Navegando por Palavras-chave "Urolithiasis"
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- ItemSomente MetadadadosAcurácia da ultrassonografia com doppler das artérias interlobares e arqueadas no diagnóstico da doença renal obstrutiva - revisão sistemática e metanálise(Universidade Federal de São Paulo (UNIFESP), 2020-04-30) Takaki, Rita De Cassia Oliveira [UNIFESP]; Iared, Wagner [UNIFESP]; Universidade Federal de São PauloUrolithiasis is the most frequent cause of acute renal obstruction in adults; it has an important socioeconomic cost given that about 30% of patients require hospitalization, up to 15% require some type of surgery and it has a high rate of recurrence. An early diagnosis can minimize the consequences of the obstructive process preserving the structure and function of the urinary tract. Ultrasonography is one of the most used tests for initial evaluation of patients with suspected obstructive uropathy. Ultrasound Doppler of the intrarenal arterial territory is considered a method that could increase the accuracy of ultrasound in the diagnosis of acute renal obstruction. Method: Systematic review and meta-analysis of studies that assessed accuracy of the Resistance Index (IR) and Delta IR of intrarenal arteries for the diagnosis of renal obstruction and to differentiate obstructive from non-obstructive hydronephrosis. The following databases were searched: MEDLINE, EMBASE, LILACS and COCHRANE LIBRARY by descriptors (DeCs / MeSH, EMTREE), words and synonyms. The assessment of the risk of bias and applicability of the studies was conducted through the Quality Assessment of Diagnostic Accuracy Studies (QUADAS 2). METADISC version 1.4 was used for data analysis and presentation. Results: Twenty-two articles were included in the quantitative synthesis (meta-analysis). The average sensitivity of the RI in the diagnosis of renal obstructions was estimated at 68% (95% CI: 61% - 71%); specificity, 81% (95% CI: 79% - 84%); area under the ROC curve, 0.901; the sensitivity of Delta IR was estimated at 74% (95% CI: 70% - 78%); specificity, 81% (95% CI: 78% - 85%). In differentiating obstructive from non-obstructive hydronephrosis, the average sensitivity of the RI was estimated at 76% (95% CI: 71% - 80%); specificity, 77% (95% CI: 72% - 82%); area under the ROC curve, 0.955; the average sensitivity of the Delta IR was estimated at 91% (95% CI: 85% - 94%); and specificity, 63% (95% CI: 52% to 73%). Conclusion: The IR of intrarenal arteries had limited sensitivity and high specificity in the diagnosis of renal obstructions. The calculation of Delta IR showed high sensitivity in the differentiation of hydronephrosis from obstructive to non-obstructive causes and high specificity in the diagnosis of renal obstructions.
- ItemSomente MetadadadosAnálise cristalográfica de cálculos urinários e sua associação com fatores metabólicos, climáticos e índice de desenvolvimento humano na população brasileira(Universidade Federal de São Paulo (UNIFESP), 2020-03-05) Cunha, Tamara Da Silva [UNIFESP]; Heilberg, Ita Pfeferman [UNIFESP]; http://lattes.cnpq.br/5039409992847018; http://lattes.cnpq.br/7891763785370265; Universidade Federal de São PauloThe frequency of renal stones in Brazil has been evaluated in the last 30 years by investigators from the areas of Urology and Nephrology based on epidemiological data focused on the number of admissions in the emergency room and hospitalization due to episodes of renal colic. However, there is scarce data in Brazil evaluating kidney stone composition using physical analysis as proposed by international guidelines. Moreover, variations in demographic, economic and environmental factors might influence the worldwide distribution of urolithiasis but scarce data is available concerning their associations with stone composition worldwide. The aims of the present study were to evaluate the frequency and composition of kidney stones and their associations with temperature, humidity and human development index (HDI) in different parts of a large country as Brazil, presenting with a handful of social contrasts and a wide variation of climate. A total of 1,158 stones from distinct regions of the country were submitted to physical analysis, and the mean annual temperature and relative humidity of each city were considered separately. A sub-group of patients (n=204) whose 24hr urine samples were available, were tested for associations with metabolic disturbances. Calcium oxalate (CaOx) stones were disclosed in 60.9% (monohydrate and dihydrate) of patients followed by uric acid stones (pure/mixed with CaOx monohydrate) in 16.7%, pure or mixed apatite/CaOx dihydrate in 11.3%, struvite in 8.3%, brushite in 1.8% and cystine/rare types in 0.8%. People living in cities with a HDI < 0.800 had twice the odds of having a struvite stone versus those living in a HDI ≥ 0.800 (OR=2.14, 95% CI 1.11–4.11). A progressive increase in the frequency of struvite stones from 4.5% to 22.8% was detected between a HDI higher than 0.800 through lower than 0.700. No significant differences for other stone types were disclosed. In separate logistic regression models assessing the association of each stone composition with covariates, no significant association was detected with climate. Among patients whom underwent 24-hour urinary metabolic workup, no significant differences were observed in comparison to the literature. In conclusion, patients living in areas with low HDI were more prone to developing struvite stones, possibly due to a more restricted access to healthcare. Temperature and humidity did not represent an independent risk factor for any stone type in our population.
- ItemSomente MetadadadosEffect of hydroalcoholic extract from Copaifera langsdorffii leaves on urolithiasis induced in rats(Springer, 2012-10-01) Brancalion, Ana Paula S.; Oliveira, Rejane B.; Sousa, Joao Paulo B.; Groppo, Milton; Berretta, Andresa A.; Barros, Marcio E. [UNIFESP]; Boim, Mirian A. [UNIFESP]; Bastos, Jairo K.; Universidade de São Paulo (USP); Apis Flora Ind & Comercial Ltda; Universidade Federal de São Paulo (UNIFESP)Copaifera langsdorffii Desf. commonly known as copaiba, produce a commercially valuable oil-resin that is extensively used in folk medicine for anti-inflammatory, antimicrobial and antiseptic purposes. We have found the hydroalcoholic extract of this plant leaf has the potential to treat urolithiasis, a problem affecting similar to 7% of the population. To isolate the functional compounds C. langsdorffii leaves were dried, ground, and macerated in a hydroalcoholic solution 7:3 to produce a 16.8% crude extract after solvent elimination. Urolithiasis was induced by introduction of a calcium oxalate pellet (CaOx) into the bladders of adult male Wistar rats. the treated groups received the crude extract by oral gavage at 20 mg/kg body weight daily for 18 days. Extract treatment started 30 days after CaOx seed implantation. To monitor renal function sodium, potassium and creatinine concentrations were analyzed in urine and plasma, and were found to be in the normal range. Analyses of pH, magnesium, phosphate, calcium, uric acid, oxalate and citrate levels were evaluated to determine whether the C. langsdorffii extract may function as a stone formation prevention agent. the HPLC analysis of the extract identified flavonoids quercitrin and afzelin as the major components. Animals treated with C. langsdorffii have increased levels of magnesium and decreased levels of uric acid in urinary excretions. Treated animals have a significant decrease in the mean number of calculi and a reduction in calculi mass. Calculi taken from extract treated animals were more brittle and fragile than calculi from untreated animals. Moreover, breaking calculi from untreated animals required twice the amount of pressure as calculi from treated animals (6.90 +/- A 3.45 vs. 3.00 +/- A 1.51). the extract is rich in flavonoid heterosides and other phenolic compounds. Therefore, we hypothesize this class of compounds might contribute significantly to the observed activity.