| Part 1 of Chapter 1The definition of complicated urolithiasisObjective:Complicated urolithiasis was the difficulty and key point of clinical diagnosis and treatment.This part was a systematic review of the definition of complicated urolithiasis.Methods:CNKI data base、Wan Fang data base、Wei Pu data base、ISI Web of Knowledge、Pubmed、Elsevier ScienceDirect were searched for Chinese and English literature among 2010-2017.The key words were:"Complicated、"Recurrent"、"Kidney stones"、"Urolithiasis"、"renal calculi"、"metabolic evaluation"、"metabolic abnormities".At last,133 literature were selected based on the inclusion and exclusion criteria.Results:There were 528 Chinese literature and 119 English literature in total according to the key words.All the literature were screened and 133 literature were included at last.Five factors which could influence the complexity of kidney stones were:crowd;location;size;composition and the risk of reccurence.The location and size of stone mainly influenced the measure and strategy of treatment while the crowd,composition and the risk of reccurence mainly influenced the etiological diagnosis.Cnclusion:This part made a precise definition of "complicated urolithiasis" based on a systematic review for the next study of etiologic research.Part 2 of Chaper 1The stone analysis of complicated urolithiasisObjective:To investigate the composition distribution of the complicated urolithiasis in the general population through the analysis of the conponents of calculi.Methods:The center has collected 356 cases of complicated urolithiasis from 2014-2016.These samples were all analyzed by infrared spectroscopy,among which,the rare or special ones were verified by scanning electron microscope(SEM method)and polarizing microscope.Results:This research contained 356 patients with complicated urolithiasis,including 238 male patients and 118 female patients.The ratio of male to female was 2.02.Calcium oxalate monohydrate was highest in the calculus composition(82.87%),then followed by carbonate apatite(70.79%),calcium oxalate dihydrate(64.61%),anhydrous uric acid(19.38%),magnesium ammonium phosphate(10.96%).Other ingredients were relatively rare(cystine ammonium in 3 cases,ammonium uric acid calculi in 2 cases,dihydrate calcium hydrogen phosphate in 1 case.All occupied a total of 1.69%).There existed significant differences in the contents of calculus among sex,ages and location(P<0.05).The most common ones in children are calcium oxalate monohydrate and calcium oxalate dehydrate(33.33%),and all the cystine stones patients were children.In those calculus with complex components,mixed stones accounted for 86.52%,of which calcium oxalate monohydrate,calcium oxalate dehydrate and carbonate apatite occupied the highest proportion(61.69%);Patients with gout had the highest rate of high risk of recurrent stones(56.52%).Conclusion:the causes of calculus formation may be different depending on gender,age and location.Therefore,for calculi occurred in patients with different gender,age and in various location,as well as those children’s calculus,calculus with complex components,calculus with high risk of recurrence which are associated with complicated urolithiasis,targeted prevention and treatment measures should be taken.Part 3 of Chaper 1The metabolic evaluation of complicated urolithiasisObjective:To investigate the etiology of complicated urolithiasis in China though complete metabolic evaluation.Methods:Metabolic evaluation was performed in 356 patients with complicated urolithiasis of Jiangsu provincial hospital from October 2014 to September 2016.The test included blood test and 24-hour urine analysis.The blood test contained renal electrolyte and parathyroid hormone,and the 24-hour urine analysis consisted of urinary calcium,oxalate,citrate,uric acid,phosphate,potassium,sodium,creatinine,and urine volume.Results:Of all the 356 patients,metabolic abnormalities were found in 318 cases(89.33%),among which,the hypocitraturia occupied a highest percentage of 75.79%,a total of 241 cases,followed by hyperoxaluria(173 cases,54.40%),hyperuricuria(86 cases,27.04%),low urine volume(73 cases,22.30%),low magnesium urine(54 cases,16.98%),hypercalciuria(49 cases,15.41%),hyperphosphateuria(37 cases,11.64%),low urine pH(24 cases,7.55%)and high urine pH(16 cases,5.03%).76 patients suffered from one kind of metabolic disorder,in the meantime,133 patients had two kinds of disorders,74 patients with three kinds of metabolic abnormalities,31 patients lived with four metabolic abnormalities,5 kinds of metabolic abnormalities in 4 patients.Conclusion:Most patients with complicated urolithiasis suffered from one or more metabolic abnormalities.Among them,the main abnormalities were hypocitraturia,hyperoxaluria and hyperuricuria.Understanding patients’metabolic abnormalities will contribute to the diagnosis of etiology and establish a comprehensive system of prevention and treatment of urolithiasis.Chapter 2:The etiological diagnosis of complicated urolithiasisObjective:To bulid a train of thought of etiological diagnosis of complicated urolithiasis based on the discussion of special cases.Methods:A case of FHHNC and a case of ceftriaxone stone were reported and dissuced based on the subsistent diagnosis and treatment measures.Results:The etiological diagnosis of complicated urolithiasis needed multi-measures.The key point was 24h urine analysis.The metabolic disorder could be discovered through simple,comprehensive and particular metabolic evaluation.Conclusion:The etiological diagnosis of complicated urolithiasis could be made through existing means of diagnosis,full evaluation of patients’ condition,close attention to the change of states and differential diagnosis.Part 1 of Chapter 3The animal model of the ceftriaxone-associated urolithiasisObjective:To establish the animal model of the ceftriaxone-associated urolithiasis.Methods:20 SD male rats,weighting 100±5g,were randomly divided to 4 group.Group G:rats were injected ceftriaxone with 500mg/kg and gavaged Ca2CO3with 1000mg/kg;Group H:rats were injected ceftriaxone with 500mg/kg and gavaged Ca2CO3with 2000mg/kg;roup I:rats were injected ceftriaxone with 1000mg/kg and gavaged Ca2CO3with 1000mg/kg;Goup J:rats were injected ceftriaxone with 1000mg/kg and gavaged Ca2CO3with 2000mg/kg.Before the rats was killed,the 24 h urinary was collected,crystals was observed by microscope.Urinary lithogenic factors,blood biochemical indexes,stone incidence,stone compositions,and histomorphology in all rats were respectively measured.Results:Crystals was observed by microscope,there was no crystal in group G,both group H and group I is 20%,group J is 80%.and 40%of group J rats were found stone in the bladder.The stone samples were analyzed by infrared spectroscopy,and scanning electron microscopy and energy disperse spectroscopy for component analysis,which is the same as the stone in human.Macroscopic observation,there was no stone in the renal pelvis and bladder mucosa edema visible.Pathological slice observation,renal biopsy did not see crystals,bladder submucosa visible structure is loose.Conclusion:The rats which were injected ceftriaxone with 1000mg/kg and gavaged Ca2CO3with 2000mg/kg,is an ideal animal model of the ceftriaxone-associated urolithiasis.Part 2 of Chapter 3The animal model of the ceftriaxone-associated urolithiasis inducedacute kidney injuryObjective:To investigate the pathophysiological process of ceftriaxone-induced urolithiasis and its associated acute kidney injury(AKI)based on an animal studyMethods:Male Sprague-Dawley rats were randomly divided into five groups of six each according to different treatments including control;ceftriaxone(1500mg/kg);ceftriaxone(1500mg/kg)with calcium(2500mg/kg);calcium(2500mg/kg);and ceftriaxone(1500mg/kg),calcium(2500mg/kg)with citrate(10ml/100g),respectively.The 24-h urine volume,serum creatinine(Scr)and blood urea nitrogen(BUN)were measured;kidney histological examination and stone analysis were performed.Results:Kidney stones and a significantly low 24-h urine volume with increased high Scr and BUN levels were found in the group that received ceftriaxone combined with calcium.Citrate was able to inhibit these biochemical changes and stone formations.Conclusion:Ceftriaxone-induced urolithiasis was associated with a high risk of AKI.The pathophysiological process may be related to urinary obstruction and crystalline nephropathy.Citrate was able to inhibit stone formation and prevent further kidney injury. |
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