The purpose of this study is to summarize the results of percutaneous nephrolithotomy (PCNL) for renal stones following failed extracorporeal shockwave lithotripsy (SWL), and to investigate the effect of previous SWL on the performances and morbidities of subsequent PCNL. Sixty-two patients with a history of failed SWL who underwent PCNL on the same kidney (group 1) were compared to 273 patients who had received PCNL as first treatment choice (group 2). Patient demographics, stone characteristics, operative findings, and complications were documented and compared. Groups 1 and 2 had similar patient demographics and stone characteristics. Mean time to establish access was comparable in both groups (10.5 ± 4.2 vs. 9.6 ± 4.5 min, p = 0.894). Time required to remove stones and total operative time were longer in group 1 (71.5 ± 10.3 vs. 62.3 ± 8.6 min, p = 0.011 and 95.8 ± 12.0 vs. 80.6 ± 13.2 min., p = 0.018, respectively). Group 1 had lower clearance rate compared to group 2 (83.9 vs. 93.4 %, p = 0.021), while postoperative complications were similar in both groups. Scattered stone fragments buried within the tissues made the procedure more difficult for stone fragmenting and extracting, which lead to longer operative time and inferior stone free rate. However, the PCNL procedure was safe and effective in patients with failed SWL. The risk of complications was similar and clearance rate was encouraging.

The purpose of this study is to summarize the results of percutaneous nephrolithotomy (PCNL) for renal stones following failed extracorporeal shockwave lithotripsy (SWL), and to investigate the effect of previous SWL on the performances and morbidities of subsequent PCNL. Sixty-two patients with a history of failed SWL who underwent PCNL on the same kidney (group 1) were compared to 273 patients who had received PCNL as first treatment choice (group 2). Patient demographics, stone characteristics, operative findings, and complications were documented and compared. Groups 1 and 2 had similar patient demographics and stone characteristics. Mean time to establish access was comparable in both groups (10.5 ± 4.2 vs. 9.6 ± 4.5 min, p = 0.894). Time required to remove stones and total operative time were longer in group 1 (71.5 ± 10.3 vs. 62.3 ± 8.6 min, p = 0.011 and 95.8 ± 12.0 vs. 80.6 ± 13.2 min., p = 0.018, respectively). Group 1 had lower clearance rate compared to group 2 (83.9 vs. 93.4 %, p = 0.021), while postoperative complications were similar in both groups. Scattered stone fragments buried within the tissues made the procedure more difficult for stone fragmenting and extracting, which lead to longer operative time and inferior stone free rate. However, the PCNL procedure was safe and effective in patients with failed SWL. The risk of complications was similar and clearance rate was encouraging.

No description available.

Introduction: Extracorporeal shock wave lithotripsy (ESWL) is the standard stone treatment. Increased excretion of tubular enzymes and hypercalciuria has been reported after ESWL. We investigated the importance of renally induced hypercalciuria after ESWL. Material and Methods: 30 calcium oxalate stoneformers (23 men, 7 women), mean age 53.3 (range 30–71) years, were evaluated prospectively. Plasma calcium and creatinine concentrations and 8-hour overnight urine were measured before ESWL and on the 1st and 2nd days after ESWL. To estimate the changes of tubular reabsorption, the calcium/creatinine clearance ratios were calculated. Results: Hypercalciuria (>5 mmol/24 h) was seen in 5/30 (16.7%) before, in 12/30 (40.0%) on day 1 and in 13/30 (43.3%) on day 2 after ESWL. The mean plasma levels of calcium were significantly decreased from 2.36 mmol/l before to 2.28 mmol/l on day 2 after ESWL (p< 0.01). The mean calcium/creatinine clearance ratio was significantly increased from 0.012 before to 0.019 after ESWL (p< 0.01). Before and on day 2 after ESWL, the calcium/creatinine clearance ratio was significantly correlated with the age of the patients (r = 0.33, p< 0.04). Conclusion: Our data show an age-related significantly increased urine calcium excretion after ESWL possibly due to decreased tubular calcium reabsorption. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

No description available.

Introduction: Extracorporeal shock wave lithotripsy (ESWL) is the standard stone treatment. Increased excretion of tubular enzymes and hypercalciuria has been reported after ESWL. We investigated the importance of renally induced hypercalciuria after ESWL. Material and Methods: 30 calcium oxalate stoneformers (23 men, 7 women), mean age 53.3 (range 30–71) years, were evaluated prospectively. Plasma calcium and creatinine concentrations and 8-hour overnight urine were measured before ESWL and on the 1st and 2nd days after ESWL. To estimate the changes of tubular reabsorption, the calcium/creatinine clearance ratios were calculated. Results: Hypercalciuria (>5 mmol/24 h) was seen in 5/30 (16.7%) before, in 12/30 (40.0%) on day 1 and in 13/30 (43.3%) on day 2 after ESWL. The mean plasma levels of calcium were significantly decreased from 2.36 mmol/l before to 2.28 mmol/l on day 2 after ESWL (p< 0.01). The mean calcium/creatinine clearance ratio was significantly increased from 0.012 before to 0.019 after ESWL (p< 0.01). Before and on day 2 after ESWL, the calcium/creatinine clearance ratio was significantly correlated with the age of the patients (r = 0.33, p< 0.04). Conclusion: Our data show an age-related significantly increased urine calcium excretion after ESWL possibly due to decreased tubular calcium reabsorption. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Calculo renal, também conhecido como urolitíase, é comum com uma taxa de prevalência estimada global recente de 14,8%, a qual parece estar aumentando, com uma taxa de recorrência em cinco anos de até 50%. As várias atividades biológcas promissoras de extratos de plantas ricas em ácidos galolquínicos, como as folhas das espécies de Copaifera, levaram nosso interesse em sintetizar o éster metílico do ácido 3,4,5-tri-O-galoilquinico trissubstituído (TGAME), com o objetivo de desenvolver um composto com potencial para prevenção de cálculos renais. A síntese total incluiu seis etapas a partir dos ácidos quínico e gálico disponíveis comercialmente. O passo-chave na via sintética foi a esterificação de Steglich viável do quinato de metila com ácido 3,4,5-tribenziloxibenzóico usando diciclo-hexilcarbodiimida e N, N-(dimetilamino)piridina como reagentes de acoplamento. As estruturas químicas do composto final e seus intermediários sintéticos foram elucidados por métodos espectroscópicos, espectrométricos e espectrofotométricos de análises. O efeito potencial do composto sobre a ligação de cristal monoidratado de oxalato de cálcio (COM) à superfície de células de rim caninas tipo I de Madin-Darby (MDCKI) e o crescimento de cristais em modelo de túbulos Malpighi de Drosophila melanogaster foi investigado. As quantidades de membrana, citosólica e total de Annexina A1 (ANXA1), Alfa-enolase e HSP90 foram examinadas por análise de transferência de Western após fracionamento subcelular, as quais foram confirmadas por coloração por imunofluorescência de células cultivadas. O pré-tratamento de células MDCKI com TGAME por até 6 h diminuiu significativamente a ligação de cristal COM de uma maneira dependente da concentração. O TGAME (50 ?M) inibiu significativamente a expressão superficial de ANXA1 por microscopia de imunofluorescência, enquanto o ANXA1 intracelular aumentou. A análise de Western Blot confirmou alterações de expressão de ANXA1 na membrana e frações citosólicas de células tratadas com os compostos, enquanto a ANXA1 de células inteiras permaneceu inalterada. O TGAME também diminuiu significativamente o tamanho, o número e o crescimento de cristais de COM induzidos em um modelo de túbulos Malpighi de Drosophila melanogaster, o qual apresentou também potente atividade antioxidante em um ensaio de DPPH. Adicionalmente, realizamos estudos de biotransformação de derivados do ácido galoilquínico, utilizando fungos filamentosos, para prever seus comportamentos farmacocinéticos. Os resultados mostraram que os ácidos galoilquínicos das folhas de Copaifera lucens (fração n-butanólica, BF) foram transformados por Aspergillus alliaceus em um metabólito majoritário, o ácido 3-O-metil gálico (M1), que é um dos metabolitos conhecidos do ácido gálico estudado em humanos. O produto biotransformado foi identificado por UPLC-MS/MS. O pré-tratamento de células MDCKI com BF e seu produto transformado por 3 h diminuiu significativamente a ligação de cristal COM a estas células em concentrações de 50 ?g/mL e 5 ?M, respectivamente. Os compostos reduziram significativamente a expressão superficial das ANXA1 e HSP90 (proteínas de ligação COM) como evidenciado por microscopia de imunofluorescência, enquanto o nível intracelular aumentou. A análise por Western blot confirmou estas alterações nas frações de membrana e citosol das células tratadas com estes compostos, enquanto as células inteiras permaneceram inalteradas. M1 também apresentou atividade antioxidante promissora no ensaio DPPH. / Renal stone disease, also known as urolithiasis, is common with a recent overall estimated prevalence rate of 14.8% that appears to be rising, with a five-year recurrence rate of up to 50%. The promising diverse bioactivities of plant extracts rich in galloylquinic acids such as Copaifera species leaves prompted our interest to synthesize the tri-substituted 3,4,5-tri-O-galloylquinic acid methyl ester (TGAME), with the goal of developing a lead compound for kidney stone prevention. The total synthesis included six steps starting from commercially available quinic and gallic acids. The key step in the synthetic pathway was through Steglich esterification of methyl quinate with 3,4,5-tribenzyloxybenzoic acid using dicyclohexylcarbodiimide and N,N-(dimethylamino) pyridine as the coupling reagents. The chemical structures of the final compound and its synthetic intermediates were elucidated by spectroscopic, spectrometric and spectrophotometric methods of analyses. The potential effect of the compound on calcium oxalate monohydrate (COM) crystal binding to the surface of Madin-Darby Canine Kidney Cells type I (MDCKI) and crystal growth in a Drosophila melanogaster Malpighian tubule model were investigated. Membrane, cytosolic and total Annexin A1 (ANXA1), ?-enolase and HSP90 amounts were examined by Western blot analysis after subcellular fractionation, then confirmed by immunofluorescence staining of cultured cells. Pretreatment of MDCKI cells with TGAME for up to 6 h significantly diminished COM crystal-binding in a concentration-dependent manner. TGAME (50 ?M) significantly inhibited ANXA1 surface expression as evident by immunofluorescence microscopy, whereas intracellular ANXA1 increased. Western blot analysis confirmed ANXA1 expression changes in the membrane and cytosolic fractions of compound-treated cells, whereas the whole cell ANXA1 remained unchanged. TGAME also significantly decreased the size, number, and growth of COM crystals induced in a Drosophila melanogaster Malpighian tubule model, and possessed a potent antioxidant activity in a DPPH assay. We also have performed a biotransformation study of galloylquinic acid compounds using filamentous fungi to predict their pharmacokinetic behaviors. The results showed that galloylquinic acids from Copaifera lucens leaves (n-butanolic fraction, BF) were transformed by Aspergillus alliaceus into one major metabolite 3-O-methyl gallic acid (M1), which is one of the known metabolites of gallic acid studied in humans. The biotransformed product was identified by UPLC-DAD-MS/MS and 1H NMR. Pretreatment of MDCKI cells with BF (50 ?g/mL) and its transformed product M1 (5 ?M) for 3 h significantly diminished COM crystal-binding to these cells. The compounds significantly reduced surface expression of ANXA1 and HSP90 (COM-binding proteins) as evidence by immunofluorescence microscopy, whereas the intracellular level increased. Western blot analysis confirmed these changes in membrane and cytosolic fractions of compound-treated cells, whereas whole cells remained unchanged. M1 also showed a promising antioxidant activity in DPPH assay.