Aortic calcification and lower bone mineral density (BMD) are significantly more common among recurrent kidney stone formers (KSFs) than among non-stone formers, researchers found. The finding suggests that vascular calcification (VC) “may be an underlying mechanism explaining reported associations between nephrolithiasis and cardiovascular disease,” according to a report published online ahead of print in the Clinical Journal of the American Society of Nephrology. Linda Shavit, MD, of the Adult Nephrology Unit, Shaaare Zedek Medical Center in Jerusalem, Israel, and colleagues conducted a retrospective study that included 57 KSFs and 54 healthy age- and gender-matched controls selected from a list of potential living kidney donors. Both groups had a mean age of 47 years. The researchers used computed tomography (CT) to assess abdominal aortic calcification (AAC) and vertebral bone mineral density (BMD). AAC is considered a strong predictor of cardiovascular (CV)-related morbidity or death, the researchers explained. The prevalence of AAC was similar in the KSFs and controls (38% and 35%, respectively), but AAC severity score was significantly higher in the KSFs than controls and average CT BMD was significantly lower in KSFs (159 vs. 194 Hounsfield units). In multivariate analysis, KSFs had higher AAC scores and lower CT BMD compared with non-stone forms, according to the investigators. The association between AAC score and hypercalciuria among stone formers was not statistically significant. “Although our study cannot prove causality,” the authors wrote, “this is the first study to our knowledge to provide controlled evidence for a possible role of vessel calcification and associated osteoporosis in CV morbidity among KSFs. Our findings may serve as a useful basis for future prospective trials exploring the potential benefit of therapeutically targeting the bones and cardiovascular system in KSFs as part of their routine management to mitigate CVD morbidity and mortality.” The researchers acknowledged some study limitations, including the retrospective collection of demographic and clinical variables. “Therefore, we cannot exclude known or unknown confounding factors entirely as an explanation for our results.” In addition, the control group consisted of potential living kidney donors, who may be “healthier” than the general population, they noted.
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Positive kidney stone cultures independently predict an increased risk of sepsis after stone percutaneous nephrolithotomy (PCNL), Israeli researchers concluded. Ohad Shoshany, MD, and colleagues at Tel Aviv University studied 206 consecutive patients undergoing PCNL. Forty-five patients had a positive stone culture (group A). These patients were compared with 161 patients who had a sterile stone culture (group B). Postoperative sepsis occurred in 31% of group A versus 5.9% of group B. In multivariate analysis, a positive stone culture was independently associated with a significant 6.9 times increased odds of postoperative sepsis, the researchers reported online Urolithiasis. According to the investigators, all patients responded well to treatment and experienced no septic complications. Among the patients with positive cultures, Enterococcus species and Escherichia coliwere the most prevalent gram positive and gram negative bacteria, respectively, isolated from 29.4% and 21.6% of patients, respectively. Researchers ordered a preoperative urine culture for all patients 2–4 weeks prior to surgery. Patients with a negative preoperative urine culture received prophylactic antibiotics with 1 gram cefamezin in accordance to American Urological Association/European Association of Urology guidelines. Those with a positive urine culture or a history consistent with infected stones were treated preoperatively with a full course of antibiotics for a minimum of 7 days, the researchers stated. Dr. Shoshany's team reported that quinolone resistance was high in both gram negative and gram positive bacteria. “One of the important measures to reduce the risk of postoperative infection is the preoperative antibiotic treatment to sterilize the urine,” the authors wrote. “However, infected stone patients pose a specific challenge, as in some patients the urine cannot be sterilized despite repeat antibiotic courses, due to stone colonization and poor antibiotic penetration into the stone.” |
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