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The Urinary System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Infection or other irritation of the lower urinary tract is often characterized by dysuria (painful or difficult urination). A UTI may also present with numerous changes in the composition of the urine, including the presence of bacteria (bacteriuria), blood (hematuria), and pus (pyuria). Some drugs such as the sulfonamides, which are often used to treat UTIs, are concentrated in the urine, causing the formation of crystals (crystalluria) that can injure the kidneys, ureters, and urethra. Other diseases also change urine composition; for example, diabetes mellitus may produce glucosuria and hyperketonuria. Similarly, several renal diseases exhibit effects on other systems, particularly blood composition since the kidneys filter wastes from the blood. For example, renal azotemia (as well as shock, dehydration, excessive protein catabolism, and GI hemorrhage) can increase blood urea nitrogen (BUN) levels.
The Rheumatologists
Published in Maria Ribeiro, Sound Diagnosis, 2018
Precipitants include diuretics, alcohol, dietary purine excess, or any severe stress such as illness, dehydration, high catabolic state with increased turnover of nucleic acid, and trauma to old gouty joints. Crystalluria predisposes to kidney stone formation. Asymptomatic hyperuricemia is part of a metabolic disease. Primary gout usually involves (one) lower limb joint(s) and can progress to upper limbs and peri-articular soft tissue. In chronic tophaceous gout multiple deposits of pasty gouty tophi are present on hands, feet, elbows and pinnae of the ears.
Cholelithiasis and Nephrolithiasis
Published in John K. DiBaise, Carol Rees Parrish, Jon S. Thompson, Short Bowel Syndrome Practical Approach to Management, 2017
Urinalysis can provide important information. Urine crystal analysis can help establish the diagnosis; however, crystalluria is often seen in the absence of renal stones. Urine-specific gravity and osmolality provide clues to daily fluid volume intake. A low urinary pH (<5.5) is linked to uric acid stones. An attempt should be made to collect the stone for analysis to identify its composition, which can then help to identify the etiology and prognosis.
Should atopic dermatitis patients starting JAK inhibitors take prophylactic acyclovir?
Published in Journal of Dermatological Treatment, 2021
Milaan A. Shah, Katherine G. Beuerlein, Joseph L. Jorizzo, Steven R. Feldman
In addition to being effective treatment, valacyclovir and acyclovir are safe and well-tolerated drug with no associated toxicities and minimal adverse effects aside from crystalluria and increased creatinine levels (37,39,40). The risk of these side effects can be mitigated with fluid administration prior to taking acyclovir and adjustment in acyclovir dosage according to renal function (41). An ability to prevent reactivation of herpes simplex virus and herpes zoster coupled with this tolerability make valacyclovir and acyclovir options for prophylaxis in patients needing long-term suppression due to severe or recurrent outbreaks or extreme immunosuppression (39,40,42,43). The use of valacyclovir or acyclovir for prophylaxis in patients at risk of eczema herpeticum specifically has not yet been studied. Valacyclovir and acyclovir are equally efficacious in the treatment and prophylaxis of herpes simplex virus, but valacyclovir requires less frequent dosing due to the increased bioavailability (44–46). Twice daily dosing of 500 mg of valacyclovir effectively prevents herpes simplex virus reactivation (47,48). A 15-day supply of this dosage could be obtained for $11 (49). Prophylaxis to prevent eczema herpeticum in patients with atopic dermatitis being treated with a JAK inhibitor may only be needed until clinical improvement occurs (reducing the risk of eczema herpteticum), which may occur in as little as four weeks depending on the agent used and the patient’s response (50).
Pharmacotherapeutic options for kidney disease in HIV positive patients
Published in Expert Opinion on Pharmacotherapy, 2021
Anam Tariq, Hannah Kim, Hashim Abbas, Gregory M. Lucas, Mohamed G. Atta
PIs, most notably indinavir and atazanavir, can crystalize in the kidney tubules, leading to nephropathy, AIN with subsequent AKI, acute on CKD, or progression of CKD [82,83]. Crystalluria occurred in 20% and nephrolithiasis in 3% in a large cohort of PLWH on indinavir [84]. Indinavir also has been associated with kidney papillary necrosis [85] and atrophy [86]. A Japanese case-control study suggested that certain genes, with single nucleotide polymorphism (SNP) in the UGT1A-3ʹ-UTR, were associated with atazanavir-induced nephrolithiasis [87]. Other risk factors include alkaline urine, reduced urine output in areas with warm climates, and the higher dosage of indinavir at 1000mg or more twice daily. Indinavir is no longer used in developed countries but individuals with prior exposure are now left with CKD and should be managed closely for kidney disease progression.
Urinary crystal formation and urothelial effects of pyroxasulfone administered to male rats
Published in Toxicology Mechanisms and Methods, 2020
Takahiro Kyoya, Lora L. Arnold, Karen L. Pennington, Satoko Kakiuchi-Kiyota, Megumi Terada, Koichi Abe, Samuel M. Cohen
In Experiment 1, light microscopic evaluation of urinary sediment collected on study day 7 prior to necropsy showed no differences between the 0 ppm pyroxasulfone group and the 2000 ppm pyroxasulfone group (data not shown). In Experiment 2, semi-quantitative evaluation by light microscopy of the amount of crystals in the urines from the control group and from the 20 000 ppm pyroxasulfone group showed that dietary administration of 20 000 ppm pyroxasulfone slightly increased crystalluria compared to the control group when urines were collected at the beginning of the light cycle on study day 6, but not when urines were collected 6 h prior to the light cycle (data not shown). However, this was not confirmed by SEM/EDS analysis of urinary filters (see Section 3.4.3 below). Overall, crystalluria in the control and 20 000 ppm pyroxasulfone groups was increased when urine was collected 6 h prior to the light period compared to when it was collected at the beginning of the light period. The majority of crystals in the control and the 20 000 ppm pyroxasulfone treated groups at both time points had the characteristic coffin shaped morphology of MgNH4PO4 crystals, although there were some irregular, round and rod-shaped crystals present in the urine in the control and treated groups at both time points.