Objective To investigate the risk factors of infantile urolithiasis resulted from taking milk powder with melamine. Methods The clinical data of infant and young children who took free-screening for melamine associated urolithiasis in the Lanzhou University Second Hospital from September 14th, 2008 to January 6th, 2009 were collected, while the infants without urolithiasis in the same number as those with urolithiasis were also randomly collected into the control group. Then both univariate and multivariate analyses were performed with a logistic regression model to assess the independent risk factors for urolithiasis. Results Of the screened children, 647 children were included in the urolithiasis group and 647 were in the control group. There were 678 boys and 616 girls with an average age of 19.27 months. The results of logistic regression analysis showed that, the children fed with Sanlu powdered infant milk formula which contained a high level of melamine were more likely to suffer from urolithiasis than those took other melamine-contaminated formula (OR=6.09, Plt;0.01); boys were more than girls (OR=1.39, Plt;0.01), and children fed with formula alone were more than those fed with both formula and breast milk (OR=1.61, Plt;0.01). The risk of urolithiasis decreased gradually with age, and the OR value of children in age of smaller than 6 months, 6 to 12 months, 12 to 24 months were 5.23 (Plt;0.01), 2.73 (Plt;0.01), and 1.60 (Plt;0.01), respectively. The risk of urolithiasis increased gradually with the time lengthening of taking melamine-contaminated formula, and the OR value of children who had took melamine-contaminated formula for 3 to 6 months, 6 to 12 months and more than or equal to 12 months were 2.10 (Plt;0.01), 2.81 (Plt;0.01), and 4.75 (Plt;0.01), respectively. Conclusion It shows that feeding with high melamine infant formula (Sanlu powdered infant milk formula), artificial feeding and male children are the risk factors of infantile urolithiasis. Additionally, the risk of urolithiasis decreases with age and increases with time of formula feeding
Objective To discuss the prevalence of melamine-induced urolithiasis in infants and its development and to formulate more effective diagnosis and treatment. Methods A total of 402 cases of melamine-induced infantile urolithiasis were retrospectively analyzed with basic information, blood, urine, urinary B-mode ultrasonic diagnosis, treatment options and prognosis for infant urolithiasis. Results A total of 402 cases of infants had an excessive melamine milk feeding history, in which there were 9 self-discharged cases. The largest calculus diameter was 4 mm × 5 mm × 6 mm. The smallest calculus diameter was 0.5 mm × 0.5 mm × 1 mm. The average calculus diameter was 1 mm × 2 mm × 2 mm. There were 30 cases of abnormal serum creatinine, 27 of abnormal urea, 2 of abnormal uric acid, and urine occult blood positive for 167 cases. There were 395 cases which were administrated medical treatment; 7 cases were administrated surgical treatment; 6 cases had obstructive renal failure. Conclusion Infants whose age is more than six months but less than 12 months with a history of exposure to melamine have the larger risk of urolithiasis. B-mode ultrasonic diagnosis is practically significant on early screening urolithiasis. It is effective to perform surgical treatment for obstructive renal failure caused by calculus.
Objective To investigate the incidence of urolithiasis in infants aged 0-3 years old fed by milk powder tainted with melamine in the middle area of the Anhui province, as well as its relationship to gender, age, milk powder consumption and drinking water. Methods Questionnaires were distributed to 1079 infants who were screened for urolithiasis by ultrasound examination from September 25, 2008 to October 17, 2008. Data was collected by Epidata and analyzed by SPSS 13.0 software. Results A total of 646 (59.87%) male infants and 433 (40.13%) female infants underwent ultrasound examination in Anhui Provincial Hospital. Of these, 86 infants were diagnosed with urolithiasis with an incidence of 7.97%, including 62 males (72.09%) and 24 females (27.91%). The mean age of those infants with urolithiasis was 1.85±0.77, and all of calculus was located in kidney. The relationship between the incidence of urolithiasis and gender, age, drinking water, feeding bottle sanitation, birth status, as well as the amount of milk powder intake was assessed by using the Pearson Chi-square test. Results showed that significant differences were noted in the incidence of urolithiasis among infants of different genders or with different drinking water sources (Plt;0.05). The result of multiple logistic regression analyses indicated that gender was related to the incidence of urolithiasis (Plt;0.05). The incidence of urolithiasis in female infants was only 58.7% of that in male infants (OR 0.587, 95%CI 0.359 to 0.959). Conclusion The incidence of urolithiasis in infants aged 0-3 years of old in the middle area of Anhui province is relatively high and has anatomical specificity. Further data during the follow-up of these cases should be collected.
Objective To evaluate and select essential medicine for urolithiasis using evidence-based methods based on the burden of disease. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) Three evidence-based guidelines were included. Based on WHOEML (2011), NEML (2009), CNF (2010) and the quantity and quality of evidence, we made a recommendation for diclofenac sodium, nifedipine, allopurinol and ibuprofen used in symptomatic treatment of urolithiasis. (3) Results of domestic studies (including four RCTs, n=566; two observational studies, n=96) indicated that calculus-removed rates of diclofenac sodium, nifedipine and allopurinol were 91.5%, 86.4%~93.3% and 86.4% respectively with significant differences. Diclofenac sodium daily cost 7.00 to 8.57 yuan, nifedipine 1.48 to 4.44 yuan, and allopurinol 0.24 to 0.82 yuan. Ibuprofen had a total efficiency of 94.5% with a significant difference for alleviating renal colic, which cost 0.11 yuan daily. Four recommended medicines with safety, clinical efficacy, high economical efficiency and applicability had been marketed with specifications and dosage forms corresponding to guidelines in China. Conclusion For urolithiasis: (1) We offer a b recommendation for diclofenac sodium (capsule/tablet, 50 mg×24, or 25 mg×24) which is contradicted in patients with gastrointestinal bleeding and in pregnant women or women with planned pregnancy. (2) We offer a weak recommendation for nifedipine (tablet/capsule, 10 mg×100 or 10 mg×60) which is contraindicated in dialysis-receiving patients with malignant hypertension and should be cautiously used in patients with irreversible renal failure. (3) We offer a weak recommend allopurinol (tablet, 100 mg×100) which is contraindicated in patients with allergic reaction, severe insufficiency of the liver or kidney, or significant lack of blood cells. (4) We offer a b recommendation for ibuprofen (tablet, 20 mg×20) which is contraindicated in patients with allergic reaction to aspirin.
Objective To investigate the incidence of urolithiasis in infants aged 0-3 years old fed by melaminetainted milk powder in Gansu province. Methods Questionnaires were distributed to 7 856 infants who were screened for urolithiasis in the Second Hospital of Lanzhou University by ultrasound examination from September 25, 2008 to November 15, 2008. Data were collected by Excel and analyzed by SPSS 13.0 software. Results A total of 4 090 (52.06%) male infants and 3 766 (47.94%) female infants underwent ultrasound examination in the Second Hospital of Lanzhou University. The mean age of the infants with urolithias was 18.30±9.68 months. Of those, 704, including 434 males (61.65%) and 270 females (38.35%), were diagnosed with urolithiasis, with an incidence of 8.96%, and 99.14% of calculus was located in kidney. And, 58 aged 0-6 months with an incidence of 3.16%, 218 aged 6-12 months with an incidence of 11.01%, 275 aged 12-24 months with an incidence of 12.55%, and 153 aged 24-36 months with an incidence of 8.27%. The relationship between the incidence of urolithiasis and gender as well as age was assessed by using the Pearson Chi-square test. The results showed significant differences in the incidence of urolithiasis among infants of different genders and different ages (Plt;0.05). The result of multiplelogistic regression analysis indicated that gender was related to the incidence of urolithiasis (Plt;0.05). Conclusion The incidence of urolithiasis in the infants aged 0-3 years old in Gansu province is relatively high. The incidence of urolithiasis focuses on the infants aged 6-24 months and has anatomical specificity.
Objective To investigate the incidence of urolithiasis in the children who ingested milk powder tainted with melamine in the Chengdu area. Methods A total of 5 795 infants were screened for urolithiasis by ultrasound examination from September 17, 2008 to December 9, 2008. The data were analyzed using SPSS 13.0 software.Results Twenty-four children were diagnosed with urolithiasis with an incidence of 0.41%, including 12 males and 12 females. The mean age of those children with urolithiasis was 2.35±1.68 years old. No significant difference was shown in the incidence of urolithiasis between males and females (Pgt;0.05). The incidence of urolithiasis in the infants aged 0-3 was significantly higher than that in the children who were more than 3 years old (Plt;0.05). Conclusion The incidence of urolithiasis in the infants aged 0-3 in Chengdu and the surrounding areas is relatively high. Further data should be collected during the follow-up of these cases.
ObjectivesTo analyze prospective incidence and risk factors of urolithiasis after Topiramate (TPM) therapy in epileptic patients. MethodsWe prospectively analyzed the incidence of urolithiasis in 120 patients with epilepsy who diagnosed in the Department of Neurology of the First Hospital Affiliated to Dalian Medical University from March 2004 to March 2013. Then calculated the incidence of urolithiasis, and analyzed the risk factors. ResultsIn the 120 cases we collected, male accounted for 74, female accounted for 46. After treated with TPM, the incidence of urolithiasis was 18.3%. All of urolithiasis were kidney stones. The stones caused by TPM were mostly single and small, most of which would disappear spontaneously after discontinuation of the medication. The incidence of asymptomatic urolithiasis was 3.4 times to that of symptomatic urolithiasis. The development of urolithiasis had no correlation with the dose of TPM and duration. Urolithiasis frequently occurred in epilepsy patients in the age over 20 or symptomatic epilepsy or duration of combined medication≥3 months. ConclusionsThe incidence of urolithiasis in epilepsy patients was 18.3% after initiating TPM therapy. The stones would disappear spontaneously after discontinuation of the medication. The development of urolithiasis had no correlation with the dose of topiramate and duration.
Objective To compare clinical outcomes of percutaneous nephrolithotomy (PCNL) in patients who initially presented with and without urosepsis. Methods The study included patients who underwent PCNL for renal and ureter urolithiasis removal from January 2010 to December 2014 in our hospital. A 1∶1 matched-pair analysis was performed to compare outcomes and complications of patients who had obstructive urolithiasis with urosepsis initially (OUU) with patients who had obstructive urolithiasis with no urosepsis initially (NOUU) before PCNL. Results A total of 172 patients were included involving 122 (71%) males and 50 (29%) females with a mean age of 46.2 years (range 32 to 65 years). There were no significant differences between two groups in age, gender, BMI, complications, the size of the stones, stone's number and stone location (P>0.05). OUU groups had the similar stone-free rates (86.0%vs. 84.8%, P=0.829) as the NOUU group. OUU group had higher overall complications rate, longer duration of nephrostomy tube (NT), longer hospital length of stay (LOS), longer courses of postoperative antibiotics and higher grade of antibiotics after PCNL (all P<0.05). Higher fever developed postoperatively (11.6%vs. 3.5%, P=0.043), higher asymptomatic bacteriuria (11.6% vs. 3.5%, P=0.043) and symptomatic urinary tract infections (10.5% vs. 2.3%, P=0.029) were also found in OUU groups. There was no significant difference between two groups in sepsis (2.3% vs. 1.2%, P=0.560). Conclusion PCNL after decompression for urolithiasis-related urosepsis has similar success but higher complication rates than obstructive urolithiasis with no urosepsis initially.
Objective To investigate the correlation between smoking, alcohol, chronic diseases, fasting plasma glucose levels, uric acid and the incidence of urolithiasis. Methods A 1∶1 pair-wise matching design was used in case-control study. We randomly selected 150 samples from 459 patients with urolithiasis in Zhongnan Hospital of Wuhan University from May 2015 to November 2015. Patient with intact information were identified as case group. The control group were patients who hospitalized in the same period without urolithiasis matched by gender, ethnic, and marital status. Univariate ANOVA and multivariate conditional logistic regression were used to test the differences between the two groups. Results A total of 125 patients in case group and 125 patients in control group were included. The peak age of urolithiasis was 50 to 70 years old, male patients accounted for 70.75% of the population, and one side urolithiasis accounted for 62.24% of the stone types. The results of multivariate conditional logistic regression showed that hyperuricemia was the related factor of urolithiasis (OR=5.19, 95%CI 2.27 to 11.91, P<0.01). Conclusions Hyperuricemia is a high risk factor for urolithiasis.