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

Obesity and urolithiasis : evidence of regional influences

There is evidence that obese patients have an increased risk of renal stone formation, although this relationship could be less evident in some populations. The aim of this study was to evaluate the impact of overweight and obesity on the risk of renal stone formation in a population consuming a Mediterranean diet and to better elucidate the mechanisms underlying the increased risk of urolithiasis observed in obese subjects. We performed a retrospective review of 1698 stone forming patients (mean age 45.9\ua0\ub1\ua014.6\ua0years; 984/714\ua0M/F), attending outpatient stone clinics in Milan and Florence, seen between January 1986 and June 2014. Records were reviewed and data collected pertaining to age, gender, weight, height, stone composition, association with diabetes type 2 or gout and metabolic profile of 24-h urine to perform a descriptive study. We estimated prevalence ratios for body mass index (BMI) categories (underweight: BMI\ua0<18.5, normal: BMI 18.5-24.9, overweight: BMI 25-29.9 and obese\ua0 6530). Overweight and obesity were present in 40.7 and 8\ua0% of the men and in 19.9 and 8.7\ua0% of the women in the study population. The mean BMI of patients with urolithiasis was found to be 24.5\ua0\ub1\ua07.5\ua0kg/m(2). BMI values were positively correlated with age (p\ua0=\ua00.000) and mean BMI was higher in males than in females (25.5\ua0\ub1\ua08.9 vs 23.2\ua0\ub1\ua04.4\ua0kg/m(2)). In males, rates of overweight and obesity in renal stone formers were higher than the rates reported in the Italian general population in 2004 only for the age group 25-44\ua0years, whereas males in all the other age groups and in females the rates of overweight and obesity in renal stone formers were similar to rates reported in the Italian general population. The rates of overweight and obesity were significantly different in patients with different chemical stone composition. In particular, patients with uric acid stones have rates of overweight and obesity higher than patients with calcium stones or other types of calculi. Also the rates of type 2 diabetes and gout were greater in patients with overweight and obesity. In overweight and obese patients, the urinary excretion of risk factors for stone formation, such as calcium, oxalate and urate, and also of inhibitory substances, such as citrate, were significantly higher than in patients with normal weight or underweight. The prevalence of overweight and obesity in patients with urinary calculi from a country consuming a Mediterranean diet is not higher than in the general population. It should be taken into account that not all the dietary patterns that are associated with obesity may involve a parallel increase in the risk of forming kidney stones and that epidemiological findings from one country could not be confirmed in other countries with different climatic, socioeconomic and cultural features

Anthropometric variables, physical activity and dietary intakes of patients with uric acid nephrolithiasis

To evaluate anthropometric variables, energy expenditure by physical activity and nutrient intake of uric acid stone formers (UA-RSFs) compared to non-forming subjects (C). The study included 33 consecutive male patients with a diagnosis of \u201cpure\u201d stones of anhydrous uric acid at infrared spectroscopy and 49 male control subjects with no history of urinary stones. A personal interview was conducted including questionnaires for physical activity and dietary intakes. Anthropometric parametric and blood pressure were measured. Mean age, weight, height, waist circumference, body mass index, systolic and diastolic blood pressure values, dietary energy, carbohydrate intake, lipid intake, dietary acid load, time spent for different physical activities and total energy expenditure for physical activity were not different in UA-RSFs with respect to C. Mean dietary protein (76.2 \ub1 19.6 vs 65.4 \ub1 14.7&nbsp;g/day, P = 0.006) and ethanol intake (10.4 \ub1 8.8 vs 4.1 \ub1 8.6, P = 0.002) were higher in UA-RSFs than in C. History of renal disease, heart disease and treatment with thiazides or allopurinol were more frequent and mean serum glucose and triglycerides (104 \ub1 12 vs 97 \ub1 11&nbsp;mg/dl, P = 0.043) (172 \ub1 77 vs 123 \ub1 52&nbsp;mg/dl, P = 0.023) were higher in UA-RSFs. Metabolic syndrome was more frequent in UA-RSFs (57% vs 39%) but not significant (p = 0.09). Increased dietary animal protein (and ethanol) intake can act as co-factors for uric acid stone formation although a more complex and not fully elucidated metabolic background can have an even more crucial role in the pathogenesis of this disease even in the absence of overweight

Cigarette-smoking effects on circadian rhythm parameters of blood pressure

Ambulatory monitoring of blood pressure (bp) and heart rate in a multicentric Italian study is used to investigate effects of smoking and of a family history of high blood pressure and cardiovascular disease in clinically healthy adults of both genders between 40 and 59 years of age. A higher 24-h rhythm-adjusted mean of systolic blood pressure is found in smokers having a positive family history of high blood pressure. The results of this chronobiologic investigation are reviewed in the context of relations between smoking and cardiovascular morbidity. It appears that the effect of smoking depends in part on interacting factors. The major factor in this context may well be the family history of bp insofar as the results of this study based on a considerable number of observations are considered

Cigarette-smoking effects on circadian rhytm parameters of blood pressure.

Ambulatory monitoring of blood pressure (bp) and heart rate in a multicentric Italian study is used to investigate effects of smoking and of a family history of high blood pressure and cardiovascular disease in clinically healthy adults of both genders between 40 and 59 years of age. A higher 24-h rhythm-adjusted mean of systolic blood pressure is found in smokers having a positive family history of high blood pressure. The results of this chronobiologic investigation are reviewed in the context of relations between smoking and cardiovascular morbidity. It appears that the effect of smoking depends in part on interacting factors. The major factor in this context may well be the family history of bp insofar as the results of this study based on a considerable number of observations are considered