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Background Urolithiasis, a prevalent condition characterized by a high rate of incidence and recurrence, necessitates accurate preoperative diagnostic methods to determine stone composition for effective clinical management. Current diagnostic practices, reliant on postoperative specimen analysis, often fail to facilitate timely and precise therapeutic decisions, leading to suboptimal clinical outcomes. This study introduces an artificial intelligence model developed to predict infectious and non-infectious urolithiasis preoperatively using clinical data and CT imaging. Methods Data from December 2014 to November 2021 involving 642 patients undergoing surgical treatment for urolithiasis were used to train and validate the model. The model integrates Visual and Textual Transformation (VTT) and Multimodal-Segmentation Attention Fusion (MSAF) modules to enhance the diagnostic process. Results The model demonstrated superior accuracy and reliability in differentiating between infectious and non-infectious urolithiasis compared to traditional diagnostic methods. It achieved a classification accuracy of 79.66%, Area Under Curve of 86.74%, significantly outperforming conventional ResNet architectures and similar models. The inclusion of clinical parameters substantially improved the model’s predictive capabilities. Conclusions Our model provides an efficient tool for the preoperative identification of urolithiasis type, supporting clinical decisions regarding surgical planning and postoperative care. Its ability to process and analyze complex clinical and imaging data preoperatively positions it as a valuable adjunct in urological practice, particularly in settings with limited access to specialized medical resources.

Excessive consumption of fructose (FR) leads to obesity, metabolic syndrome (MS) and insulin resistance, which are known risk factors for kidney stones. The epidemiological study has suggested the association between fructose consumption and urolithiasis, but the precise mechanism is still not well understood. Male Wistar rats were assigned for 8 weeks to three groups with different FR content in diet: RD (n = 5)—regular diet with a FR < 3%; F10 (n = 6)—regular diet with an addition of 10% Fr in drinking water; F60 (n = 5)—60% FR as a solid food. Serum concentration of FR, creatinine (Cr), insulin (Ins), triglycerides (Tg), homocysteine (HCS), uric acid (UA), calcium (Ca), phosphate (Pi), magnesium (Mg) and sodium (Na) were measured. Based on 24 h urine collection the following tests were performed: urine pH, proteinuria (PCR), excretion of N-Acetyl-(D)-Glucosaminidase (NAG), monocyte chemoattractant protein (MCP-1), uric acid (uUAEx), phosphate (uPiEx), calcium (uCaEx), magnesium (uMgEx) and sodium (uNaEx). The creatinine clearance (CrCl) was calculated. Calcium deposits in kidney sections were examined using hematoxylin and eosin (HE) and von Kossa stains. The rats on F10 and F60, as compared to the RD diet, showed a tendency for lower CrCl, higher HCS level and some features of MS as higher Ins and TG levels. Interestingly, F10 (fluid) versus F60 (solid) diet led to higher serum Ins levels. F10 and F60 versus RD demonstrated higher urinary excretion of MCP-1 and NAG which were suggestive for inflammatory injury of the proximal tubule. F10 and F60 as compared to RD showed significantly lower uUAEx, although there were no differences in clearance and fractional excretion of UA. F60 versus RD induced severe phosphaturia (>30×) and natriuria (4×) and mild calciuria. F10 versus RD induced calciuria (3×), phosphaturia (2×) and mild natriuria. Calcium phosphate stones within the tubules and interstitium were found only in rats on FR diet, respectively, in two rats from the F10 group and another two in the F60 group. The rats which developed stones were characterized by significantly higher serum insulin concentration and urinary excretion of calcium and magnesium. A fructose-rich diet may promote development of calcium stones due to proximal tubule injury and metabolic syndrome.

Abstract Background Symmetric dimethylarginine (SDMA), a sensitive biomarker for detecting renal injury, has not been characterized in goats. Obstructive urolithiasis (OU) is the most common urinary tract disease in male small ruminants. Hypothesis/Objective Establish an SDMA reference interval (RI) in healthy adult goats and describe SDMA concentrations in goats with OU. We hypothesize that the SDMA RI in healthy adult goats will be similar to that of other adult veterinary species and that SDMA can be utilized to assess the renal function of goats experiencing OU. Animals Fifty-five healthy adult male and female goats from a university herd were enrolled for SDMA RI development. Twenty male and female goats from a university herd were enrolled for validation of the SDMA RI established. Thirteen male goats diagnosed with OU were enrolled. Methods Clinical trial. Serum samples for all animals enrolled were collected and analyzed for SDMA using an immunoassay (IDEXX Laboratories, Inc); goats with OU had additional blood work analyzed (PCV, total solids, and serum biochemistry). Symmetric dimethylarginine and other values in goats with OU were analyzed and compared at specific time points. Results The SDMA RI for healthy, adult goats is 8.03 μg/dL (90% CI 4.81-11.04) to 25.93 μg/dL (90% CI 22.88-28.97). There was no correlation identified between serum creatinine and SDMA in goats with OU. Conclusions and Clinical Importance The SDMA RI for adult goats is higher than in other adult large animal species. Use of SDMA in goats with OU is not useful in assessing their renal function.

Patients with intestinal fat malabsorption and urolithiasis are particularly at risk of acquiring fat-soluble vitamin deficiencies. The aim of the study was to evaluate the vitamin status and metabolic profile before and after the supplementation of fat-soluble vitamins A, D, E and K (ADEK) in 51 patients with fat malabsorption due to different intestinal diseases both with and without urolithiasis. Anthropometric, clinical, blood and 24-h urinary parameters and dietary intake were assessed at baseline and after ADEK supplementation for two weeks. At baseline, serum aspartate aminotransferase (AST) activity was higher in stone formers (SF; n = 10) than in non-stone formers (NSF; n = 41) but decreased significantly in SF patients after supplementation. Plasma vitamin D and E concentrations increased significantly and to a similar extent in both groups during intervention. While plasma vitamin D concentrations did not differ between the groups, vitamin E concentrations were significantly lower in the SF group than the NSF group before and after ADEK supplementation. Although vitamin D concentration increased significantly in both groups, urinary calcium excretion was not affected by ADEK supplementation. The decline in plasma AST activity in patients with urolithiasis might be attributed to the supplementation of ADEK. Patients with fat malabsorption may benefit from the supplementation of fat-soluble vitamins ADEK.

Background In light of inconsistent evidence from previous observational studies regarding the correlation between serum vitamin D levels and urolithiasis, this study aimed to investigate the genome-wide causal association between genetically predicted serum 25(OH)D levels and urolithiasis using the Mendelian randomization (MR) approach. Methods In this study, we utilized genome-wide association studies (GWAS) summary statistics from the UK Biobank and SUNLIGHT consortium for serum vitamin D levels, as well as urolithiasis data from FinnGen. We employed bidirectional two-sample MR analysis to evaluate potential causal relationships. The primary MR analysis relied on the inverse variance weighted (IVW) method, supplemented by MR-Egger, weighted median, and weighted mode approaches. Sensitivity analyses were conducted to ensure result robustness, including Cochran’s Q test, MR-Egger intercept test, leave-one-out tests, and MR pleiotropy residual sum and outlier (MR-PRESSO) test. Results The MR analysis indicated no significant causal effects of serum 25(OH)D levels on urolithiasis [IVW method: (kidney and ureteral stones: OR = 1.134;95% CI, 0.953 to 1.350, p  = 0.155; lower urinary tract stones: OR = 1.158; 95% CI, 0.806 to 1.666, p  = 0.428)]. However, according to the IVW results, genetically predicted kidney and ureteral stones were associated with decreased serum 25(OH)D levels (beta = -0.025; 95% CI, -0.048 to -0.003; p  = 0.028), while they did not indicate a causal effect of lower urinary tract stones on serum 25(OH)D levels (beta = -0.002; 95% CI, -0.013 to -0.008; p  = 0.662). A sensitivity analysis suggested the robustness of these causal associations. Conclusions Our MR study did not provide evidence supporting a causal association between serum 25(OH)D levels and urolithiasis among individuals of European descent. However, there might exist a negative causal association between kidney and ureteral stones and serum 25(OH)D levels.

Background Urolithiasis is a multifactorial systemic metabolic disease influenced by genetic, environmental, and dietary factors. Although previous observational studies have established strong links between the gut microbiome, plasma metabolome, inflammatory proteome, and urolithiasis, may be influenced by various confounding factors. This study aims to elucidate the causal relationships between gut microbiota (GM) and urolithiasis, and to investigate whether plasma metabolites and inflammatory proteins mediate this interaction. Methods We utilized publicly available dataset from genome-wide association studies (GWAS) to obtain data on GM, plasma metabolites, inflammatory proteins and urolithiasis. To elucidate the causal relationship between GM and urolithiasis, we conducted bidirectional Mendelian randomization (MR) analyses. Additionally, a two-step MR approach was applied to investigate whether GM contributes to the development of urolithiasis via plasma metabolites and inflammatory proteins, quantifying the mediation effect. Inverse variance weighting (IVW) was the primary method, with Bayesian weighted Mendelian randomization (BWMR), MR-Egger, and weighted median (WM) analyses used to ensure the robustness of our findings. Tests for horizontal pleiotropy and heterogeneity were conducted to confirm the reliability of the results. Outcome MR analyses identified causal relationships between seven GM taxa and six metabolic pathways with urolithiasis, while urolithiasis induced changes in 13 GM taxa and five metabolic pathways. Additionally, 43 plasma metabolites (27 identified, 8 unidentified, and 8 metabolite ratios) and six inflammatory proteins were identified as potential mediators in the GM-urolithiasis connection. Through two-step mediation analysis, 13 causal pathways were identified. After excluding metabolic pathways and unidentified metabolites, we determined that galactonate and LAP-TGF-β1 mediate the relationship between Bacteroides faecis , Alistipes finegoldii , and urolithiasis, with mediation proportions of 16.99% ( P  = 0.0371) and 9.61% ( P  = 0.0469), respectively. Conclusion The present MR analysis provides evidence supporting causal relationships between specific GM taxa and urolithiasis, with plasma metabolites and inflammatory proteins emerging as potential mediators.

The peritoneal injection of monosodium glutamate (MSG) can induce kidney injury in adult rats but the effects of long-term oral intake have not been determined. We investigated the kidney histology and function in adult male Wistar rats that were fed ad libitum with a standard rat chow pellet and water with or without the addition of 2 mg/g body weight MSG/day in drinking water (n=10 per group). Both MSG-treated and control animals were sacrificed after 9 months when renal function parameters, blood and urine electrolytes, and tissue histopathology were determined. MSG-treated rats were more prone to kidney stone formation, as represented by the alkaline urine and significantly higher activity product of calcium phosphate. Accordingly, 3/10 MSG-treated rats developed kidney stones over 9 months versus none of the control animals. Further, 2/10 MSG-treated rats but none (0/10) of the controls manifested hydronephrosis. MSG-treated rats had significantly higher levels of serum creatinine and potassium including urine output volume, urinary excretion sodium and citrate compared to controls. In contrast, MSG-treated rats had significantly lower ammonium and magnesium urinary excretion. Oral MSG consumption appears to cause alkaline urine and may increase the risks of kidney stones with hydronephrosis in rats. Similar effects in humans must be verified by dedicated studies.

Background Urolithiasis is among the most prevalent and possibly devastating diseases. It affects millions worldwide, and a cheap or rapid biomarker is required to diagnose it. Previous investigations revealed that inflammation has a role in the progression of urolithiasis patients, and an elevated neutrophil-to-lymphocyte ratio (NLR) value can be a valuable biomarker to ensure inflammation and, consequently, renal stones. This study was conducted to summarize the results of studies investigating the role of NLR in urolithiasis. Methods We systematically searched three main databases (Scopus, PubMed, and Web of Science) up to January 1, 2023. Our study was registered in PROSPERO (CRD42024500756). Results Ultimately, 33 studies were selected for this review article. Patients in either acute or subacute phase exhibited higher NLR levels than healthy controls. Also, patients in acute and subacute phases significantly differed regarding NLR levels. In addition, studies showed that NLR could predict sepsis and systemic inflammatory response syndrome (SIRS) among urolithiasis patients. In addition, evidence reported that NLR was helpful in the prediction of spontaneous stone passage among these patients. Conclusion Our results support a reliable biomarker that is easily added into clinical settings to help predict urolithiasis patients’ condition.

Background Urolithiasis is a highly prevalent global disease closely associated with metabolic factors; however, the causal relationship between blood metabolites and urolithiasis remains poorly understood. Method In our study, we employed a bi-directional two-sample Mendelian randomization (MR) analysis to investigate the causal associations between urolithiasis and metabolites. The random-effects inverse-variance weighted (IVW) estimation method was utilized as the primary approach, complemented by several other estimators including MR-Egger, weighted median, colocalization and MR-PRESSO. Furthermore, the study included replication and meta-analysis. Finally, we conducted metabolic pathway analysis to elucidate potential metabolic pathways. Results After conducting multiple tests for correction, glycerol might contribute to the urolithiasis and dehydroisoandrosterone sulfate (DHEA-S) might inhibit this process. Furthermore, several blood metabolites had shown potential associations with a causal relationship. Among the protective metabolites were lipids (dehydroisoandrosterone sulfate and 1-stearoylglycerol (1-monostearin)), amino acids (isobutyrylcarnitine and 2-aminobutyrate), a keto acid (acetoacetate) and a carbohydrate (mannose). The risk metabolites included lipids (1-palmitoylglycerophosphoethanolamine, glycerol and cortisone), a carbohydrate (erythronate), a peptide (pro-hydroxy-pro) and a fatty acid (eicosenoate). In reverse MR analysis, urolithiasis demonstrated a statistically significant causal relationship with butyrylcarnitine, 3-methyl-2-oxobutyrate, scyllo-inositol, leucylleucine and leucylalanine. However, it was worth noting that none of the blood metabolites exhibited statistical significance after multiple corrections. Additionally, we identified one metabolic pathway associated with urolithiasis. Conclusion The results we obtained demonstrate the causal relevance between two metabolites and urolithiasis, as well as identify one metabolic pathway potentially associated with its development. Given the high prevalence of urolithiasis, further investigations are encouraged to elucidate the mechanisms of these metabolites and explore novel therapeutic strategies.

Desmodium styracifolium (D. styracifolium) has been widely used in traditional Chinese medicine for the treatment of urolithiasis. This work was undertaken to investigate extracts from different polarity fractions of D. styracifolium for possible antilithic effects as well as antioxidant potential to explore the underlying phytochemically active constituents of this plant. The extracts of D. styracifolium were divided into four different polarity fractions by petroleum ether (Fr. PE), chloroform (Fr. CH), ethyl acetate (Fr. EA), and n-butyl alcohol (Fr. NB). The antilithic and antioxidant effects were evaluated and compared in vivo on an animal model of calcium oxalate (CaOx) urolithiasis, which was established by administration of 1 % ethylene glycol along with 2 % ammonium chloride in drinking water for 28 days. A total of 60 male Sprague-Dawley rats were randomly divided into six groups: normal control group, lithogenic group, and four different polarity fractions of D. styracifolium-treated groups. At the end of the study, urine, blood, and kidney tissue samples were all collected for evaluation. Among the four polarity fractions of D. styracifolium extracts, the Fr. PE and Fr. NB treatment significantly reduced the CaOx crystal deposition in kidneys, prevented the renal toxic changes like pH, Cr, and BUN. In addition, Fr. PE and Fr. NB treatment significantly decreased urinary excretion of oxalate along with a increase of citrate excretion. The increased amounts of malondialdehyde and decreased activities of superoxide dismutase, catalase, and glutathione peroxidase were detected in lithogenic group, D. styracifolium extracts treatment prevented the oxidative stress changes especially for the Fr. PE and Fr. NB extracts. In conclusion, our data suggest that the extracts from D. styracifolium possess the antiurolithic activity, possibly mediated through the inhibition of CaOx crystal aggregation as well as the alleviation of oxidative injury in the kidney, and the Fr. PE and Fr. NB extracts are the active fractions of D. styracifolium extract.