Navegando por Palavras-chave "nephrolithiasis"
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- ItemSomente MetadadadosA critical appraisal of the radiological evaluation of nephrocalcinosis(Karger, 2007-01-01) Cheidde, Lara; Aron Ajzen, Sergio; Tamer Langen, Cecilia Helena; Christophalo, Dejaldo; Pfeferman Heilberg, Ita; Universidade Federal de São Paulo (UNIFESP)Background/Aim: the level of agreement concerning the diagnosis of nephrocalcinosis (NC) based on ultrasonography (US), computed tomography (CT) or kidney/ureter/bladder (KUB) X-ray was assessed. Methods: Sequences of KUB+US+CT from 62 patients, 48 with at least one exam suggesting NC and 14 with pelvicalyceal calcifications ( nephrolithiasis) were reviewed twice by 3 radiologists ( firstly randomized and secondly presenting KUB+US+CT of each patient together). Results: the intraobserver concordance varied from 76 to 90% for KUB, 77 to 85% for US and 82 to 89% for CT. There was a significant change in diagnosis between the 1st and 2nd reviews for observer 1 in KUB and CT, for observer 2 in US, but not for observer 3. Evaluating patients' exams together did not provide a better agreement. the highest sensitivity and specificity ( 92 and 89%, respectively) were only attained when 2 exams suggested NC diagnosis, being CT one of them. These enabled us to suggest that 33 out of 48 (62.5%) patients had NC ( evidenced in US+CT+KUB (81.8%), US+CT (12.1%) or KUB+CT (6.1%). Conclusion: the low level of concordance renders the radiological diagnosis of NC difficult. Nephrocalcinosis should be confirmed by CT combined with either US or KUB. Copyright (c) 2007 S. Karger AG, Basel.
- ItemAcesso aberto (Open Access)Efeito de doses elevadas de vitamina D3 associada à suplementação de cálcio em modelo experimental de nefrolitíase(Sociedade Brasileira de Nefrologia, 2014-06-01) Ramos, Maria Fátima de Paula; Santana, Luciane Gomes de; Razvickas, Clara Versolato; Teixeira, Vicente de Paulo Castro [UNIFESP]; Schor, Nestor [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction:There is little information in the literature relating supplementary oral usage of vitamin D and calcium to the development of kidney stones. Objective:To evaluate the effect of high dose, 200 IU of vitamin D3 (V) with calcium supplementation (Ca). Methods:Experimental model consists of insertion of pellets into the bladder of rats. V was administered for 30 days with or without Ca. The rats were divided in 6 groups: 1. Sham, 2. Pellets control; 3. V control; 4. Pellets + V; 5. Pellets + Ca and 6. Pellets + Ca + V. Results:50% and 17% decreases bladder stones formation in groups 5 and 6, p < 0.005 comparing with the group 2 were observed. There was no hypercalcemia or hypercalciuria in all groups. We observed a significant decrease in calciuria in group 6 (p = 0.03). Conclusion:The administration of the V associated with Ca significantly decreased the formation of stones and caused a significant reduction in urinary calcium, suggesting a protection in the lithogenic pathophysiology.
- ItemSomente MetadadadosEffect of etidronate treatment on bone mass of male nephrolithiasis patients with idiopathic hypercalciuria and osteopenia(Karger, 1998-08-01) Heilberg, I. P.; Martini, L. A.; Teixeira, S. H.; Szejnfeld, V. L.; Carvalho, A. B.; Lobao, R.; Draibe, S. A.; Universidade Federal de São Paulo (UNIFESP)Osteopenia is frequently found among calcium stone forming (CSF) patients with hypercalciuria. We investigated the effect of a 2-year therapeutic course of etidronate, a bone-sparing agent, in 7 young male CSF patients. the treatment consisted of a cyclic intermittent administration of phosphate followed by sodium etidronate and calcium supplementation every 74 days. Bone mineral density (BMD) measured at 12-month intervals and bone biopsies performed at baseline and after 2 years were the primary efficacy parameters. Mean lumbar spine BMD increased significantly after the 1st year by 2.6 +/- 1.0% (mean +/- SE, p < 0.05) and nonsignificantly after the 2nd year by 5.6 +/- 2.6 %. Nonsignificant changes were observed for femoral neck mean BMD after either the 1st or the 2nd year (decrease of 2.0 +/- 1.0% and 2.0 +/- 3.0%, respectively). Mean histomorphometric parameters showed that bone volume, osteoid volume, and eroded surfaces did not differ from baseline (13.9 +/- 2.2 vs. 12.2 +/- 1.1%, 1.2 +/- 0.7 vs. 2.6 +/- 0.7%, and 20.7 +/- 6.2 vs. 13.7 +/- 1.3%, respectively). Osteoid surface was significantly lower than baseline values (9.5 +/- 5.2 vs. 18.8 +/- 5.3%, p < 0.05). These data suggest that etidronate given to young male CSF patients presenting with hypercalciuria and osteopenia led to a significant amelioration of BMD, evident only in the lumbar spine after 1 year of treatment. There was no histological evidence of long-term improvement in bone remodeling.
- ItemAcesso aberto (Open Access)Litíase urinária e gestação(Sociedade Brasileira de Nefrologia, 2014-09-01) Korkes, Fernando; Rauen, Eduardo Costa; Heilberg, Ita Pfeferman [UNIFESP]; Faculdade de Medicina do ABC; Hospital Israelita Albert Einstein; Hospital São Luiz; Universidade Federal de São Paulo (UNIFESP)The diagnosis of urolithiasis during pregnancy is common, even though no additional measures are required in asymptomatic cases. Renal colic or complications of urinary lithiasis occur more frequently during the last months of pregnancy, and there are several particularities for the diagnosis and treatment of this subset of women. The present manuscript aim to review the current knowledge concerning this subject and present authors personal experience.
- ItemAcesso aberto (Open Access)Pain determinants of pain in autosomal dominant polycystic kidney disease(Sociedade Brasileira de Nefrologia, 2013-09-01) Nishiura, José Luiz [UNIFESP]; Eloi, Samara Rodrigues Moreira [UNIFESP]; Heilberg, Ita Pfeferman [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Pain is the most common symptom reported by ADPKD patients, afflicting approximately 60% of cases and may result from renal hemorrhage, calculi, urinary tract infections, cyst rupture, or due to stretching of the capsule or traction of the renal pedicle. We have recently investigated pain patterns in AD-PKD patients using a translated version of a pain questionnaire specific for AD-PKD population. The questionnaire revealed that 67% patients with ADPKD exhibited some type of pain. The findings of that study emphasized that pain appeared early in the course of ADPKD, when patients still exhibited preserved renal function. In the present study, a multivariate logistic regression analysis disclosed that renal volume (9-fold increased risk) and nephrolithiasis (4-fold increased risk) were the most important determinant factors for pain in ADPKD patients with preserved renal function, after adjustments for the presence of hypertension and duration of the disease.
- ItemSomente MetadadadosPhyllanthus niruri normalizes elevated urinary calcium levels in calcium stone forming (CSF) patients(Springer, 2004-10-01) Nishiura, J.; Campos, A.; Boim, M.; Heilberg, I; Schor, N.; Universidade Federal de São Paulo (UNIFESP)Phyllanthus niruri is a plant used for years in Brazil to treat urinary calculi. We prospectively evaluated the effect of P. niruri intake on 24 h urinary biochemical parameters in an attempt to assess its in vivo effect in calcium stone forming (CSF) patients. A total of 69 CSF patients (39 males and 30 females, 38+/-8 years old) were randomized to take either P. niruri (n=33) (450 mg capsules, td) or placebo (n=36) for 3 months. Blood calcium, uric acid, citrate, magnesium, oxalate, sodium and potassium were determined at baseline and at the end of the study. A subset analysis was made in patients classified according to the presence of metabolic abnormalities (hypercalciuria, hyperuricosuria, hyperoxaluria, hypocitraturia and hypomagnesiuria). Overall, there were no significant differences in the mean values of urinary parameters between the urine samples before and after P. niruri intake, except for a slight reduction in mean urinary magnesium after P. niruri, which was within the normal range. However, in the subset analysis, we observed that P. niruri induced a significant reduction in the mean urinary calcium in hypercalciuric patients (4.8+/-1.0 vs 3.4+/-1.1 mg/kg/24 h, P<0.05). in this short-term follow-up, no significant differences in calculi voiding and/or pain relief between the groups taking P. niruri or the placebo were detected. Our data suggest that P. niruri intake reduces urinary calcium based on the analysis of a subset of patients presenting with hypercalciuria. Larger trials including primary hypercalciuric stone formers should be performed in order to confirm these findings and to determine the possible clinical consequences of urinary calcium reduction during P. niruri administration.
- ItemSomente MetadadadosSensitivity to calcium intake in calcium stone forming patients(Karger, 1996-06-01) Heilberg, Ita Pfeferman [UNIFESP]; Martini, Ligia Araujo [UNIFESP]; Draibe, Sergio Antonio [UNIFESP]; Ajzen, Horacio [UNIFESP]; Ramos, Oswaldo Luiz [UNIFESP]; Schor, Nestor [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The absorptive or renal origin of hypercalciuria can be discriminated using an acute oral calcium load test (ACLT). Of 86 patients with calcium oxalate kidney stones, 28 (23%) were found to be hypercalciuric (HCa) and 58 (67%) normocalciuric (NCa) on their customary free diet, containing 542 +/- 29 mg/day (mean +/- SE) of calcium. Since the apparently normal 24-hour calcium excretion of many calcium stone formers (CSF) may be due to a combination of high calcium absorption with moderately low calcium intake, all patients were investigated by ACLT. Of 28 HCa patients, 13 (46%) were classified as absorptive (AH) and 15 (54%) as renal hypercalciuria (RH). Of the 58 NCa patients, 38 (65%) presented features of intestinal hyperabsorption and were therefore designated as AH-like, and 20 (35%) as RH-like. To further elucidate the role of dietary calcium in these CSF, a chronic calcium load test (CCLT), consisting of 1 g/day of oral Ca for 7 days, was designed. A positive response to the CCLT was considered to occur when urinary calcium (uCa) was greater than or equal to 4 mg/kg/24 h on the 7th day. Among NCa patients, 29% of AH-like subjects responded to the CCLT and 71% did not; 50% of RH-like subjects also responded and 50% did not. In HCa patients, 85% of AH and 67% of RH subjects maintained uCa greater than or equal to 4 mg/kg/24 h after the CCLT and 15% of AH and 23% of RH subjects did not. However, a significant additional increase in mean uCa was not observed among HCa patients. All patients were submitted to a second evaluation of fasting calciuria (Ca/Cr). A modification of this parameter was noticed in 89% of RH-like and 78% of RH patients, In conclusion, these data suggest the presence of subpopulations of patients sensitive or not to calcium intake, regardless of whether the acute response to a calcium overload test suggested AH or RH. The CCLT disclosed dietary hypercalciuria in 21/58 (36%) of previously NCa patients. In these NCa patients, the ACLT may be replaced by the CCLT. The distinction between AH and RH initially evidenced by the ACLT was not further confirmed. These data suggest that either fasting Ca/Cr is not adequate for subclassification of HCa or that AH and RH represent a different spectrum of the same disease, and that a primary resorptive component should also be considered.
- ItemSomente MetadadadosUpdate on dietary recommendations and medical treatment of renal stone disease(Oxford Univ Press, 2000-01-01) Heilberg, Ita Pfeferman [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
- ItemSomente MetadadadosVitamin D receptor gene polymorphism and bone mineral density in hypercalciuric calcium-stone-forming patients(Karger, 2002-01-01) Heilberg, I. P.; Teixeira, S. H.; Martini, L. A.; Boim, M. A.; Universidade Federal de São Paulo (UNIFESP)Reduced bone mineral density (BMD) and an increased risk of vertebral fracture have been reported in calcium-stone-forming (CSF) patients presenting with idiopathic hypercalciuria. We investigated the association between Bsml vitamin D receptor (VDR) polymorphism and BMD in 68 hypercalciuric CSF patients (35 males and 33 premenopausal females, mean age +/- SD = 39 +/- 10 years). BMD was measured at lumbar spine (L-2-L-4) and femur neck sites using dual energy X-ray absorptiometry. A 72-hour dietary record and a 24-hour urine sample were obtained from each patient to determine calcium intake and excretion. the allelic frequency found for the sample as a whole was 16% BB, 44% Bb and 40% bb. Mean BMD values did not significantly differ among BB, Bb and bb patients at L2-L4 (1.162 +/- 0.10, 1.133 +/- 0.11 and 1.194 +/- 0.19 g/cm(2), mean SD, respectively) or at neck sites (0.920 +/- 0.11, 0.931 +/- 0.15 and 0.982 +/- 0.15 g/cm(2), respectively). Calcium intake and excretion were also not significantly different among the three genotypes. Patients were then divided into two groups, normal BMD, T-score greater than or equal to -1 (n = 34) and low BMD, T-score <-1 (n = 34), to further evaluate the allele influence on previous bone loss. Despite a trend for a higher mean BMD at spine or neck sites for patients with one or two b alleles when compared to BB patients, the difference did not reach statistical significance. the distribution of BB, Bb and bb genotypes in the low-bone-mass group (15, 47 and 38%, respectively) was similar to that in the normal-bone-mass group (18, 41 and 14%, respectively). These data suggest that Bsml VDR polymorphism does not play an important role in the bone loss seen in hypercalciuric CSF patients. Copyright (C) 2002 S. Karger AG, Basel.