Aspetti epidemiologici della calcolosi di calcio in Italia: distribuzione dei fenotipi intermedi nella popolazione italiana

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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

Biochemical evaluation in renal stone disease

Renal stone disease may ensue from either derangements of urine biochemistries or anatomic abnormalities of kidneys and urinary tract

The general practitioner and nephrolithiasis

Nephrolithiasis is a multifactorial disease the genesis of which is influenced by genetic, metabolic and environmental factors which determine a series of alterations in the urinary excretion of a number of substances, the cause of the disease itself. The general practitioner is often the first professional to be consulted as regards clinical and therapeutic treatment at the moment of the onset of nephrolithiasis, renal colic, inasmuch as contacted directly by the patient. His role however should not be limited to this initial phase but becomes of strategic importance throughout the subsequent diagnostic procedure; this is especially true with regard to relapses, in correctly placing the patient and, if necessary, referring him/her to the most appropriate specialist area. Running through the entire process which the lithiasic patient encounters from the onset of the disease until therapeutic treatment begins, it is clear how an appropriate initial approach can, in many cases, simplify and optimise such process. On the basis therefore of a complete medical record, and a few simple, biochemical and instrumental tests, the general practitioner is in a position to decide whether to treat the patient directly or to refer him/her to the most appropriate specialist field for investigation at a higher level

Idiopathic hypercalciuria and calcium renal stone disease: our cases

Renal idiopathic stone disease affects about 8% of the Italian population. The most common form in western countries (70- 80% of the cases) is calcium nephrolithiasis, with stones formed mainly by calcium oxalate and phosphate. One of the main metabolic anomalies that is often associated with calcium nephrolithiasis is hypercalciuria. Primary hypercalciuria is a metabolic defect characterized by an increased renal calcium excretion. This metabolic alteration is present in the general population with a frequency of 5-10%, but can reach 45-50% in subjects affected by nephrolithiasis. We studied 149 patients affected by idiopathic calcium nephrolithiasis.The aim of the present study was to evaluate the association between familiarity for nephrolithiasis and hypercalciuria in this population of patients

Use of <i>Lactobacillus plantarum</i> in Preventing Clinical Cases of American and European Foulbrood in Central Italy

American and European Foulbrood (AFB and EFB) are considered the most contagious infectious diseases affecting honeybees worldwide. New sustainable strategies need to be implemented for their prevention and control, and probiotics may represent one solution to investigate. In our study, we evaluated the efficacy of one strain of Lactobacillus plantarum (L. plantarum) isolated from northern Italy, orally administered to the bees for AFB and EFB prevention. From March to September 2014, a total of 979 honeybee colonies (9.6% of Viterbo province—Central Italy) were taken under observation from 22 apiaries. Overall prevalence of AFB was 5.3% in treated colonies and 5.1% in the untreated ones. On the contrary, EFB prevalence was lower in the treated colonies (2.5%) compared to the untreated ones (4.5%). L. plantarum showed a significant effect in reducing insurgence of cases of EFB up to 35 days after the end of the treatment (p-value: 0.034). Thanks to this study we could investigate the preventive efficacy of L. plantarum in controlling AFB and EFB, and obtain official data on their clinical prevalence in Central Italy

The Risk of Chronic Kidney Disease Associated With Urolithiasis and its Urological Treatments: a Review

PURPOSE: Urolithiasis can impair kidney function. This literature review focuses on the risk of kidney impairment in stone formers, the specific conditions associated with this risk and the impact of urological surgery. MATERIALS AND METHODS: The PubMed and Embase databases were searched for publications on urolithiasis, its treatment, and the risk of chronic kidney disease (CKD), end-stage renal disease (ESRD) and nephrectomy in stone formers. RESULTS: In general, renal stone formers carry twice the risk of CKD or ESRD, and for female and overweight stone formers the risk is even higher. Patients with frequent urinary tract infections, struvite stones, urinary malformations and diversions, malabsorptive bowel conditions, and some monogenic disorders are at high risk of CKD/ESRD. Shock wave lithotripsy or minimally-invasive urological interventions for stones do not adversely affect renal function. Declines in renal function generally occur in patients with pre-existing CKD or with a large stone burden requiring repeated and/or complex surgery. CONCLUSIONS: Although the effect size is modest, urolithiasis may cause CKD thus it is mandatory to assess patients with renal stones for their risk of developing CKD/ESRD. We suggest that all guidelines dealing with renal stone disease should include assessing this risk

Defining metabolic activity of nephrolithiasis - Appropriate evaluation and follow-up of stone formers

Considering the variation in metabolic evaluation and medical management of kidney stone disease, this consensus review was created to discuss the metabolic activity of nephrolithiasis, define the difference between single and recurrent stone formers, and develop a schema for metabolic and radiologic follow-up. A systematic review of the literature was performed to identify studies of metabolic evaluation and follow-up of patients with nephrolithiasis. Both single and recurrent stone formers share many similarities in metabolic profiles. The study group determined that based on an assessment of risk for stone recurrence and metabolic activity, single and recurrent stone formers should be evaluated comprehensively, including two 24 h urine studies on a random diet. Targeted medication and dietary recommendations are effective for many patients in reducing the risk of stone recurrence. Follow-up of those with stone disease should be obtained depending on the level of metabolic activity of the patient, the risk of chronic kidney disease and the risk of osteoporosis/osteopenia. A standard scheme includes a baseline metabolic profile, a repeat study 3-6 months after initiation of treatment, and then yearly when stable, with abdominal imaging obtained every 1-2 years