risk Factors

OBJECTIVES To evaluate the possible role of being overweight on stone-forming risk factors. METHODS A total of 264 patients were included in the study. After a detailed stone disease history, the systolic and diastolic blood pressure was precisely measured and recorded for all patients, and the body mass index, 24-hour urine composition, and serum stone-forming risk parameters were evaluated in overweight (n = 164; 52 men and 112 women; group 1) and normal (n = 100; 44 men and 56 women, group 2) patients. Of the 264 patients, 110 were men and 154 were women (male/female ratio 1:1.4); none had undergone any medical or dietetic treatment before study entry. RESULTS The evaluation of the stone-forming risk factors in both groups revealed that obesity increased the excretion of these substances in group 1. Of the 164 patients in group 1, most (58; 35.3%) demonstrated hyperoxaluria compared with group 2 (P <0.001). Also, the mean urinary oxalate level was 44.91 +/- 24.89 mg/24 hours in group 1 and was 26.67 +/- 24.59 mg/24 hours in group 2 (P <0.001). Similarly, patients in group 1 had elevated mean urinary calcium excretion and lower citrate excretion compared with those in group 2 (P = 0.045 and P = 0.032, respectively). CONCLUSIONS Our results have clearly shown that being overweight might be associated with an elevated risk of stone formation in both sexes owing to alterations in urine composition. People who are overweight could be more prone to stone formation and should be carefully evaluated and followed up regarding this aspect.

Treatment of Ureteral Calculi with Semirigid Ureteroscopy: Where Should We Stop?

Objectives: To evaluate the efficacy of semirigid ureteroscopy in the management of ureteral stones located in different parts of the ureter. Methods: 1,503 patients were treated with semirigid ureteroscopy. All ureteral stones were either removed only by a basket catheter or disintegrated by pneumatic lithotripsy. Success rates, auxiliary procedures, complication rates and operation time were comparatively evaluated according to stone location. Results: Overall, mean stone size and age were 12.1 ± 3.7 mm and 43.2 ± 9.72 years, respectively. While 1,416 patients (94.2%) were completely stone-free, the procedure was unsuccessful in 87 cases (5.8%). The success rate was relatively low in the proximal ureter (71.7%) when compared with the mid (94.8%) and distal ureter (98.9%) (p = 0.021). Mean operation time was 25.4 ± 11.7 min. Longer duration of operation and higher complication rate were found in proximal ureteral calculi. Stone migration to the kidney and hematuria were the main reasons of failure in the proximal ureter and ureteral stenting was needed for 56.4% of patients with upper ureteral stone. Conclusions: Semirigid ureteroscopy can be the treatment of choice in lower and midureteral stones. However, it is an invasive and less successful treatment modality for proximal ureteral stones with relatively high complication rates.

Evaluation of urinary oxalate levels in patients receiving gastrointestinal lipase inhibitor.

Objective: The purpose of this study was to examine the possible effects of a gastrointestinal lipase inhibitor “Orlistat (Xenical)” on the intestinal absorption of oxalate and thereby on the urinary levels of oxalate excretion in overweight patients.

Association Between the T-593A and C6982T Polymorphisms of the Osteopontin Gene and Risk of Developing Nephrolithiasis

BACKGROUND AND AIMS Increased synthesis of several urinary proteins including osteopontin (OPN) has been shown to be associated with stone formation within the urinary tract. The objective of this study was to analyze the genotype distributions and allele frequencies for OPN gene promoter T-593A and C6982T (in exon 7) polymorphisms among patients with kidney stones. METHODS In this case-control study, the study group consisted of 121 patients with radiologically confirmed nephrolithiasis. Genomic DNA from patients and control cases (n = 100) was analyzed by single-strand conformation polymorphism method and nucleotide sequence analysis. RESULTS Homozygous carriers of the T-593T genotype were more frequent, but carriers of the A-593A genotype were less frequent in patients than in controls. There was also an increase in -593T allele (88% in patients vs. 79% in controls) and decrease in -593A allele frequencies (21% in control vs. 12% in patients) in the nephrolithiasis groups (p = 0.013). The carriers of C6982C genotype were less frequent, but marked increases in T6982T genotype (25.6% in patients vs. 7% in controls, p = 0.001) and 6982T allele frequency (53.3% in patients vs. 37.5% in controls, p = 0.001) were noted in patients of Turkish ancestry. CONCLUSIONS These results are the first to demonstrate the existence of T-593A promoter polymorphism of the OPN gene and significant association with risk of developing nephrolithiasis. Our results showed marked associations between polymorphisms (C6982T and T-593A) of the OPN gene and the stone-forming phenotypes in the Turkish population.

Primary synovial sarcoma of the kidney: use of PET/CT in diagnosis and follow-up

Primary renal synovial sarcoma is a rarely seen renal neoplasm. An experienced uropathologist is needed to make the pathological diagnosis. A patient, operated on with a prediagnosis of renal cell carcinoma, the pathology of which was reported as synovial sarcoma, is presented in this article. 18F-fluoro-deoxyglucose positron emission tomography and computed tomography were performed preoperatively and in the postoperative follow-up to detect the primary tumor and lymph node metastases.

Treatment alternatives for urinary system stone disease in preschool aged children: results of 616 cases.

INTRODUCTION The treatment of stone disease is mostly similar in those adult and children. The standard treatment procedures are as follows: extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS), percutaneous nephrolithotomy (PCNL), and laparoscopic surgery in selected cases. Open surgery (OS) is another option particularly in such cases with anatomic abnormalities of urinary tract. OBJECTIVE The present study aims to provide comparative results of stone removal procedures in preschool aged patients who were diagnosed with urinary system stone disease. STUDY DESIGN The retrospective data of 616 pediatric preschool patients consulted with urinary system stone disease between January 2009 and July 2013 were evaluated. All patients were evaluated with Kidney-Ureter-Bladder (KUB) Xray and abdomino-pelvic ultrasound. Intravenous pyelography, unenhanced computed tomography (CT), and renal scintigraphy were performed when needed. Patients were categorized according to the procedures as: Group ESWL, Group URS, Group PNL, Group micro-PNL and Group OS. Following the procedures, opaque residual stones were evaluated with KUB Xray, and non-opaque residual stones were evaluated with unenhanced CT. RESULTS In groups (ESWL, URS, PNL, micro-PNL, OS), the stone-free rate was 68%, 66%, 85%, 100% and 94 %, respectively. The stone analysis were observed as, calcium oxalate in 377 patients (61.2%), uric acid in 106 patients (17.2%), infection stone in 73 patients (11.8 %), and cysteine in 60 patients (9.7%). There was no significant difference in stone analysis between the groups (p > 0.05) (Table). DISCUSSION Minimally invasive procedures are frequently preferred in the pediatric age urinary system stone disease. These procedures are ESWL, PCNL, and ureteroscopy [10,11]. Open surgery is reserved only for rare cases [12]. Similarly the current literature, 18 (2.9%) patients had anatomical anomaly and had high complex stone burden were treated with open surgery in our study. ESWL is a preferred treatment method for pediatric urolithiasis patients with a stone size <20 mm, and the rate of stone-free after ESWL ranges between 57 and 92% [13]. In a study showed the effect of stone size on the success rate in ESWL, the success rate was 91% for stones <10 mm, and 75% for stones >10 mm [15]. In the present study, stone-free rate was noted as 68% on 15 mm or lower stone size. PNL is commonly used to treat stone disease in preschool children [18-20]. In the beginning, urologists hesitated to use instruments suited for adults in case of pediatric kidneys. While some authors accept a cut-off value of 24 F for tract dilatation in the pediatric age, Desai et al. recommended a threshold value <22 F [19,21]. In our study, we used adult PNL instruments in the early period, whereas mini-PERC was performed in the later years. The success rate in PNL group was found as 85%. In recent years, the micro-PNL procedure has been developed to reduce/prevent the complications of standard PNL. In our study, the success rate was calculated as 100% with micro-PNL. This study has certain limitations. The major limitation of our study is its retrospective nature. In addition, sample size of micro-PNL group is fewer than other groups. CONCLUSION The goal of kidney stone treatment is to achieve minimal kidney damage and a high success rate. Thus, the procedures are important in the pediatric age group where life expectancy is high, and particularly in the preschool age group.

A Prospective, Randomized Controlled Study Comparing Lidocaine and Tramadol in Periprostatic Nerve Blockage for Transrectal Ultrasound-guided Prostate Biopsy

OBJECTIVES To assess the efficacy of tramadol and lidocaine in reducing pain using the periprostatic nerve block technique with a spinal needle, guided by transrectal ultrasound (TRUS) before the biopsy application. METHODS Of the 112 eligible candidates who were asked to participate in the study, 90 agreed and provided informed consent. These 90 men were randomized into 3 groups. Group 1 (n = 30) received lidocaine, group 2 (n = 29) received tramadol, and group 3 (n = 31) received saline solution. Within 10 minutes of biopsy procedure completion, the patients were presented with visual pain scales and asked to rate the pain. The patients also asked whether they would be to return for this procedure if it became medically necessary. RESULTS The postprocedural mean pain scores of lidocaine, tramadol, and placebo groups were found to be 1.73, 2.89, and 4.32, respectively. The mean pain scores were significantly lower in both the lidocaine and the tramadol groups compared with the placebo group (P <.001). In addition, statistically significant differences were found among the 3 groups regarding how willing they would be to return for the procedure if necessary. CONCLUSIONS In this study, we showed that the local anesthetic effect of tramadol in decreasing pain in periprostatic nerve block during TRUS-guided biopsy. The use of tramadol for pain relief in transrectal ultrasound-guided prostate biopsy is a practical, effective, and comfortable method compared with the results of the control group.

Verapamil prevents the apoptotic and hemodynamic changes in response to unilateral ureteral obstruction.

Introduction:  Obstruction of the urinary tract has marked effects on renal blood flow, glomerular filtration rate (GFR), and tubular function. Moreover, ureteral obstruction results in an injury response that can progress to irreversible renal fibrosis and tubular atrophy by apoptosis.

Can the Hounsfield unit predict the success of medically expulsive therapy

BACKGROUND We investigate the predictability of medical expulsive therapy (MET) success with alpha blockers based on Hounsfield unit (HU) values and Hounsfield density (HD) values measured by computed tomography (CT) for distal ureteral stones. METHODS Between July 2011 and May 2012, 44 patients (19 female and 25 male) with 5- to 10-mm stones in the distal ureters were included in this randomized prospective study. Non-contrast CT examinations were performed in these patients. HU and HD values of stones were calculated. Doxazosine, 4 mg/day orally, was administered as a single dose to all patients for MET. RESULTS Patients were divided into 2 groups. Group 1 included 18 patients (43.9%) with dropped stones with MET. Group 2 included 23 patients (56.1%) with no stone passage with MET. In Group 1, the mean stone size was 7.7 mm, the mean HU was 507, and the HD was 53.04/mm. In Group 2, the mean stone size was 8.25 mm, the mean HU was 625, and the mean HD was 61.54/mm. The HU and HD values in Group 2 were higher than in Group 1. However, there was no statistically significant difference (p = 0.85 and 0.93 for HU and HD, respectively). INTERPRETATION We found that HU and HD values cannot be used to predict the chances of success for MET. Although the sample size is appropriate for the study, further comparative studies involving more patients are warranted.