Lithiasis,treatment

Urinary lithiasis is a disease in which calculi form in the kidney and urinary tract. Roughly 5 % of the human population suffers to some degree from urinary lithiasis. A number of severely afflicted patients (e.g. ca. 60,000 in West Germany and more than 100,000 in the U.S.) are hospitalized yearly for major surgical treatment. Obviously, nephrolithiasis is not only a common ailment but also an issue of great social and economic consequence. 

If the patient had a severe attack of gouty arthritis, a complicated course of uric acid lithiasis, a substantially elevated serum uric acid (greater than 10 mg/dL), or a 24-hour urinary excretion of uric acid of more than 1,000 mg, then prophylactic treatment should be instituted immediately after resolution of the acute episode. 

Before starting chronic therapy for gout, patients in whom hyperuricemia is associated with gout and urate lithiasis must be clearly distinguished from those who have only hyperuricemia. In an asymptomatic person with hyperuricemia, the efficacy of long-term drug treatment is unproved. In some individuals, uric acid levels may be elevated up to 2 standard deviations above the mean for a lifetime without adverse consequences. 

Cometta A, Gallot-Lavallee-Villars S, Iten A, Cantoni L, Anderegg A, Gonvers JJ, Glauser MP. Incidence of gallbladder lithiasis after ceftriaxone treatment. J Antimicrob Chemother 1990 25(4) 689-95. 

The mainstay of drug therapy for recurrent uric acid lithiasis is allopurinol. It is effective in reducing both serum and urinary uric acid levels, thus preventing the formation of calculi. Allopurinol is also recommended as prophylactic treatment in patients who wfll receive cytotoxic agents for the treatment of lymphoma or leukemia. The marked increase in uric acid production associated with cytolysis of a neoplasm predisposes a patient to the development of uric acid nephrolithiasis. 

Abstract— Hemiaria fcmUoKsU Gay (caiyophyllaceae) is widespread in the Mediterranean area. In the traditional pharmacopoda of Morocco, the aerial parts of this plant are used for the treatment of lithiasis. We have studied the title plant and now we report the isolation and identification of tree flavonoids and four oleanane saponins. The mixture of glycosides was isolated from the methanol extract of the aerial parts of H.fontanesii and separated by multiple chromatographic steps. The structure of the pure glycosids was elucidated by means of mass spectrometry (FAB-MS), NMR technics ( H, C, 2D homo and heteronuclear COSY) and chemical analysis (methanolysis, methylation, alkaline hydrolysis). The flavonoids isolated are (-) catechine 1 3-0-robinobioside Isorhamnetine 2 and a new one 3 feniloyl-3-O-robinobioside Isorhamnetine 3. 

Approximately 10% of the human population (with regional differences indicating both genetic and environmental factors [33]) is affected by the formation of stones or calculi in the urinary tract. Urolithiasis is not only a painful condition, but also causes annual costs to the health system in the order of billions of dollars in the USA alone [34, 35]. Based on their composition, structure and location in the urinary tract, renal stones have been classified into 11 groups and their formation mechanisms have been discussed together with alterations in urinary parameters and metabolic risk factors for renal lithiasis [35]. Approximately 70% of these stones contain calcium oxalate monohydrate (COM) and dihydrate as major components, while other calculi are composed of ammonium magnesium phosphate (struvite), calcium phosphates (hydroxyapatite and brushite), uric acid and urates, cystine and xanthine. An accurate knowledge of the solubilities of these substances is necessary to understand the cause of renal or bladder calculi formation and find ways towards its prevention and treatment [36]. 

ANALYSIS OF TREATMENT RESULTS IN URIC ACID LITHIASIS WITH AND WITHOUT HYPERURICEMIA... 

Impressed by the good results of purely conservative treatment of uric acid lithiasis, one might easily be lead to believe that every uric acid concrement could be thus treated and medicinally dissolved. However, our clinical observations indicate that frequently, only the urologist can determine whether a conservative... 

The broad spectrum of clinical presentation highlights the importance of particular steps in purine and pyrimidine metabolism to different cells and tissues and should have assisted in the development of appropriate treatment. Unfortunately, only three of the nineteen disorders described can be treated successfully hereditary orotic aciduria with life-long uridine, 2,8-di-hydroxyadenine lithiasis with allopurinol. ADA deficiency is treatable by bone marrow transplantation (BHT), or enzyme replacement with polyethylene glycol (PEG)-ADA, but the cost is prohibitive. Er/throcyte-encapsu-lated ADA is effective and less expensive. Oral ribose is reportedly beneficial in myoadenylate deaminase deficiency [1, 4] and also in adenylosucci-nase deficiency [1, 5]. PNP deficiency is also treatable by BMI. 

A calyceal diverticulum is an eventration of a calyx into the renal parenchyma that is filled with urine. Most of the diverticula are small and asymptomatic. Complications include the development of milk of calcium and lithiasis and rarely hematuria infection is unusual. The relation between diverticulum and isolated renal cyst is unclear. The diverticulum is usually detected by US as an isolated cystic structure. However, the connection with the pyelocaly-ceal system is usually not visualized on US it can be demonstrated on IVU or on CT (Fig. 5.1). Treatment is necessary only when complications such as hemorrhage or lithiasis occur (Siegel and McAllister 1979 WuLFSOHN 1980 Ulchaker et al. 1996). 

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