Cholelithiasis and Nephrolithiasis
John K. DiBaise, Carol Rees Parrish, Jon S. Thompson in Short Bowel Syndrome Practical Approach to Management, 2017
In the majority of cases, nephrolithiasis is asymptomatic. The most characteristic symptom of nephrolithiasis is pain, which is often associated with hematuria, nausea, and vomiting. The classic ureteral colic is characterized by a mild and barely noticeable ache initially followed by an intense pain that typically waxes and wanes in severity and occurs in waves. Severe pain usually lasts 20–60 minutes. The site of obstruction determines the location of pain. The abrupt severe flank pain resolves after passage or removal of the stone. Gross or microscopic hematuria occurs in the majority of patients presenting with symptomatic nephrolithiasis but can also be present in asymptomatic patients. This finding is the single most discriminating predictor of a kidney stone in patients presenting with unilateral flank pain. Other manifestations include urinary tract infection and acute renal failure due to outflow obstruction. In SBS patients, the recurrence rate of stones is unknown but is most likely higher than in the general population (5-year recurrence rate, 40%) [68].
The Child With Vomiting
Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan in Diagnosing and Treating Common Problems in Paediatrics, 2017
Renal stones or nephrolithiasis can present acutely with vomiting and abdominal pain or renal colic. There may be associated haematuria and/or dysuria. However, the commonest presentation of nephrolithiasis in children is with a urinary tract infection. Stones can be made up of:magnesium-ammonium phosphatecalcium phosphateuratexanthinecysteineoxate.
Presentation of primary hyperparathyroidism
Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner in Endocrine Surgery, 2017
Patients with asymptomatic PHPT should be evaluated to see if they meet the current guidelines for surgical referral, shown in Table 19.1. These guidelines have changed since the first workshop in 1990, and are likely to continue to evolve as more is learned about the manifestations of asymptomatic PHPT. At this time, evaluation of patients with asymptomatic PHPT should include the following tests: measurement of biochemistries (including calcium, PTH, phosphorus, alkaline phosphatase, blood urea nitrogen [BUN], and creatinine), PTH, and 25-hydroxyvitamin D [4]. BMD should be assessed by DXA that includes measurements at the spine, hip and distal one-third radius. Assessment for vertebral fractures is recommended, with either an X-ray or vertebral fracture assessment by DXA. Twenty-four-hour urine tests should include a urinary calcium determination to confirm the diagnosis of PHPT and to rule out familial hypocalciuric hypercalcemia (FHH). If the urinary calcium excretion is greater than 400 mg in 24 hours, a stone risk profile should be done to better characterize a patient’s risk for nephrolithiasis, and parathyroidectomy should be considered in high-risk patients. Abdominal imaging to assess for asymptomatic nephrolithiasis or nephrocalcinosis should be done with X-ray, renal ultrasound, or a CT scan [4].
Fremanezumab as a preventive treatment for episodic and chronic migraine
Published in Expert Review of Neurotherapeutics, 2019
Marcelo E. Bigal, Sarah Walter, Alan M. Rapoport
Serious adverse events (SAEs) were reported by one patient in the placebo group, one patient in the 675/225/225 mg group, and two patients in the 900 mg group; all SAEs were considered non-related to the study drug (Table 2). One patient with a history of nephrolithiasis had an acute kidney stone pain; one patient developed pneumonia after having influenza and a third patient had an exacerbation of irritable bowel syndrome. Finally, a patient with a well-documented history of severe depression had an episode of depression with suicidal ideation, considered severe by the investigator. All the above cases resolved during the course of the study. Two (1%) patients registered as positive for antibodies against fremanezumab before receiving study medication (considered false positives) and none after receiving study drug [40].
CYP24A1 Variants in Two Chinese Patients with Idiopathic Infantile Hypercalcemia
Published in Fetal and Pediatric Pathology, 2019
Yan Sun, Jun Shen, Xuyun Hu, Yu Qiao, Jianmei Yang, Yiping Shen, Guimei Li
There were 56 subjects with missense variants who had a mean serum calcium level of 3.24 ± 0.10 mM and a PTH level of 5.39 ± 0.50 pg/mL. Fifty patients had renal evaluations, and all showed nephrolithiasis or nephrocalcinosis. There were 11 subjects who carried variants of loss of function (LOF), with a mean serum calcium level of 3.30 ± 0.17mM and a PTH level of 6.37 ± 1.99 pg/mL. Seven of the eight (87.50%) subjects who had renal evaluations showed nephrolithiasis or nephrocalcinosis. There were nine subjects with one missense variant and the other LOF variant, with a mean serum calcium level of 3.34 ± 0.34 mM, and a PTH level was 5.71 ± 1.43 pg/mL. Eight of the patients had renal evaluations, and all had nephrolithiasis or nephrocalcinosis. With all the different types of variants, symptom onset was consistently within infancy. There was no difference in the phenotype of HCINF1 (e.g., serum calcium and PTH levels) among variants (p > .05), and the frequency of nephrolithiasis or nephrocalcinosis were high for all. There were three affected subjects with one LOF variant, and another three affected subjects with one missense variant. In short, the specific type of variant had no significant effect on the severity of the clinical HCINF1 phenotype.
Acute and chronic non-pulmonary complications in adults with cystic fibrosis
Published in Expert Review of Respiratory Medicine, 2019
Lucile Regard, Clémence Martin, Guillaume Chassagnon, Pierre-Régis Burgel
With a prevalence of 2.0–6.3% [39], nephrolithiasis is more frequent in CF patients than in the general population (Figure 2(f)). Risk factors associated with stone formation include decreased urine output, hyperoxaluria, and hypocitraturia [40]. Hyperoxaluria is the consequence of a reduction in enteric colonization by Oxalobacter formigenes (an oxalate-degrading bacterium) secondary to PI and recurrent courses of antibiotics [41]. Although nephrolithiasis can be asymptomatic, acute symptomatic nephrolithiasis can occur in CF adults who show the classical symptoms of renal colic and hematuria. Management should involve pain relief and hydration. For recurrent or complicated nephrolithiasis, lithotripsy or surgery should be considered [39]. Prevention includes increased fluid intake, and a low-oxalate/high-calcium diet [22].
Related Knowledge Centers
- Calculus
- Dysuria
- Hematuria
- Hypercalciuria
- Renal Colic
- Ureter
- Urinary System
- Kidney
- Crystallopathy
- Genetics