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S54 CHEMICAL COMPOSITION OF URINARY TRACT STONES IN REPUBLIC OF MACEDONIA
S52
Central anti-inflammatory action of Serenoa repens in Wistar rats
Duborija-Kovacevic N.1, Jakovljevic V.2, Sabo A.2 1 Medical School of The University of Montenegro, Dept. of Pharmacology and Clinical Pharmacology, Podgorica, Montenegro, 2Medical School of The University In Novi Sad, Dept. of Pharmacology, Toxicology and Clinical Pharmacology, Novi Sad, Serbia Introduction & Objectives: The etiology of BPH is multifactorial and still not fully clarified. In recent time, chronic inflammation has been mentioned as one of the possible non-hormonal etiological factors. The aim of our study was to examine the central anti-inflammatory potential of lipidosterolic extracts of Serenoa repens in experimental animals in suitable pharmacodynamic model. Material & Methods: We applied the test that was introduced by Dubuisson and Dennis 1977th as a model for chronic pain and investigation of the central anti-inflammatory effects of drugs. The first control group of Wistar rats (O, n=6) received food and water ad libitum. The second control group (OO, n = 6) received olive oil (1ml/kgBW daily). S. repens extract was dissolved in olive oil and was applied in 5 and 10 times higher daily doses in relation to human (SR5 and SR10). After thirty-day treatment, animals were injected with 0.1 ml of 1% formalin solution into the skin of the right hind paw, while their left paw was injected with the same amount of sterile saline. Animals were returned to cages to develop inflammation. Anti-inflammatory action of applied substances was estimated by the comparison of the percentage of the paws’ weight change. Results: One-month pretreatment with SR5 in applied dose of 150mg/kg didn’t cause a significant central anti-inflammatory action compared to both control groups of rats (O and OO) (p>0.05). Difference in paws’ weight and the percentage of weight change in SR5 were unchanged significantly compared to control groups (p>0.05). SR10 showed central anti-inflammatory action to some extent in relation to OO. Difference in paws’ weight in SR10 was statistically significant compared to OO (0.41+0.04/0.56+0.09) (p<0.01), but percentage of weight change (20.27+2.38/25.31+4.86) didn’t achieve significant difference (p>0.05). Conclusions: In applied pharmacodynamic model S. repens didn’t show antiinflammatory effect on the central level, which doesn’t mean that it does not exist at the peripheral level. The results obtained in the group of animals that received a tenfold higher dose of extract (SR10) indicate the need for further and more comprehensive examination.
Poster Session IV STONES UROLITHIASIS Friday, 14 October, 14.50-16.30, Poster session room 1
S53
Primary gout as a risk factor for urolithiasis
Radosavljevic Z.1, Savic S.2, Savic N.2, Radosavljevic N.3 1 SBIB-Mladenovac, Dept. of Urology, Belgrade, Serbia, 2KBC-Misovic, Dept. of Urology, Belgrade, Serbia, 3Institute For Rehabilitation, Dept. of Rheumatology, Belgrade, Serbia Introduction & Objectives: Frequency of urolithiasis in patients with gout is higher than in general population. Earlier studies found out the incidence of urolithiasis in patients with gout is around 20% and recent data obtained by monitoring and asymptomatic patients suggest that percentage of patients with urolithiasis in primary gout patients is between 37% and 50%. The data indicate that urolithiasis may be associated with hyperlipidemia, elevated arterial pressure and diabetes. The aim of this study was to determine the frequency of urolithiasis in the observed group of patients with gout. Material & Methods: This study included 78 gout patients . Data abut presense of urolithiasis were obtained from the previously recorded episode ofcliniclu confirmed urolithiasis in the medical records of patients or on the basis of ultrasonographic examination. We also recorded data about patients age, disease duration, presence of hyperlipidemia, hypertension and diabetes mellitus, and examed correlation with the presence of urolithiasis. Results: In our study we have 78 patients with primary gout, 69 (88,46%) males, average age of 58.32. Duration of gout was between 1 and 35 years, in average 6.83 years. In this sample 42 (53, 85%) patients with primary gout didn`t have urolithiasis, 15 (19.23%) had episodes of urolithiasis in their medical record, and 21 (26, 92%) were patients with silent kidney stone. Overall frequency of urolithiasis with primary gout in our sample was 46, 15%. We recorded hyperlipidemia in 52 cases (66, 67%), arterial hypertension in 43 cases (55, 12%) and diabetes in 26 cases 33, 33%). There was no statistically significant correlation of presents of urolithiasis in gout patients, and their age, hyperlipidemia, high blood pressure and diabetes. We found statically significant correlation between urolothiasis and duration of gout (p<0.001).
Conclusions: The frequency of urolithiasis in our sample was 46.15%, and 26, 92% were patients with silent kidney stone. The most important predictive factor for the development of urolithiasis is duration of gout and regular ultrasound examination is essential to detect patients with urolithiasis in this population.
S54
Chemical composition of urinary tract stones in Republic of Macedonia
Davceva O.1, Nikolov G.2, Ivanovski O.3 1 Medical Faculty, University “Ss Cyril and Methodius”, University Clinic of Clinical Biochemistry, Skopje, Macedonia, 2Medical Faculty, University “Ss Cyril and Methodius”, University Clinic of Nephrology, Skopje, Macedonia, 3Medical Faculty, University “Ss Cyril and Methodius”, University Clinic of Urology, Skopje, Macedonia Introduction & Objectives: The aim of the study was to assess the chemical composition of spontaneously excreted or surgically removed stones of patients with urolithiasis from Republic of Macedonia using the Merckognost reagent kit. Material & Methods: A total of 522 urinary tract calculi were obtained from 522 patients (334 males; 188 females) in the last 10 years. Results: The most common component of renal calculi was oxalate (99.8%). This was followed by calcium (98,7%), phosphate (92,9%), ammonium (55.3%) uric acyd (16.8%), and magnesium (8.6%). There were four cystine containing stones (2.6%). By using the calculation formula proposed in the kit, the following chemical compounds were determined: Calcium oxalate containing stones were predominant (98.4%) followed by magnesium ammonium phosphate (52,6%), calcium phosphate (25%), ammonium urate (18,1%), ammonium phosphate (15,9%) and cystine (4%). The majority of stones were mixed (calcium oxalate + magnesium ammonium phosphate, calcium oxalate + calcium phosphate, calcium oxalate + ammonium urate and calcium phosphate + magnesium ammonium phosphate). The male-to-female ratio was 1.7:1. Conclusions: In our series, calcium oxalate with magnesium ammonium phosphate were the most frequent components of urinary calculosis. Uric acid was more frequently the major component in men, while magnesium ammonium phosphate was more frequent in women. These findings may be related to regional factors such as weather and nutritional habits.
S55
Morphology and composition of kidney stones in patients with autosomal dominant polycystic kidney disease (ADPKD)
Nikolov I.G.1, Ivanovski O.2, Daudon M.3, Sikole A.1, Knebelman B.4 1 Medical Faculty, University “Ss Cyril and Methodius”, University Clinic of Nephrology, Skopje, Macedonia, 2Medical Faculty, University “Ss Cyril and Methodius”, University Clinic of Urology, Skopje, Macedonia, 3Necker Hospital, Department of Biochemistry A, Paris, France, 4Necker Hospital, Univerisity Rene Descartes, Department of Nephrology, Paris, France Introduction & Objectives: Nephrolithiasis is more prevalent in patients with autosomal dominant polycystic kidney disease (ADPKD) than in general population. The diagnosis of lithiasis in these patients is hindered by the distorted anatomy of the polycystic kidneys and the frequent occurrence of parenchymal and cystic wall calcifications. Morphologic examination of urinary stones that points to specific lithogenic factors has been seldom reported in ADPKD. Material & Methods: A retrospective study of ADPKD patients in a referral center in Paris, France was performed. Medical files of 208 ADPKD patients referred to our center between 1998 and 2008 were analysed to assess kidney stones frequency by radiological methods and to understand its characteristics using morphological, infra-red spectrophotometry and chemical stone analysis. Cyst wall calcifications detected by radiographic procedures were excluded. Results: We have found that during this period of time 29 (13.9%) ADPKD patients had experienced nephrolithiasis including those who had a clinical manifestation of colic pain and/or ultrasonography, native roentgen, CT scan detection of kidney stones. Ten kidney stones could be analysed in 8 patients. The most common type of stone was IIIb in 5 (50%) cases or 4 patients and oxalo dependent in 3 (30%) cases or 2 patients (25%). Two patients (25%) had a combined urico-oxalodependent lithiasis and in these patients the stone nucleus was uric acid (type IIIb). Superficial morphology of the stones was IIIb in 5 cases and Ia, Ib and Id each in 1 case. Morphology of the stone nucleus was IIIb in 7 cases, Ia, Ib, and IVa in 1 case. Infrared spectophotometry analysis confirmed uric acid in the nucleus of 7/10 stones. In two cases, whewellite (calcium oxalate monohydrate) was the main component of the stone (60%), whereas uric acid represented only 30% but was the only component found in the nucleus. Mean value for urine pH was 5.3±0.7, and mean value for urinary uric acid was 3.5±1.5 mmol/L/24h suggesting that increased urinary uric acid was not a major determinant of stone formation. Conclusions: Our data provide evidence that ADPKD is associated with a high proportion of uric acid stones. Composition of the stone, low urine pH, suggest that metabolic, along with mechanical factors are responsible for the occurrence of nephrolithiasis in ADPKD. The undergoing pathophysiology of uric acid stone formation in ADPKD remains to be clarified. Upcoming therapies aimed at reducing the size of cysts, may help to reduce the occurrence of renal stones.
Eur Urol Suppl 22011;10(9):589
Central anti-inflammatory action of Serenoa repens in Wistar rats
Duborija-Kovacevic N.1, Jakovljevic V.2, Sabo A.2 1 Medical School of The University of Montenegro, Dept. of Pharmacology and Clinical Pharmacology, Podgorica, Montenegro, 2Medical School of The University In Novi Sad, Dept. of Pharmacology, Toxicology and Clinical Pharmacology, Novi Sad, Serbia Introduction & Objectives: The etiology of BPH is multifactorial and still not fully clarified. In recent time, chronic inflammation has been mentioned as one of the possible non-hormonal etiological factors. The aim of our study was to examine the central anti-inflammatory potential of lipidosterolic extracts of Serenoa repens in experimental animals in suitable pharmacodynamic model. Material & Methods: We applied the test that was introduced by Dubuisson and Dennis 1977th as a model for chronic pain and investigation of the central anti-inflammatory effects of drugs. The first control group of Wistar rats (O, n=6) received food and water ad libitum. The second control group (OO, n = 6) received olive oil (1ml/kgBW daily). S. repens extract was dissolved in olive oil and was applied in 5 and 10 times higher daily doses in relation to human (SR5 and SR10). After thirty-day treatment, animals were injected with 0.1 ml of 1% formalin solution into the skin of the right hind paw, while their left paw was injected with the same amount of sterile saline. Animals were returned to cages to develop inflammation. Anti-inflammatory action of applied substances was estimated by the comparison of the percentage of the paws’ weight change. Results: One-month pretreatment with SR5 in applied dose of 150mg/kg didn’t cause a significant central anti-inflammatory action compared to both control groups of rats (O and OO) (p>0.05). Difference in paws’ weight and the percentage of weight change in SR5 were unchanged significantly compared to control groups (p>0.05). SR10 showed central anti-inflammatory action to some extent in relation to OO. Difference in paws’ weight in SR10 was statistically significant compared to OO (0.41+0.04/0.56+0.09) (p<0.01), but percentage of weight change (20.27+2.38/25.31+4.86) didn’t achieve significant difference (p>0.05). Conclusions: In applied pharmacodynamic model S. repens didn’t show antiinflammatory effect on the central level, which doesn’t mean that it does not exist at the peripheral level. The results obtained in the group of animals that received a tenfold higher dose of extract (SR10) indicate the need for further and more comprehensive examination.
Poster Session IV STONES UROLITHIASIS Friday, 14 October, 14.50-16.30, Poster session room 1
S53
Primary gout as a risk factor for urolithiasis
Radosavljevic Z.1, Savic S.2, Savic N.2, Radosavljevic N.3 1 SBIB-Mladenovac, Dept. of Urology, Belgrade, Serbia, 2KBC-Misovic, Dept. of Urology, Belgrade, Serbia, 3Institute For Rehabilitation, Dept. of Rheumatology, Belgrade, Serbia Introduction & Objectives: Frequency of urolithiasis in patients with gout is higher than in general population. Earlier studies found out the incidence of urolithiasis in patients with gout is around 20% and recent data obtained by monitoring and asymptomatic patients suggest that percentage of patients with urolithiasis in primary gout patients is between 37% and 50%. The data indicate that urolithiasis may be associated with hyperlipidemia, elevated arterial pressure and diabetes. The aim of this study was to determine the frequency of urolithiasis in the observed group of patients with gout. Material & Methods: This study included 78 gout patients . Data abut presense of urolithiasis were obtained from the previously recorded episode ofcliniclu confirmed urolithiasis in the medical records of patients or on the basis of ultrasonographic examination. We also recorded data about patients age, disease duration, presence of hyperlipidemia, hypertension and diabetes mellitus, and examed correlation with the presence of urolithiasis. Results: In our study we have 78 patients with primary gout, 69 (88,46%) males, average age of 58.32. Duration of gout was between 1 and 35 years, in average 6.83 years. In this sample 42 (53, 85%) patients with primary gout didn`t have urolithiasis, 15 (19.23%) had episodes of urolithiasis in their medical record, and 21 (26, 92%) were patients with silent kidney stone. Overall frequency of urolithiasis with primary gout in our sample was 46, 15%. We recorded hyperlipidemia in 52 cases (66, 67%), arterial hypertension in 43 cases (55, 12%) and diabetes in 26 cases 33, 33%). There was no statistically significant correlation of presents of urolithiasis in gout patients, and their age, hyperlipidemia, high blood pressure and diabetes. We found statically significant correlation between urolothiasis and duration of gout (p<0.001).
Conclusions: The frequency of urolithiasis in our sample was 46.15%, and 26, 92% were patients with silent kidney stone. The most important predictive factor for the development of urolithiasis is duration of gout and regular ultrasound examination is essential to detect patients with urolithiasis in this population.
S54
Chemical composition of urinary tract stones in Republic of Macedonia
Davceva O.1, Nikolov G.2, Ivanovski O.3 1 Medical Faculty, University “Ss Cyril and Methodius”, University Clinic of Clinical Biochemistry, Skopje, Macedonia, 2Medical Faculty, University “Ss Cyril and Methodius”, University Clinic of Nephrology, Skopje, Macedonia, 3Medical Faculty, University “Ss Cyril and Methodius”, University Clinic of Urology, Skopje, Macedonia Introduction & Objectives: The aim of the study was to assess the chemical composition of spontaneously excreted or surgically removed stones of patients with urolithiasis from Republic of Macedonia using the Merckognost reagent kit. Material & Methods: A total of 522 urinary tract calculi were obtained from 522 patients (334 males; 188 females) in the last 10 years. Results: The most common component of renal calculi was oxalate (99.8%). This was followed by calcium (98,7%), phosphate (92,9%), ammonium (55.3%) uric acyd (16.8%), and magnesium (8.6%). There were four cystine containing stones (2.6%). By using the calculation formula proposed in the kit, the following chemical compounds were determined: Calcium oxalate containing stones were predominant (98.4%) followed by magnesium ammonium phosphate (52,6%), calcium phosphate (25%), ammonium urate (18,1%), ammonium phosphate (15,9%) and cystine (4%). The majority of stones were mixed (calcium oxalate + magnesium ammonium phosphate, calcium oxalate + calcium phosphate, calcium oxalate + ammonium urate and calcium phosphate + magnesium ammonium phosphate). The male-to-female ratio was 1.7:1. Conclusions: In our series, calcium oxalate with magnesium ammonium phosphate were the most frequent components of urinary calculosis. Uric acid was more frequently the major component in men, while magnesium ammonium phosphate was more frequent in women. These findings may be related to regional factors such as weather and nutritional habits.
S55
Morphology and composition of kidney stones in patients with autosomal dominant polycystic kidney disease (ADPKD)
Nikolov I.G.1, Ivanovski O.2, Daudon M.3, Sikole A.1, Knebelman B.4 1 Medical Faculty, University “Ss Cyril and Methodius”, University Clinic of Nephrology, Skopje, Macedonia, 2Medical Faculty, University “Ss Cyril and Methodius”, University Clinic of Urology, Skopje, Macedonia, 3Necker Hospital, Department of Biochemistry A, Paris, France, 4Necker Hospital, Univerisity Rene Descartes, Department of Nephrology, Paris, France Introduction & Objectives: Nephrolithiasis is more prevalent in patients with autosomal dominant polycystic kidney disease (ADPKD) than in general population. The diagnosis of lithiasis in these patients is hindered by the distorted anatomy of the polycystic kidneys and the frequent occurrence of parenchymal and cystic wall calcifications. Morphologic examination of urinary stones that points to specific lithogenic factors has been seldom reported in ADPKD. Material & Methods: A retrospective study of ADPKD patients in a referral center in Paris, France was performed. Medical files of 208 ADPKD patients referred to our center between 1998 and 2008 were analysed to assess kidney stones frequency by radiological methods and to understand its characteristics using morphological, infra-red spectrophotometry and chemical stone analysis. Cyst wall calcifications detected by radiographic procedures were excluded. Results: We have found that during this period of time 29 (13.9%) ADPKD patients had experienced nephrolithiasis including those who had a clinical manifestation of colic pain and/or ultrasonography, native roentgen, CT scan detection of kidney stones. Ten kidney stones could be analysed in 8 patients. The most common type of stone was IIIb in 5 (50%) cases or 4 patients and oxalo dependent in 3 (30%) cases or 2 patients (25%). Two patients (25%) had a combined urico-oxalodependent lithiasis and in these patients the stone nucleus was uric acid (type IIIb). Superficial morphology of the stones was IIIb in 5 cases and Ia, Ib and Id each in 1 case. Morphology of the stone nucleus was IIIb in 7 cases, Ia, Ib, and IVa in 1 case. Infrared spectophotometry analysis confirmed uric acid in the nucleus of 7/10 stones. In two cases, whewellite (calcium oxalate monohydrate) was the main component of the stone (60%), whereas uric acid represented only 30% but was the only component found in the nucleus. Mean value for urine pH was 5.3±0.7, and mean value for urinary uric acid was 3.5±1.5 mmol/L/24h suggesting that increased urinary uric acid was not a major determinant of stone formation. Conclusions: Our data provide evidence that ADPKD is associated with a high proportion of uric acid stones. Composition of the stone, low urine pH, suggest that metabolic, along with mechanical factors are responsible for the occurrence of nephrolithiasis in ADPKD. The undergoing pathophysiology of uric acid stone formation in ADPKD remains to be clarified. Upcoming therapies aimed at reducing the size of cysts, may help to reduce the occurrence of renal stones.
Eur Urol Suppl 22011;10(9):589