Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement

Background: Recently published guidelines on the medical management of renal stone disease did not address relevant topics in the field of idiopathic calcium nephrolithiasis, which are important also for clinical research. Design: A steering committee identified 27 questions, which were proposed to a faculty of 44 experts in nephrolithiasis and allied fields. A systematic review of the literature was conducted and 5216 potentially relevant articles were selected; from these, 407 articles were deemed to provide useful scientific information. The Faculty, divided into working groups, analysed the relevant literature. Preliminary statements developed by each group were exhaustively discussed in plenary sessions and approved. Results: Statements were developed to inform clinicians on the identification of secondary forms of calcium nephrolithiasis and systemic complications; on the definition of idiopathic calcium nephrolithiasis; on the use of urinary tests of crystallization and of surgical observations during stone treatment in the management of these patients; on the identification of patients warranting preventive measures; on the role of fluid and nutritional measures and of drugs to prevent recurrent episodes of stones; and finally, on the cooperation between the urologist and nephrologist in the renal stone patients. Conclusions: This document has addressed idiopathic calcium nephrolithiasis from the perspective of a disease that can associate with systemic disorders, emphasizing the interplay needed between urologists and nephrologists. It is complementary to the American Urological Association and European Association of Urology guidelines. Future areas for research are identified

Randall’s plaque of patients with nephrolithiasis begins in basement membranes of thin loops of Henle

Our purpose here is to test the hypothesis that Randall’s plaques, calcium phosphate deposits in kidneys of patients with calcium renal stones, arise in unique anatomical regions of the kidney, their formation conditioned by specific stone-forming pathophysiologies. To test this hypothesis, we performed intraoperative biopsies of plaques in kidneys of idiopathic-calcium-stone formers and patients with stones due to obesity-related bypass procedures and obtained papillary specimens from non–stone formers after nephrectomy. Plaque originates in the basement membranes of the thin loops of Henle and spreads from there through the interstitium to beneath the urothelium. Patients who have undergone bypass surgery do not produce such plaque but instead form intratubular hydroxyapatite crystals in collecting ducts. Non–stone formers also do not form plaque. Plaque is specific to certain kinds of stone-forming patients and is initiated specifically in thin-limb basement membranes by mechanisms that remain to be elucidated

Alvorecer de uma nova ciência: a medicina tropicalista baiana The dawning of a new science

No século XIX, o saber e o ensino médico e a assistência clínica, de caráter especulativo e elitista, entram em choque, no Brasil, com novas teorias da doença e do cuidado médico baseadas na parasitologia, bacteriologia e anatomopatologia e numa clínica experimental orientada para enfermidades tropicais dos pobres. O novo referencial teórico e social, que influi na política pública de saúde, entra em decadência quando é apropriado pela ideologia da inferioridade racial e cultural da população de origem africana. Duas novas disciplinas - antropologia física criminal e medicina legal - geram conhecimentos inéditos nos meios intelectuais e, ao mesmo tempo, são funcionais à ordem dominante, dando curso forçado a princípios e dispositivos de que a mesma elite usa para se perpetuar no poder. Essa construção híbrida é o legado de barbárie à civilização atual.<br>Medicine in 19th-century Brazil was a scientific field where traditional knowledge, academic teaching, and clinical care found themselves clashing with new theories of illness and medical care underpinned by pioneer disciplines like parasitology, bacteriology, and anatomopatbology and an experimental clinical practice focused on tropical diseases which afflict the poor. This new set of theoretical and social references which affected public health-care policy saw its decadence when it was appropriated by an ideology that argued that the Afro-Brazilian population was racially and culturally inferior. Two new disciplines- criminal physical anthropology and legal medicine- contributed to the development of specialized knowledge within intellectual circles. At the same time, they were placed at the service of the ruling order, reinforcing principles and devices that the elite utilized to keep itself in power. This hybrid structure constitutes the legacy of barbarianism which is sundering today's civilization