Yoshinari Katoh

Randomized trial of trigger point injection for renal colic

Abstract Background: Many drugs have been utilized for the treatment of renal colic, but to date no drugs that relieve pain quickly and completely have been developed. Thus, we conducted a prospective trial to evaluate the effects of trigger point injection on renal colic. In this study, we used a local injection of lidocaine to the trigger point of patients experiencing renal colic, and evaluated the efficacy in patients using the visual analog scale.

Prevalence of Urolithiasis in Kaizuka City, Japan—An Epidemiologic Study of Urinary Stones

Background: According to the results of nationwide surveys, the prevalence of urolithiasis has been steadily increasing in Japan. However, these surveys relied on hospital statistics, and there has been no survey of the prevalence of urolithiasis in Japan utilizing postal questionnaires. We surveyed the prevalence of urolithiasis among the inhabitants of Kaizuka City.

Dietary Intake and Habits Of Japanese Renal Stone Patients

The daily consumption of various nutrients as well as the daily habits of 241 male stone patients were investigated. Hypercalciuric (300 mg. or more per day) calcium stone patients ingested much more total protein, fats, oils and calcium than normocalciuric calcium stone patients, and uric acid stone patients ingested much more total and animal protein, and carbohydrates than calcium stone patients. However, the amount of ingested calcium by the patients (470 mg.) was similar to that of age-matched healthy male subjects (476 mg.) and did not reach the level of the daily nutritive requirements (600 mg.). The patients ingested large amounts of nutrients, especially animal protein, during the evening meal. From these results it was believed that synthetic dietary management, including not only ingesting various amounts of nutrients but also changing dietary habits, is necessary for the prophylaxis of renal stones.

Clinical Effects of Prophylactic Dietary Treatment on Renal Stones

From the investigation of the dietary intake and habits of male Japanese renal stone patients we established several general guidelines. Fluid intake should be increased, especially after dinner. Unbalanced diets should be corrected and avoided (the diet should include different types of food, with vegetables being eaten at every meal and an excessive intake of meat should also be avoided). Three meals a day should be eaten and an excessive intake at dinner should be avoided. The interval from dinner until retiring should be extended. By following these individual dietary guidelines the stone recurrence rate in 199 male calcium stone patients who had received individual dietary instruction decreased remarkably compared to that in male calcium stone patients who had not received individual dietary instruction, not only during the period of outpatient visits but also after outpatient visits were discontinued. From these results we conclude that individual dietary management should be the primary measure for the prophylaxis of renal stone disease in Japan.

Immunofluorescent study on the interaction between collagen and calcium oxalate crystals in the renal tubules

The interaction of calcium oxalate crystals and renal tubular cells was studied. Rat renal collecting tubular cells were cultured and immunologically stained with anti-type-IV collagen antiserum (type-IV collagen exists in renal tubular basement membrane). When renal tubular cells and calcium oxalate crystals were mixed, clumps were formed. These clumps were examined by immunological staining with anti-type-IV collagen antiserum. In another series of experiments, calcium-containing crystals were found to be adsorbed onto mucous threads and cast-like materials, although no such adsorption was observed on squamous cells. These absorbed materials interacted with anti-type-IV collagen antiserum. These results suggest that collagen in the renal tubular basement membrane may act as matrix in urinary stone formation.

Epidemiology of urolithiasis in the elderly

To estimate the epidemiology of upper urinary stones in the elderly, a total of 1,957 patients (1,349 men and 608 women) with urolithiasis were studied. The ratio of men to women was approximately 3∶1 in middle-aged (between 30 and 59 years), 1∶1 in young (29 or younger) and 1∶1 in old patients (60 or older). Compared with the age distribution of the entire Japanese population, the incidence of urinary stones was very low in both male and female children, twice as high in middle-aged men, slightly higher in middle-aged women, and equal or slightly lower in the male and female elderly. Stones of calcium oxalate and uric acid occurred more frequently and those of calcium phosphate and struvite less frequently in men than in women. This tendency was especially obvious in the middle-aged. In the old generation, calcium oxalate stones occurred almost equally in men and women. Results of urinary stone analysis were similar among men of the three generations, although the incidence of uric acid stones increased with patient age. In women, however, the incidence of calcium oxalate was higher in the young and old generations, while that of calcium phosphate was higher in the middle-aged.

Magnesium-To-Calcium Ratio in Tap Water, and its Relationship to Geological Features and the Incidence of Calcium-Containing Urinary Stones

We examined the relationship among magnesium and calcium content in tap water, the geological features and urinary stone incidence in Japan. The magnesium-to-calcium ratio in tap water correlated negatively with the incidence of urolithiasis. There was no correlation between calcium and magnesium concentration in tap water and urinary stone incidence. Geological features in Japan were classified into 5 groups. The magnesium-to-calcium ratio in the basalt areas was higher than in the other areas, while ratio in the granite areas was low. In the sedimentary rock areas calcium and magnesium concentrations were high; the magnesium-to-calcium ratio in these areas was between those of the basalt and granite areas. The limestone areas had a much higher calcium concentration. The incidence of urinary stones in the sedimentary rock and basalt areas was lower than that of the granite areas, while that in the limestone areas was the highest. Thus, the incidence of urinary stone is related to the magnesium-to-calcium ratio in tap water and the geological area.

Relationship between metabolic acidosis and calcium phosphate urinary stone formation in women.

The relationship between the degree of metabolic acidosis and calcium phosphate stone formation was studied. Furthermore, the reasons why renal tubular acidosis (RTA) and primary hyperparathyroidism (PHPT) dominantly occur in women, and female stone formers more often produce calcium phosphate stone are discussed. Blood was slightly more acidotic in women than in men in both the urolithiasis and the control groups. Likewise, blood was significantly more acidotic and urinary pH significantly higher in patients with PHPT. Patients with RTA had severe metabolic acidosis, and urinary pH was highest among all groups. Calcium phosphate concentration was significantly higher in women than in men, and was also higher in patients with PHPT than in those with urolithiasis. All patients with RTA had pure calcium phosphate stones.The reasons why females are more acidotic and have more calcium phosphate in stones are suspected to be related to progesterone and urinary tract infection.

Calcium oxalate crystal formation in patients with hyperparathyroidism and hyperthyroidism and related metabolic disturbances.

The crystallization of calcium oxalate in the urine of patients with hyperparathyroidism and hyperthyroidism was studied using a mixed suspension mixed product removal (MSMPR) system. In addition, calcium metabolism in hyperthyroidism and its relationship to urolithiasis was investigated. The urines from all the three groups (normal subjects, hyperparathyroid and hyperthyroid patients) showed reduced nucleation rates and increased growth rates in comparison with the control synthetic urine. The nucleation rate was not significantly different between the three human urine groups, while the growth rate was significantly higher in the hyperparathyroid group compared to the normal and hyperthyroid groups. Crystal volume (suspension density) in the hyperparathyroid group was approximately twice that in the other two groups. Serum and ionized calcium levels in hyperparathyroid patients were higher than in normal subjects, while hyperthyroid patients had levels only slightly higher than those in normal subjects. The hyperparathyroid and hyperthyroid groups differed significantly from the normal group in urinary calcium excretion. These two groups also showed significantly higher levels of serum alkaline phosphatase and urinary hydroxyproline than did the normal group. Although hyperthyroid patients have a calcium metabolism similar to hyperparathyroid patients, the incidence of urolithiasis is no different between hyperthyroid and normal subjects. The results of both crystallization and calcium metabolism in hyperparathyroid patients were not significantly different between those with and without urolithiasis. The result of crystallization was also not significantly different between hyperparathyroid patients with and without hypercalciuria. This study suggests that hypercalciuria alone does not produce urinary stones and that urine from hyperparathyroid patients may contain promotors of calcium oxalate crystallization and calcium stone formation.

Inhibitory effect of glutamic acid and aspartic acid on calcium oxalate crystal formation.

The effects of Glu and Asp on calcium stone formation was evaluated in three experiments. Studies using mixed suspension, mixed product removal crystallization and scanning electron microscopy showed that Glu and Asp inhibited the nucleation rate, growth rate and suspension density (crystal mass produced) in proportion to the concentration. The main amino acids in calcium oxalate stones and calcium phosphate stones were Glu and Asp. However, the main amino acids in uric acid stones were glycine and urea, and there were no specific amino acids in struvite stones. The activity of urinary GOT and GPT, which convert Asp and alanine, respectively, to Glu in normal subjects was significantly greater than in calcium stone formation.