Assessment of kidney perfusion in patients with urolithiasis using radiological methods
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01.01.2018 |
Aleksandrova K.
Serova N.
Rudenko V.
Kapanadze L.
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Russian Electronic Journal of Radiology |
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0 |
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© 2018 Russian Electronic Journal of Radiology. All Rights Reserved. Urolithiasis (ICD) is one of one the most actual health problem in the world. The significant prevalence of urolithiasis in the population (at least 5% of the population in industrially developed countries) forces us to constantly investigate the etiology and pathogenesis, look for effective prevention mechanisms, improve diagnostic methods and develop new technologies for conservative and operative treatment. The relevance of urolithiasis in connection with global demographic shifts has become especially important in recent years. The constant displacement of the age pyramid of the developed countries society towards the proportion of elderly and senile populations leads to an increase in the ICD frequency. The development of endoscopic equipment, the creation of new contact lithotripotors improving the methods of nephrolithotripsy have made it possible to solve the problem of ICD. Currently, one of the topical issues is the choice of diagnostic method to predict and evaluate the effectiveness of treatment in patients with ICD. Studies have shown that urolithiasis directly affects intracellular hemodynamics. The change in renal blood flow in ICD patients depends on the nature of urodynamic disturbances, localization and size of the calculus, the duration of the disease, the presence of complications and the age of the patient. Therefore, evaluation of perfusion is necessary in studying of kidney function.
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Results of application of dual-energy computed tomography in the diagnosis of urolithiasis
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01.01.2018 |
Kapanadze L.
Serova N.
Rudenko V.
Kuzmicheva G.
Aleksandrova K.
Novikov I.
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Russian Electronic Journal of Radiology |
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© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. To improve the diagnosis of urolithiasis using the latest technique-dualenergy computed tomography (DECT). Materials and methods. A prospective study of a group of 91 (100%) patients was conducted at the department of radiology and urology at the Russian-Japanese Center in Sechenov University. All patients underwent a dual-energy CT scan to predict the chemical composition of urinary stones "in vivo". All patients underwent surgical treatment after diagnostics: distance lithotripsy (DLT), percutaneous nephrolithotripsy (PHNLT), contact ureterolithotripsy (CULT). All the stones after operations were subjected to physico-chemical analysis (X-ray phase analysis, infrared spectroscopy) in order to verify the composition. Further, the diagnostic value of the dual-energy computed tomography was assessed by comparing the DECT results with the physico-chemical analysis data. Results. Using DECT in the preoperative period, the following results were obtained: 40 patients had vevellit stones, 34 patients had Ca-containing stones without vevellit, 10 patients had stones with uric acid, in 7 patients stones were classified in the group of cystine/struvite. After verification studies in the postoperative period, the following urinary stone composition was determined: 42 stones-vevellit, 34 stones-Ca-containing stones without vevellit, 10 stones with uric acid, 5 stones-struvite stones. At the same time the following results were obtained incorrectly using DECT: 7 stones with vevellit from which 4 stones were postoperatively confermed to the group of Ca-containing stones without vevellit, 3 stones-struvite/cystine stones; 4 Ca-containing stones without vevellite were classified in the group of the vevellite; 2 struvite stones: 1 stone was incorrectly assigned to the group of uric acid, 1 stone-to the group of the vevellite; 1 stone uric acid was incorrectly assigned to the group of struvite stones. It should also be noted that 1 stone had a mixed composition (uric acid 70% + vevellit 23% + veddellite 7%), according to the results of DECT it was incorrectly assigned to the group of stones from uric acid, at the same time the prevailing component was determined correctly. Conclusions. In order to predict the chemical composition of the stone "in vivo" with a high degree of reliability DECT in the preoperative period can differentiate not only the urate and Ca-containing stones, but also separately identify the stones in which vevellit is the predominant component. The detailed differentiation of Ca-containing stones, as well as of more rare stones, such as struvite and cystine, requires further studies with more significant groups of stones.
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Prediction of the results of remote shock-wave lithotripsia in patients with nephrolythisis
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01.01.2018 |
Bobylev D.
Chekhonatskaya M.
Osadchuk M.
Rossolovsky A.
Ilyasova E.
Osnovin O.
Kireeva N.
Kryuchkov I.
Chekhonatsky I.
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Russian Electronic Journal of Radiology |
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© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. The aim of the study is an increasing frequency of predicting the results of remote shock wave lithotripsy in patients with nephrolithiasis. Matherials and methods. The study involved 127 patients with diagnosed urolithiasis with the presence of a single renal calculus from 10 to 17 mm in size. All patients underwent a complex of laboratory analyses, multispiral computed tomography. The concrement elimination was carried out by extracorporeal shock-wave lithotripsy. Results. In this study, there were no sufficient relationships between the maximum size and average density of stone and the number of extracorporeal lithotripsy sessions in patients with nephrolithiasis. On the contrary, the parameter of the "homogeneity" of the stone, reflecting its structure, showed a strong reliable relationship with the effectiveness of extracorporeal shock-wave lithotripsy, as well as high sensitivity and specificity. Using this indicator, it was possible to increase the percentage of successful procedures from 56,9% to 75,8%. Conclusion. The maximum size and average density of stone have insufficient diagnostic value in predicting the results of shock-wave lithotripsy in patients with single kidney stones 10-17 mm in size. In this case, an indicator of the "homogeneity" can be used to select the optimal method of treatment.
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Genetic and biochemical features of the monogenic hereditary urolithiasis
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01.01.2018 |
Mikhaylenko D.
Prosyannikov M.
Baranova A.
Nemtsova M.
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Biomeditsinskaya Khimiya |
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© 2018 Russian Academy of Medical Sciences. All Rights Reserved. Urolithiasis is a common urological problem. In most cases, this multifactorial pathology develops due to the combination of inherited low-penetrance gene variants and environment factors such as urinary tract infections and unbalanced diet. However, some cases are monogenic. These hereditary forms of urolithiasis manifest in childhood, and are characterized by multiple, bilateral and recurrent kidney stones and progress to chronic renal failure relatively early. Due to widening acceptance of exome and gene panel sequencing, substantially larger percentages of urolithiasis cases are now attributed to hereditary causes, up to 20% among patients of 18 years old or younger. Here we review genetic and biochemical mechanisms of urolithiasis, with an emphasis on its hereditary forms, including fermentopathies (primary hyperoxaluria, adenine phosphorobosyltransferase deficiency, phosphoribosyl-pyrophosphate-synthetase deficiency, xanthinuria, Lesch-Nihan syndrome) and these caused by membrane transport alterations (Dent's disease, familial hypomagnesia with hypercalciuria and nephrocalcinosis, hypophosphatemic urolithiasis, distal tubular acidosis, cystinuria, Bartter's syndrome). We suggest a comprehensive gene panel for NGS diagnostics of the hereditary urolithiasis. It is expected that accurate and timely diagnosis of hereditary forms of urolithiasis would enable the counselling of the carriers in affected families, and ensure personalized management of the patients with these conditions.
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