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Uric Acid Nephrolithiasis

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81. Bladder Stones

management of bladder stones specifically; therefore, we refer the reader to the general guidance on the medical management of urinary tract stones in Chapter 3.4.9 of the EAU Urolithiasis Guidelines [ ]. Stones composed of uric acid or struvite can be dissolved by chemolysis. Uric acid stones can be dissolved by oral urinary alkalinisation when a pH > 6.5 is consistently achieved, typically using an alkaline citrate or sodium bicarbonate. Careful monitoring is required during therapy [ ]. Irrigation (...) chemolysis is possible for struvite or uric acid stones; a two-way or three-way Foley catheter can be used [ ]. See also Chapter 3.4.4. of EAU Urolithiasis Guidelines [ ]. 3.3.3. Bladder stone interventions Minimally invasive techniques for the removal of bladder stones have been widely adopted to reduce the risk of complications and shorten hospital stay and convalescence. Bladder stones can be treated with open, laparoscopic, robotic assisted laparoscopic, endoscopic (transurethral or percutaneous

2019 European Association of Urology

82. Urolithiasis

tomography of the kidneys, ureters and bladder for urolithiasis. J Med Imaging Radiat Oncol, 2017. 61: 582. 52. Poletti, P.A., et al. Low-dose versus standard-dose CT protocol in patients with clinically suspected renal colic. AJR Am J Roentgenol, 2007. 188: 927. 53. Zheng, X., et al. Dual-energy computed tomography for characterizing urinary calcified calculi and uric acid calculi: A meta-analysis. Eur J Radiol, 2016. 85: 1843. 54. Niemann, T., et al. Diagnostic performance of low-dose CT (...) of percutaneous chemolysis in the management of urolithiasis: review and results. Urolithiasis, 2013. 41: 323. 127. Bernardo, N.O., et al. Chemolysis of urinary calculi. Urol Clin North Am, 2000. 27: 355. 128. Tiselius, H.G., et al. Minimally invasive treatment of infection staghorn stones with shock wave lithotripsy and chemolysis. Scand J Urol Nephrol, 1999. 33: 286. 129. Rodman, J.S., et al. Dissolution of uric acid calculi. J Urol, 1984. 131: 1039. 130. Becker, G. Uric acid stones. Nephrology, 2007. 12

2019 European Association of Urology

85. 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

87. Urolithiasis

tomography of the kidneys, ureters and bladder for urolithiasis. J Med Imaging Radiat Oncol, 2017. 61: 582. 52. Poletti, P.A., et al. Low-dose versus standard-dose CT protocol in patients with clinically suspected renal colic. AJR Am J Roentgenol, 2007. 188: 927. 53. Zheng, X., et al. Dual-energy computed tomography for characterizing urinary calcified calculi and uric acid calculi: A meta-analysis. Eur J Radiol, 2016. 85: 1843. 54. Niemann, T., et al. Diagnostic performance of low-dose CT (...) of percutaneous chemolysis in the management of urolithiasis: review and results. Urolithiasis, 2013. 41: 323. 127. Bernardo, N.O., et al. Chemolysis of urinary calculi. Urol Clin North Am, 2000. 27: 355. 128. Tiselius, H.G., et al. Minimally invasive treatment of infection staghorn stones with shock wave lithotripsy and chemolysis. Scand J Urol Nephrol, 1999. 33: 286. 129. Rodman, J.S., et al. Dissolution of uric acid calculi. J Urol, 1984. 131: 1039. 130. Becker, G. Uric acid stones. Nephrology, 2007. 12

2018 European Association of Urology

88. Study of the Biological and Physical Manifestations of Spontaneous Uric Acid Kidney Stone Disease

Study of the Biological and Physical Manifestations of Spontaneous Uric Acid Kidney Stone Disease Pathophysiology of Uric Acid Nephrolithiasis - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Pathophysiology (...) of Uric Acid Nephrolithiasis (IUAN) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT00904046 Recruitment Status : Recruiting First Posted : May 19, 2009 Last Update Posted : May 22, 2018 See Sponsor: University of Texas

2009 Clinical Trials

89. 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

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2017 British Society for Rheumatology

90. 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

91. 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

92. 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

93. 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: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772648 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

94. Chronic Kidney Disease for the Medical Resident: A Cheat Sheet for Primary Care Providers

electrolytes for eGFR and electrolyte abnormalities (e.g. metabolic acidosis) ● Complete Blood Cell Count (Anemia) ● Lipid profile ● Uric Acid ● Serum albumin ● Renal ultrasound ○ to look for hydronephrosis, obstruction, cysts, stones, and assess kidney size and characterization ● Urinalysis ○ Quantify proteinuria with urine protein-to-creatinine ratio (Urine albumin-to-creatinine will miss multiple myeloma Bence-Jones proteins) ○ Look for hematuria or other signs of glomerulonephritis ● Consider biopsy (...) to the glomerular filtering capabilities. Other risk factors include a family history of CKD, autoimmune disease (e.g. SLE, vasculitis, scleroderma), HIV, Hepatitis B or C, amyloidosis, obstructive nephropathy from recurrent UTI or nephrolithiasis, and certain medications ( , immune suppressants, HIV medications). may also contribute to CKD, . Recent evidence suggests . Staging and Estimating GFR Staging CKD is most frequently done by calculating the estimated glomerular function rate (eGFR) as a proxy

2018 Renal Fellow Network

95. A Prospective Study of Risk Factors for Nephrolithiasis After Roux-en-Y Gastric Bypass Surgery. (PubMed)

to undergo Roux-en-Y gastric bypass surgery were enrolled in this prospective study between November 2006 and November 2007. Exclusion criteria included history of nephrolithiasis or inflammatory bowel disease. Serum uric acid, parathyroid hormone, calcium, albumin, and creatinine and 24-hour urine collections were obtained within 6 months before Roux-en-Y gastric bypass, and at 6 to 12 months postoperatively. A Wilcoxon signed-rank test was used to compare preoperative and postoperative serum laboratory (...) A Prospective Study of Risk Factors for Nephrolithiasis After Roux-en-Y Gastric Bypass Surgery. Roux-en-Y gastric bypass surgery has become an increasingly common form of weight management. Early retrospective reviews have suggested that new onset nephrolithiasis develops in some patients after undergoing Roux-en-Y gastric bypass. We present a prospective longitudinal study to assess risk factors for nephrolithiasis after Roux-en-Y gastric bypass.A total of 45 morbidly obese patients scheduled

2009 Journal of Urology

96. Relationship Between Body Mass Index and Quantitative 24-Hour Urine Chemistries in Patients With Nephrolithiasis. (PubMed)

. In women, multivariate analysis demonstrated positive association between BMI and urine sodium, creatinine, and phosphate and a negative relationship with urine citrate and sulfate.Increasing body mass index was related to several risk factors for urinary stone disease in this study, including increasing urine sodium and decreasing pH in men and increasing urine uric acid, sodium, and decreasing urine citrate in women. Just as general recommendations for patients with nephrolithiasis include high (...) explored using bivariate and multivariate linear regression.On bivariate analysis, increasing body mass index was associated with a significant increase in sodium, calcium, citrate, uric acid, magnesium, calcium oxalate, uric acid, and a decrease in pH in men. In women, it was associated with a significant increase in sodium, uric acid, oxalate, uric acid, and decreasing pH. On multivariate analysis, BMI was associated only with increases in sodium and calcium oxalate and decrease in pH in men

2009 Urology

97. Topiloric/Uriadec (topiroxostat)

for the indications and dosage and administration as shown below. [Indication] Gout, hyperuricaemia [Dosage and administration] The usual adult initial dosage is 20 mg/dose of topiroxostat orally administered twice daily in the morning and evening. Thereafter, the dose should be gradually increased, as needed, while monitoring blood uric acid levels. The usual maintenance dosage should be 60 mg/dose twice daily. The dose may be adjusted according to the patient’s condition, up to 80 mg/dose twice daily. 4 Review (...) of topiroxostat orally administered twice daily in the morning and evening. Thereafter, the dosage should be gradually increased, as needed, while monitoring blood uric acid levels. The usual maintenance dosage should be 60 mg/dose twice daily. The dose may be adjusted according to the patient’s condition, up to 80 mg/dose twice daily. II. Summary of the Submitted Data and Outline of Review by the Pharmaceuticals and Medical Devices Agency (PMDA) A summary of the submitted data and an outline of the review

2013 Pharmaceuticals and Medical Devices Agency, Japan

98. 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)

99. 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 4.6.6.1 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

100. Modification of lifestyle and nutrition interventions for management of early chronic kidney disease

, diuresis, natriuresis, and kaliuresis with associated blood pressure changes, increased risk for nephrolithiasis, and various metabolic alterations. Although there was a dearth of evidence pertaining to HP diets in patients with CKD, it was concluded that, while there are no clear renal-related contraindications to HP diets in individuals with healthy kidney function, the theoretical risks should (...) therapy. Once blood pressure is controlled, low-dose acetylsalicylic acid therapy should be considered. _______________________________________________________________________________________________________________________ Early Chronic Kidney Disease July 2012 Page 20 of 50 SUGGESTIONS FOR FUTURE RESEARCH 1. An RCT of different levels of fluid intake ( 3L/day) on CKD progression in patients with stage 1-3 CKD. 2. A study of the impact of moderation of alcohol intake on CKD progression in patients

2013 KHA-CARI Guidelines

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