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Uric Acid Nephrolithiasis

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82. Management of Chronic Kidney Disease

THE PROGRESSION 11 OF CHRONIC KIDNEY DISEASE 4.1 Treatment of Hypertension and Proteinuria for 11 Renoprotection 4.2 Glycaemic Control for Renoprotection 16 4.3 Protein Restriction for Renoprotection 17 4.4 Lipid Lowering for Renoprotection 17 4.5 Uric Acid Reduction for Renoprotection 18 4.6 Miscellaneous Agents for Renoprotection 18 4.7 Special Precautions Management of Chronic Kidney Disease in Adults (Second Edition) TABLE OF CONTENTS No. Title Page 5. INTERVENTIONS IN REDUCING THE RISK OF 20 (...) with cumulative dose of exposure. 14 - 16, level II-2 However, this association was not evident with cumulative dose of H 2-blocker. 16, level II-2 • Certain herbal products including those containing aristolochic acid are associated with CKD. 9 H. Family history Family history of kidney disease in first degree relatives increases the risk of CKD by 40% in a 25-year follow-up. 9 I. Other risk factors Gout 17, level II-2 and asymptomatic hyperuricaemia 18, level II-2 are associated with CKD. Individuals

2018 Ministry of Health, Malaysia

83. BSR guideline on the management of gout

fractional clearance of uric acid in > 90% of patients with gout [ ]. Age, male gender, menopausal status in females, impairment of renal function, hypertension and the co-morbidities that comprise the metabolic syndrome are all risk factors for incident gout associated with decreased excretion of uric acid, as are the use of diuretic and many anti-hypertensive drugs, ciclosporin, low-dose aspirin, alcohol consumption and lead exposure. Tophi and chronic arthritis [ ], alcohol consumption [ ] and recent (...) [ , ] and secondary care [ , ] do not achieve reductions of serum uric acid (sUA) levels to the target level recommended in the BSR/BHPR (300 µmol/l) or EULAR (360 µmol/l) guidelines. Finally, as evidence has accumulated that the provision of information to patients with gout is suboptimal [ ] and qualitative studies have begun to define a range of patient and provider barriers to effective care [ ], preliminary data are emerging that demonstrate that these barriers can be overcome, and outcomes improved

2017 British Society for Rheumatology

84. CRACKCast E123 – Selected Oncologic Emergencies

than bisphosphonates, but tachyphylaxis may develop; consider calcitonin in hypercalcemic patients with active cardiac or neurologic symptoms (eg, dysrhythmias, seizures). TLS is manifested by the combination of hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia, often accompanied by acute renal failure. Patients with TLS should have their potassium, phosphate, calcium, and uric acid levels, as well as renal indices monitored closely. Intravenous fluids should be administered, as well (...) Hyperuricemia treatment i) Allopurinol (prevents conversion xanthine –> uric acid, does not eliminate existing uric acid) ii) Rasburicase (direct elimination) Hypocalcemia treatment i) IV Calcium only if cardiac or neurological complications [13] What is Leukostasis? How does it present? Pathophysiology WBC high enough to cause vascular congestion, particularly in lungs or CNS (no specific WBC threshold), most often occurs in pulmonary or central nervous systems. Associated with leukemias (AML, CLL

2017 CandiEM

85. CRACKCast E097 – Renal Failure

, hemoglobinuria Other Diseases and Conditions Severe liver disease Allergic reactions NSAIDs 6) List the RFs for contrast induced ATN According to LITFL Top 3: Pre-existing renal disease (especially Cr >120) Diabetes mellitus Age >75yrs Others: CHF Hypertension Hypovolemia Nephrotoxins (NSAIDs, cyclosporin, aminoglycosides, amphotericin) High dose contrast, intra-arterial worse than IV Cirrhosis/nephrotic syndrome Multiple myeloma PVD High uric acid and hypercholesterolemia 7) List the causes of postrenal (...) renal failure Box 87.3 Intrarenal and Ureteral Causes Kidney stone Sloughed papilla Malignancy Retroperitoneal fibrosis Uric acid, oxalic acid, or phosphate crystal precipitation Sulfonamide, methotrexate, acyclovir, or indinavir precipitation Bladder Kidney stone Blood clot Prostatic hypertrophy Bladder carcinoma Neurogenic bladder Urethra Phimosis Stricture 8) List the causes of pigment induced AKI Box 87.5 Rhabdomyolysis and myoglobinuria Crush injury Compartment syndrome Electrical injury

2017 CandiEM

86. Hypercalciuria Associated with High Dietary Protein Intake Is Not Due to Acid Load. (Full text)

Hypercalciuria Associated with High Dietary Protein Intake Is Not Due to Acid Load. Dietary intake of animal proteins is associated with an increase in urinary calcium and nephrolithiasis risk. We tested the hypothesis that the acid load imposed by dietary proteins causes this hypercalciuria.In a short-term crossover metabolic study, an alkali salt was provided with a high-protein diet (HPD) to neutralize the acid load imparted by dietary proteins.Eleven healthy volunteers were evaluated (...) and net acid excretion) and increased urinary citrate. Urinary calcium increased during both HPD phases compared with CD but was not significantly different between the HPD + KCl and HPD + KCitrate phases (182 ± 85 vs. 170 ± 85 mg/d; P = 0.28). Increased urinary saturation with respect to calcium oxalate and uric acid with HPD was abrogated by KCitrate.This study suggests that, at least in the short-term, mechanism(s) other than acid load account for hypercalciuria induced by HPD. The beneficial

2011 Journal of Clinical Endocrinology and Metabolism PubMed abstract

87. Zurampic - lesinurad

SD standard deviation SE standard error SI International System of Units SMQ Standardised MedDRA Query SOC (MedDRA) system organ class sUA serum uric acid (also referred to as serum urate) SURI selective uric acid reabsorption inhibitor TEAE treatment-emergent adverse event UK United Kingdom ULT urate-lowering therapy URAT1 uric acid transporter 1 US United States uUA urinary uric acid vs versus XO xanthine oxidase XOI xanthine oxidase inhibitor Assessment report EMA/6459/2016 Page 5/128 1 (...) treatment of hyperuricaemia in combination with allopurinol or febuxostat in gout patients when additional therapy is warranted (i.e. not at target serum uric acid levels or with presence of tophus). Zurampic is indicated in adults. The legal basis for this application refers to: Article 8.3 of Directive 2001/83/EC - complete and independent application. The applicant indicated that lesinurad was considered to be a new active substance. The application submitted is composed of administrative information

2016 European Medicines Agency - EPARs

88. CUA guideline on the evaluation and medical management of the kidney stone patient

. Prevention of recurrent calcium stone formation with potassium citrate therapy in patients with distal renal tubular acidosis. J Urol 1985;134:20-3. 123. Fabris A, Lupo A, Bernich P, et al. Long-term treatment with potassium citrate and renal stones in medullary sponge kidney. Clin J Am Soc Nephrol 2010;5:1663-8. 124. Cameron MA, Sakhaee K. Uric acid nephrolithiasis. Urol Clin North Am 2007;34:335-46. http://dx.doi. org/10.1016/j.ucl.2007.05.001 125. Reichard C (...) ” uric acid nephrolithiasis compared with “pure” calcium oxalate stone-formers. Urol Res 2007;35:247-51. http:// 128. Trinchieri A, Esposito N, Castelnuovo C. Dissolution of radiolucent renal stones by oral alkalinization with potassium citrate/potassium bicarbonate. Arch Ital Urol Androl 2009;81:188-91. 129. Pak CY, Sakhaee K, Fuller C. Successful management of uric acid nephrolithiasis with potassium citrate. Kidney Int 1986;30:422-8.

2016 Canadian Urological Association

89. Citrate, Malate and Alkali Content in Commonly Consumed Diet Sodas: Implications for Nephrolithiasis Treatment. (Abstract)

Citrate, Malate and Alkali Content in Commonly Consumed Diet Sodas: Implications for Nephrolithiasis Treatment. Citrate is a known inhibitor of calcium stone formation. Dietary citrate and alkali intake may have an effect on citraturia. Increasing alkali intake also increases urine pH, which can help prevent uric acid stones. We determined citrate, malate and total alkali concentrations in commonly consumed diet sodas to help direct dietary recommendations in patients with hypocitraturic (...) calcium or uric acid nephrolithiasis.Citrate and malate were measured in a lemonade beverage commonly used to treat hypocitraturic calcium nephrolithiasis and in 15 diet sodas. Anions were measured by ion chromatography. The pH of each beverage was measured to allow calculation of the unprotonated anion concentration using the known pK of citric and malic acid. Total alkali equivalents were calculated for each beverage. Statistical analysis was done using Pearson's correlation coefficient.Several

2010 Journal of Urology

90. Pharmacological and toxicological effects of Paronychia argentea in experimental calcium oxalate nephrolithiasis in rats. (Abstract)

) nephrolithiasis in Wistar rats.The two extracts (APA and BPA) were administrated orally and daily, during 28 days to nephrolithiasic treated rats at the dose of 250, 500 mg/kg b.w. and 10, 20mg/kg b.w. respectively. Body weight, renal index, liver index, serum level of creatinine, uric acid, urea, K(+), Ca(2+), Mg(2+), Na(+) and transaminase (alanine aminotransferase, ALT; aspartate aminotransferase, AST), phosphatase alkaline activity (PAL) were evaluated following the 28 days treatment in rats. In addition (...) Pharmacological and toxicological effects of Paronychia argentea in experimental calcium oxalate nephrolithiasis in rats. Renal protection and antiurolithiasic effects of two extracts of Paronychia argentea (PA), a traditional Algerian plant commonly known as Algerian tea, were evaluated. This study was carried out to determine whether the aqueous extract (APA) or the butanolic extract (BPA) of aerial parts could prevent or reduce calculi aggregation in experimental calcium oxalate (Ox

2010 Journal of Ethnopharmacology

91. Testosterone and Androgen Receptor in Human Nephrolithiasis. (Abstract)

or uric acid. Mean±SD serum total and free testosterone was 13.29±4.79 ng/ml and 63.23±28.58 pg/ml in patients, and 7.30±0.82 ng/ml and 35.59±24.91 pg/ml in healthy men, respectively (each p<0.001). Immunohistochemistry revealed androgen receptor up-regulation in the kidneys of patients with nephrolithiasis.Our data suggest the important role of enhanced androgen signaling in human nephrolithiasis.Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc (...) Testosterone and Androgen Receptor in Human Nephrolithiasis. We investigated the relationship of kidney calculi with plasma free and total testosterone, and androgen receptor up-regulation in the kidneys of men with nephrolithiasis.Male patients with kidney stone and healthy men were included in the study. Blood was collected in a tube containing 2% heparin in the morning. Total and free serum testosterone was measured by enzyme linked immunosorbent assay. All patients underwent percutaneous

2010 Journal of Urology

92. Nephrolithiasis Prevention by Lemon Juice

Nephrolithiasis (LIMONE Study) Actual Study Start Date : January 2009 Estimated Primary Completion Date : December 2018 Estimated Study Completion Date : March 2019 Resource links provided by the National Library of Medicine related topics: related topics: available for: Arms and Interventions Go to Arm Intervention/treatment Experimental: Lemon supplementation YES 60 ml of lemon juice twice daily (an amount expected to provide 6 grams or 92 mEq of citric acid per day) Dietary Supplement: Lemon (...) calcium oxalate or mixed (calcium oxalate and phosphate, calcium oxalate and uric acid) stone formation over the last 5 years at least one kidney stone at baseline documented by renal echography and/or X-ray evaluation. written informed consent Exclusion Criteria: Obstructive uropathy, chronic urosepsis, renal failure (serum creatinine >1.8 mg/dl), renal tubular acidosis, primary hyperparathyroidism, primary hyperoxaluria, pure uric acid and cystine stones, medullary sponge kidney lithotripsy

2010 Clinical Trials

93. Adequacy of a single 24-hour urine collection for metabolic evaluation of recurrent nephrolithiasis. (Full text)

collected 3 days or less apart before pharmacological intervention and analyzed elsewhere for routine stone risk profiles of urine calcium, oxalate, citrate, uric acid, sodium, potassium, magnesium, phosphorus, ammonium, chloride, urea nitrogen and creatinine.No parameters showed a statistically significant difference between 24-hour urine samples 1 and 2 when mean values were compared (pairwise t test each p >0.05, range 0.06 to 0.87). Using Pearson's correlation all parameters showed positive (...) Adequacy of a single 24-hour urine collection for metabolic evaluation of recurrent nephrolithiasis. There is much debate about whether 1 or 2, 24-hour urinalyses are adequate for metabolic evaluation of stone formers. We determined whether repeat 24-hour urine collection provides information similar to that of the initial 24-hour urine collection and whether repeat collection is necessary.We analyzed 2, 24-hour urine collections in 777 patients obtained from 2001 to 2005. Samples were

2010 Journal of Urology PubMed abstract

94. Management of Ureteral Calculi

to SWL and may be better served by ureteroscopic management. 12 Moreover, in the case of cystine and calcium oxalate monohydrate, the frag- ments created by SWL may be large which can result in poor clearance. Uric acid stones, while fragile in the face of SWL, present a challenge with respect to localization for SWL treatment. Either the use of ultrasound or pyelography (IVP or retrograde) is required to target the stone. In addition, follow-up cannot be completed in the conventional fashion (...) with plain radiography, and requires the use of either ultra- sound or, more often, CT scanning to ensure the patient is successfully treated. In many instances the exact stone composition will not be known prior to treatment, or in the case of recurrent stone formers, it may have changed over time. 13 Non-contrast CT scans using dual energy can distinguish some types of stones in vivo. Uric acid stones can be differentiated from calcium stones; however, there is significant overlap in the attenua- tion

2015 Canadian Urological Association

95. Gout

Gout Gout - NICE CKS Share Gout: Summary Gout is a disorder of purine metabolism characterized by a raised uric acid level in the blood (hyperuricaemia) and the deposition of urate crystals in joints and other tissues. The natural history of gout can occur in three distinct phases: A long period of asymptomatic hyperuricaemia. A period during which acute attacks of gouty arthritis are followed by variable intervals (months to years) when there are no symptoms. The final period of chronic (...) . There is an underlying systemic illness. Gout occurs during pregnancy or in a person under 30 years of age. There are persistent symptoms despite treatment. ULT is required but allopurinol and febuxostat are not tolerated, contraindicated or inadequate in lowering serum uric acid levels to target. Complications are present. The person is at risk of adverse effects of drug treatment. Have I got the right topic? Have I got the right topic? From age 16 years onwards. This CKS topic covers the management of asymptomatic

2018 NICE Clinical Knowledge Summaries

96. Surgical Management of Stones: AUA/Endourology Society Guideline

or distal ureteral stones who require intervention (who were not candidates for or who failed MET), clinicians should recommend URS as first-line therapy. For patients who decline URS, clinicians should offer SWL. (Index Patients 2,3,5,6) Strong Recommendation; Evidence Level Grade B 12. URS is recommended for patients with suspected cystine or uric acid ureteral stones who fail MET or desire intervention. Expert Opinion 13. Routine stenting should not be performed in patients undergoing SWL. (Index (...) ' published in 2014. 6 The surgical management of patients with various stones is described below and divided into 13 respective patient profiles. Index Patients 1-10 are non-morbidly obese; non-pregnant adults (≥ 18 years of age) with stones not thought to be composed of uric acid or cystine; normal renal, coagulation and platelet function; normally positioned kidneys; intact lower urinary tracts without ectopic ureters; no evidence of sepsis; and no anatomic or functional obstruction distal to the stone

2016 American Urological Association

97. Prevention of Recurrent Kidney Stones

with residual or recurrent struvite stones in whom surgical options have been exhausted, AUA cites acetohydroxamic acid as a treatment option. AUA recommends potassium citrate for patients with uric acid and cystine stones in order to raise urinary pH to an optimal level. Prevention of Recurrent Kidney Stones ACP (2014) Recommendation 1 : The ACP recommends management with increased fluid intake spread throughout the day to achieve at least 2 L of urine per day to prevent recurrent nephrolithiasis. ( Grade (...) high urinary calcium (limit sodium intake and consume 1,000-1,200 mg/day of dietary calcium); calcium oxalate stones and relatively high urinary oxalate (limit intake of oxalate-rich foods and maintain normal calcium consumption); calcium stones and relatively low urinary citrate (increase intake of fruits and vegetables and limit non-dairy animal protein); uric acid stones or calcium stones and relatively high urinary acid (limit intake of non-dairy animal protein); cystine stones (limit sodium

2015 National Guideline Clearinghouse (partial archive)

98. Urolithiasis

related to calcium stones 44 4.6.1 Hyperparathyroidism 44 4.6.2 Granulomatous diseases 45 4.6.3 Primary hyperoxaluria 45 4.6.4 Enteric hyperoxaluria 45 4.6.5 Renal tubular acidosis 45 4.6.6 Nephrocalcinosis 47 Diagnosis 47 4.7 Uric acid and ammonium urate stones 47 4.7.1 Diagnosis 47 4.7.2 Interpretation of results 47 4.7.3 Specific treatment 48 4.8 Struvite and infection stones 48 4.8.1 Diagnosis 48 4.8.2 Specific treatment 49 4.8.3 Recommendations for therapeutic measures of infection stones (...) can be classified into those caused by: infection, or non-infectious causes (infection and non-infection stones); genetic defects [8]; or adverse drug effects (drug stones) (Table 3.1.2). Table 3.1.2: Stones classified by aetiology* Non-infection stones • Calcium oxalate • Calcium phosphate, • Uric acid Infection stones • Magnesium ammonium phosphate • Carbonate apatite • Ammonium urate Genetic causes • Cystine • Xanthine • 2,8-dihydr oxyadenine Drug stones *See Section 4.4.2UROLITHIASIS - LIMITED

2015 European Association of Urology

99. Olodaterol inhalation solution (Striverdi Respimat)

) Chronic obstructive pulmonary disease 20 (1.8) 18 (1.6) 38 (1.7) Acute respiratory failure 0 (0.0) 5 (0.4) 5 (0.2) Pulmonary hypertension 1 (0.1) 1 (0.1) 2 (0.1) Respiratory failure 1 (0.1) 1 (0.1) 2 (0.1) Gastrointestinal disorders 5 (0.4) 7 (0.6) 12 (0.5) Gastritis 1 (0.1) 1 (0.1) 2 (0.1) Intestinal obstruction 1 (0.1) 1 (0.1) 2 (0.1) Esophagitis 1 (0.1) 1 (0.1) 2 (0.1) Renal and urinary disorders 3 (0.3) 3 (0.3) 6 (0.3) Nephrolithiasis 2 (0.2) 0 (0.0) 2 (0.1) Renal failure acute 1 (0.1) 2 (0.2) 3

2014 FDA - Drug Approval Package

100. Treatment Strategies for Patients with Renal Colic

Treatment Strategies for Patients with Renal Colic TITLE: Treatment Strategies for Patients with Renal Colic: A Review of the Comparative Clinical and Cost-Effectiveness DATE: 17 November 2014 CONTEXT AND POLICY ISSUES Urinary track calculi or urinary stones, formed from crystalized chemicals in the urine such as calcium oxalate, uric acid and cystine, occur in one of ten Canadians in their lifetime. 1 The obstruction of the urinary tract by calculi at the narrowest anatomical areas leads (...) [Internet]. 2013 Mar [cited 2014 Oct 24];14(4):435-47. Available from: 6. Eisner BH, Goldfarb DS, Pareek G. Pharmacologic treatment of kidney stone disease. Urol Clin North Am. 2013 Feb;40(1):21-30. 7. Saigal CS, Joyce G, Timilsina AR, Urologic Diseases in America Project. Direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management? Kidney Int. 2005 Oct;68(4):1808-14. 8. Pearle MS, Calhoun EA, Curhan GC

2014 Canadian Agency for Drugs and Technologies in Health - Rapid Review

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