A new study published in the medical journal Neurology suggests that impaired kidney function is a risk factor for cognitive decline in old age.

The study, conducted by researchers at Rush University Medical Center, found that poor kidney function was linked specifically with cognition related to memory functions. Damage to one of these functions, episodic memory, which retrieves memories of time, place, associated emotions and other contextual knowledge, is often the earliest sign of Alzheimers disease.

“Given the dearth of modifiable risk factors for agerelated cognitive decline, these results have important public health implications,” said Dr. Aron Buchman, a neuroscientist in the Rush Alzheimers Disease Center. “Further work to understand the link between kidney function and the brain may provide new strategies for preventing memory loss in elders.”

Buchman said the findings suggest that there are common disease processes that affect both the brain and the kidneys in the elderly, and hypothesized that underlying vascular problems, such as diabetes and hypertension, may account for the association between kidney problems and cognitive decline.

The study analyzed data for 886 older adults who participated in the Rush Memory and Aging Project, a group of communitydwelling seniors with a mean age of 81, all of them initially free of dementia. The participants were examined annually for up to six years to track changes in cognition over time. Cognitive assessments included multiple tests that were summarized as a composite measure of overall cognition and of five individual cognitive abilities.

The individual cognitive systems assessed were visuospatial ability; perceptual speed, or the ability to quickly and accurately compare letters, numbers, objects, pictures or patterns; semantic memory, related to meaning, understanding and other conceptbased knowledge; working memory, which temporarily stores and manipulates information; and episodic memory.

Ruling out the influence of factors like aging and medications, which can affect cognition, the researchers found that poor kidney function, assessed at the beginning of the study, was linked with a more rapid rate of decline in cognition over the next several years not in visuospatial ability or perceptual speed, but in three specific areas episodic, semantic and working memory.

The rate of decline in cognition was equivalent to that of a person seven years older at baseline, Buchman said.

The study was supported by funds from the National Institute on Aging, the Illinois Department of Public Health and the Robert C. Borwell Endowment Fund.

About Rush

Rush University Medical Center includes a 674bed (staffed) hospital; the Johnston R. Bowman Health Center; and Rush University (Rush Medical College, College of Nursing, College of Health Sciences and the Graduate College).

Rush is currently constructing a 14floor, 806,000squarefoot hospital building at the corner of Ashland Avenue and Congress Parkway. The new hospital, scheduled to open in 2012, is the centerpiece of a $1billion, 10year campus redevelopment plan called the Rush Transformation, which also includes a new orthopedics building (to open in Fall 2009), a new parking garage and central power plant completed in June 2009, renovations of selected existing buildings and demolition of obsolete buildings. The new hospital is being designed and built to conserve energy and water, reduce waste and use sustainable building materials. Rush is seeking Leadership in Energy and Environmental Design (LEED) gold certification from the U.S. Green Building Council. It will be the first fullservice “green” hospital in Chicago.

Rushs mission is to provide the best possible care for our patients. Educating tomorrows health care professional, researching new and more advanced treatment options, transforming our facilities and investing in new technologies all are undertaken with the drive to improve patient care now, and for the future.

US health officials are considering whether to promote routine circumcision for all baby boys born in the country as a way to reduce the spread of HIV; a topic that is giving rise to considerable debate in anticipation of the Centers for Disease Control and Preventions official draft recommendations on the subject that are due out at the end of the year.

The New York Times reported online yesterday, in an article that will appear in todays print edition, that experts are also considering whether circumcision should also be offered to adult heterosexual men whose sexual behaviour puts them at higher risk of infection.

The reasons behind the consideration stem from several studies in support of male circumcision as a way to reduce HIV spread.

Trials in Africa, where there are several countries with severe AIDS and HIV epidemics, have shown that male circumcision reduced HIV infection risk by 50 per cent in heterosexual men who were at high risk of infection from women with HIV.

And earlier this year, an Australian study suggested that the inner foreskin has the largest concentration of Langerhans cells, which are the initial cellular targets in the sexual transmission of HIV. The researchers suggested that removing the skin surface which is most susceptible to the virus would reduce the risk of contracting HIV.

However, there is also a strong opinion that large scale male circumcision will not make a big difference in the US where the group at highest risk is men who have sex with men, and there is no evidence that circumcision prevents the spread of HIV among this group.

Another reason that the measure might have less impact in the US is because health officials there suggest that nearly 80 per cent of adult American males are already circumcised, although this is likely to go down in the future because there is less routine circumcision of newborns nowadays, reports the New York Times.

Another argument that is being put against the idea of promoting male circumcision in newborn boys is that it subjects them to a medical procedure of questionable health value without their permission.

However, the CDC HIV/AIDS Divisions chief epidemiologist, Dr Peter Kilmarx said every potential step that could prevent the spread of HIV should be seriously considered. He said there is a significant HIV epidemic in the US and every opportunity to add another “tool in the toolbox” should be examined.

“What weve heard from our consultants is that there would be a benefit for infants from infant circumcision, and that the benefits outweigh the risks,” he told the New York Times.

However, he did acknowledge that the situation in Africa was different to the US and the effect of male circumcision was likely to be less dramatic both because the disease was not so prevalent in the US and because the routes of infections were also different. Another consideration was the difference in health care infrastructures.

Circumcision will be a discussion topic at the CDCs National HIV Prevention Conference which takes place this week in Atlanta and is expected to be attended by thousands of HIV health professionals.

Intact America, a group that is against the idea of routine circumcision for newborns is holding a protest in the city to coincide with the conference.

They will be arguing that the facts show that circumcision only reduces the risk of HIV infection, it does not eliminate it, and circumcised men still have to wear condoms.

Sources New York Times, MNT archives

Written by Catharine Paddock, PhD

“An apple a day…” Not all medical problems require a stateoftheart solution, and it would be nice to think that products from the corner shop could treat a widespread and uncomfortable ailment. Cranberry juice and related products have been touted as a simple solution for urinary tract infections, but Raul Raz, a member of F1000 Medicine, finds little to support this claim.

Urinary tract infections (UTIs) are a common complaint. Between 10% and 20% of women will suffer a UTI at least once, and a third of these will experience it recurrently. Some recent studies support the use of cranberry as a preventative, but Dr Raz, Director of Infectious Diseases at the Technion School of Medicine in Israel, and his associate Faculty Member, Hana Edelstein, advise the medical community that “cranberry should no longer be considered as an effective [preventative] for recurrent UTIs”.

Cranberry contains hundreds of compounds, and it has been difficult to determine which might be responsible for any therapeutic effect, hindering its adoption. Raz and Edelstein point to differences in clinical trial design and the lack of standardization for doses and formulation. There is a range of potential sideeffects including stomach upsets and weight gain. Cranberry can also interact badly with other medicines such as Warfarin, commonly used to treat heart disease.

In any event, up to 55% of patients discontinue cranberry therapy after a short time. It would seem that the public have already voted with their feet.

UroToday.com Paradigm shift; instead of having the robot all around the patient and weighing 800 kg., how about having the patient all around the robot and weighing only a few 100 mg? The pioneering work of Cadeddu at Southwestern Medical School with magnetically controlled intracorporeal robots and by Dmitry Oleynikov at the University of Nebraska with electrically tethered intracorporeal robots could change the entire face of LESS and of NOTES.

Oleynikov and colleagues have developed a fixedbase camera that can be deployed through a small incision into the abdomen as well as a mobile, insertable robot capable of “rolling” onto an organ and taking a biopsy. It seems clear that technology will conquer the current shortcomings of the microrobot and that in the future a squadron of these robots may be deployed via a single 15 mm umbilical, transvaginal, or transvesical incision. Once inserted, the surgeon may well retire to a console where he/she can activate each robot as need be and direct it to complete the task at hand.

The transition from the unimaginable to the common everyday world seems to be taking less and less time over the years, to the point whereby yesterdays science fiction becomes the next years surgical advance.

Canes D, Lehman AC, Farritor SM, Oleynikov D, Desai MM
J Endourol. 2009 May;23(5)78792
10.1089/end.2008.0318

Written by UroToday.com Medical Editor Ralph V. Clayman, MDUroToday the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go tourotoday.com

Physicianscientists from NewYorkPresbyterian Hospital/Weill Cornell Medical Center believe that a heightened level a certain growth factor in the blood may explain why blacks have a greater prevalence of hypertension and kidney disease compared to whites. Results from a new study are the first to show that an elevated level of a protein, called transforming growth factor B1 (TGFB1), raises the risk of hypertension and renal disease in humans.

African Americans constitute about 32 percent of all patients treated for kidney failure in the U.S. and are four times more likely to develop renal disease than whites, according to the National Institutes of Healths U.S. Renal Data System. The researchers findings, published in this months issue of the journal Kidney International, may someday lead to the development of a new class of antihypertensive and kidney disease drugs that target the TGFB1 protein.

“I believe we may now understand a great puzzle why the black population has a greater prevalence of hypertension and kidney disease,” says Dr. Manikkam Suthanthiran, first author of the study and attending physician at NewYorkPresbyterian/Weill Cornell, Stanton Griffis Distinguished Professor of Medicine, Professor of Biochemistry and Professor of Medicine in Surgery at Weill Cornell Medical College.

Results from the study revealed that the TGFB1 protein was significantly higher in 186 black study participants compared with 147 white participants.

After controlling for race, sex and age, TGFB1 protein levels were highest in hypertensive blacks (46 ng/ml). Nonhypertensive blacks also had higher levels (42 ng/ml) compared to hypertensive whites (40 ng/ml) and nonhypertensive whites (39 ng/ml), demonstrating that even healthy black patients may be at higher risk for future hypertension and renal disease compared to healthy and hypertensive whites.

“Many black patients may have a disadvantage from the start having a higher baseline level of TGFB1,” says Dr. Phyllis August, senior author and attending physician in the division of hypertension at NewYorkPresbyterian Hospital/Weill Cornell Medical Center, Ralph A. Baer Professor of Medical Research and professor of medicine atWeill Cornell Medical College.

While the exact mechanisms of TGFB1 require further study, the authors believe that in black patients, higher levels of the growth factor are correlated with lower renin activity an enzyme that constricts blood vessels and raises blood pressure. High blood pressure is the leading risk factor for endstage kidney disease.

The authors believe it may be possible that higher levels of TGFB1 boost retention of sodium salt within the kidneys, leading to higher blood pressure in the kidney and also lower levels of renin.

Greater levels of TGFB1 in blacks were also positively associated with body mass index (BMI) indicator of body fatness compared to height and metabolic syndrome a group of abnormalities that is associated with atherosclerotic vascular disease and diabetes.

“Future clinical studies must be done so we may fully understand the specific role of TGFпЃў1 in how the kidney handles sodium, blood pressure and kidney disease.” Says Dr. August.

Source
Limda Kamateh

UroToday.com In the online issue of the World Journal of Urology, a group headed by Professor Markus Hohenfellner compared the outcomes of radical prostatectomy (RP) in men younger and older than age 70 years. They suggest that in wellselected men over age 70 years, the outcomes are comparable.

The study cohort consisted of 626 men who underwent RP at their institution between 1990 and 2006. A total of 526 were younger than 70 years old, and 100 were older than 70 years. The majority underwent radical retropubic RP and 46 underwent a perineal approach. The majority had a pelvic lymphadenectomy performed. Median patient age was 64.4 years, median PSA was 8.9ng/ml, and median followup was 5.3 years. For the analysis preop PSA, pathologic tumor stage, WHO tumor grading, margin status, time of PSA recurrence, time of distant metastatic recurrence, CaP specific and overall survival were considered.

ECOG status was >1 in 7% of the older cohort compared to 2.3% of the younger men. While median age was almost 10 years older, percentage of organconfined cancer, grade, positive lymph node and positive margin status did not differ. Median PSAfree survival was 10.2 years for the young men and not yet reached for the older men. The 10year PSAfree survival was 51.8% for the young and 57.4% for the older men. The 10year metastasisfree survival was 86.9% and 89.7% for the 70 year old patients, respectively. The 10year prostate cancer specific survival was 92.3% and 97.6% for the young and old men, respectively. Median overall survival was 14 and 12.4 years and 10year overall survival was 78.1% and 71.2% for the 70 year old patients, respectively. In multivariable analysis, there was no difference in any of the categories for clinical outcome where the age was a risk factor for adverse outcome.

Pfitzenmaier J, Pahernik S, Buse S, Haferkamp A, Djakovic N, Hohenfellner M
World J Urol. 2009 Apr 26. Epub ahead of print.
doi10.1007/s0034500904140

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

UroToday the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go tourotoday.com

Antisense Therapeutics Ltd. (ASX ANP) is pleased to report further positive results from its collaborative preclinical research studies on the therapeutic potential of ATL1101 in prostate cancer. In experimental models, ATL1101 treatment significantly enhanced the tumorsuppressive effect of the cancer drug Paclitaxel. Paclitaxel is one of a class of drugs known as taxanes. Along with androgen (a male hormone) blockade, taxane chemotherapy is an important treatment option in the most dangerous form of the disease, castrationresistant prostate cancer (CRPC).

Illustrating the positive effects of the drug in this mouse model of prostate cancer, prostate tumor volume was halved after 5 weeks of Paclitaxel/ATL1101 combination treatment, compared with control Paclitaxel treated mice.

In cell culture experiments, the amount of Paclitaxel required to induce tumor cell apoptosis (cell death) was significantly reduced when used in combination with ATL1101. This ability to sensitize tumor cells to the cytotoxic effects of Paclitaxel affirms ATL1101s potential as a chemosensitizing agent to be used in combination with existing prostate treatments to improve the outcomes for patients.

ATL1101 is a second generation antisense inhibitor of the insulinlike growth factorI receptor (IGFIR) which as reported previously suppressed the growth of human prostate tumors in an animal model of prostate cancer, and slowed down transition to CRPC when used as a single agent. Drugs targeting IGFIR are being developed by a number of the major pharmaceutical companies for a variety of cancer indications, indicating the importance of the IGFIR target in cancer.

ANPs research collaborator in the study is Prof. Martin Gleave, a leader in prostate cancer treatment and drug development. Martin Gleave, a professor at the Department of Urological Sciences, University of British Columbia and Director of The Prostate Centre at Vancouver General Hospital commented, “Resistance of tumor cells to the effects of existing treatment is a major challenge in the management of prostate cancer. Tumor cells build resistance to chemotherapy treatment via survival mechanisms that include IGFI signaling. In our prostate cancer model we have shown that ATL1101, which is an IGFI receptor blocker, can inhibit this mechanism and restore sensitivity to chemotherapy.”

ANP is in dialogue with various parties regarding the continued development of ATL1101 in prostate cancer, aiming to build on ATL1101s robust preclinical pharmacology data package, completed mouse toxicology study, established drug manufacturing process and strong intellectual property protection.

Further details on study design and outcomes follow.

ATL1101 combination study with Paclitaxel in prostate cancer laboratory models design and outcomes

Design

In vitro experiment Human androgenindependent prostate tumor cell line PC3 was transfected with ATL1101 or mismatch control oligonucleotide ISIS 306064 at concentrations ranging from 12.5 nM to 50 nM. After 2nd transfection, cultured cells were treated with Paclitaxel at concentrations ranging up to 50 nM, then the number of viable cells remaining after a further 72 hrs was counted.

In vivo experiment PC3 cells (2 x 10(6) cells) were xenografted by subcutaneous injection into recipient 68 weekold athymic nude (nu/nu) mice. When tumors reached 200 mm(3), mice were randomly assigned to one of two treatment groups IGFIR antisense drug ATL1101 or mismatched oligonucleotide ISIS 306064.

Treatment was with 15 mg/kg ATL1101 or ISIS 306064 once daily for 5 days and three times per week thereafter by intraperitoneal injection. At days 7, 9, 11 and 21, 23, 25, 0.5 mg of micellar Paclitaxel was administrated intravenously once daily. Each experimental group consisted of 10 mice. Mean tumor volume (+/ standard error of the mean) was assessed in each group (ATL1101 or ISIS 306064) every week for up to 8 weeks.

Representative outcomes of the study include the following

In cultured PC3 cells, cell viability decreased as expected with increasing concentrations of Paclitaxel. Transfection with ATL1101 further reduced viable cell count at a given Paclitaxel concentration, and reduced the concentration of Paclitaxel required to give the same viable cell count.

For example, at 0.1 nM Paclitaxel, the viable cell count for PC3 cells was only reduced by approximately 5%, compared with transfection reagent alone and no paclitaxel. Cells treated with both 0.1 nM Paclitaxel and mismatch control oligonucleotide ISIS 306064 at 12.5 nM also had approximately 5% reduced viability. In contrast, cells treated with 0.1 nM Paclitaxel and ATL1101 at 12.5 nM had approximately 45% reduced viability.

In another example, PC3 cell count could be controlled with reduced concentrations of Paclitaxel when ATL1101 was also present cells treated with 1 nM paclitaxel and 25 nM ATL1101 had similar viability to cells treated with a 10fold higher Paclitaxel concentration (10 nM) and 25 nM mismatch control oligonucleotide ISIS 306064.

In PC3 mice, after 5 weeks of treatment, mean tumor size in mice treated with Paclitaxel and mismatch control oligonucleotide ISIS 306064 was 326 +/ 40.9 mm(3) compared with 175 +/ 20.1 mm(3) in mice treated with Paclitaxel and ATL1101, or 53.7% of control (p < 0.01).

After 8 weeks of treatment, mean tumor size in mice treated with Paclitaxel and mismatch control oligonucleotide ISIS 306064 was 1417 +/ 222 mm(3) compared with 507 +/ 79.3 mm(3) in mice treated with Paclitaxel and ATL1101, or a further reduction to only 35.8% of control (p < 0.01).

About Prostate cancer

Prostate cancer is the second most frequently diagnosed cancer in men after skin cancer. It is estimated there will be 218,890 new cases diagnosed in the U.S. this year. Around 1 in 6 men will develop prostate cancer, a third to a half of whom will recur after local treatment and risk progression to metastatic prostate cancer. Metastatic disease invariably progresses to hormone refractory or castrate resistant prostate cancer (CRPC) if given enough time. Prostate tumors are initially androgen (male sex hormone) dependent, and can be treated with androgen ablation therapy (the term “castration” can be used to describe removal of the source of androgen), however once the disease progresses to its most dangerous and aggressive form, CRPC, treatment options are limited and prognosis is poor. Treatment options depend on disease severity and include radiation and chemotherapy, which are designed to induce programmed cell death (apoptosis) of tumor cells. There is a pressing need for the development of new treatment options.

About ATL1101

ATL1101 is an antisense inhibitor of IGFIR, which has shown potent activity in laboratory studies, including in human cancer cells. IGFIR is one of the best known of a family of cell signaling molecules that are referred to as “antiapoptotic.” These molecules prolong cell survival by inhibiting programmed cell death (apoptosis). The connection between IGFIR activity and prostate cell tumorigenicity has been studied for many years. Drugs targeting IGFIR are designed to slow down tumor growth and make tumor cells more susceptible to cell death. Inhibition of IGFIR is also designed to make tumor cells more susceptible to killing by cytotoxic treatments like radiation therapy and chemotherapy. Such therapeutic approaches are under investigation in several large pharmaceutical companies, lending support to our own antisensebased strategy against the same target. Designed to block IGFIR synthesis, ATL1101 offers potential advantages over other therapies targeting IGFIR due to its highly differentiated pharmacokinetics and unique antisense mode of action.

ATL1101 was a product of a discovery collaboration between ANP and Isis Pharmaceuticals (NASDAQ ISIS) and utilizes secondgeneration antisense technology, licensed from Isis. Several antisense drugs with the same chemical modifications and design as ATL1101 are advancing in cancer clinical trials, strengthening support for second generation drugs as targeted cancer therapeutics. For example OGX011, developed by OncoGenex and Isis, is currently being evaluated in Phase II clinical trials in prostate, lung and breast cancer.

Source

Researchers are zeroing in on the genetic abnormalities predisposing to vesicoureteric reflux (VUR), one of the most common causes of urinary tract infections and kidney failure in children, reports a study in an upcoming issue of the Journal of the American Society of Nephrology (JASN). “In this study, we accomplished a very critical step towards the identification of the VUR gene,” says Ali G. Gharavi, MD (Columbia University, New York).

Led by Patricia L. Weng, MD (Mount Sinai School of Medicine), and Simone SannCherchi, MD (Columbia University), the researchers, including Gharavi, performed genetic studies in 16 large families affected by VUR. “In VUR, a faulty valve in the bladder allows urine to flow back, or reflux, up to the kidneys,” Gharavi explains. If VUR persists, it can lead to repeated urinary tract infections and kidney failure. It affects about one percent of children and runs in families.

A method called linkage analysis was used to pinpoint the location of the abnormal genes associated with VUR. “We narrowed down the location of the VUR susceptibility gene to a region on chromosome 12 that is less than one percent of the entire genome,” says Gharavi.

In contrast to previous studies, the VUR susceptibility gene appeared to be inherited in autosomal recessive fashion affected children inherit one copy of the faulty gene from each parent. According to Gharavi, “This means that there are many different inherited forms of VUR, some with dominant and some with recessive inheritance.”

The next step will be conducting studies to identify the exact gene predisposing to VUR. “We plan to study more families and other patients with VUR so that we can better understand how the kidney and urinary tract develop and then create better diagnostic tests and treatments,” Gharavi adds.

Although the study does not identify the gene causing VUR, it represents the initial, critical step towards achieving that goal. The study was limited to a specific group of Caucasian patients; more research will be needed to determine whether the results apply to other populations and ethnicities.

The authors reported no financial disclosures. The research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, the National Kidney Foundation, and the Telethon Institute.

Founded in 1966, the American Society of Nephrology (ASN) is the worlds largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its worldrenowned meetings and firstclass publications, disseminates information and educational tools that empower physicians.

Source American Society of Nephrology (ASN)

A metaanalysis of 17 randomised controlled trials has shown that preprocedural treatment with sodium bicarbonate based hydration is the optimal treatment strategy to prevent contrastinduced nephropathy (CIN). The research, published in the open access journal BMC Medicine, shows that although the benefit may have been overestimated by previous studies, sodium bicarbonate is clearly superior to normal saline.

Hitinder Gurm from the University of Michigan worked with a team of international researchers to study the results of trials featuring a total of 2633 people to assess the effectiveness of saline versus sodium bicarbonate for the prevention of CIN. According to Gurm, “Contrast agents are administered in millions of procedures annually worldwide. In the USA and Europe, contrastinduced nephropathy (CIN) is the third leading cause of acute renal failure in hospitalized patients, accounting for about 10% of hospitalacquired renal failure. Although CIN is generally limited to a transient decline of renal function, it cannot be regarded as a benign complication as many as 30% of cases result in lasting kidney damage”.

The authors found that CIN occurred in 109 of the 1327 patients treated with sodium bicarbonate and in 175 of the 1306 patients who received normal saline. The number needed to prevent one case of CIN was 16. The exact mechanism of CIN is still unknown, but sodium bicarbonate is thought to prevent it by increasing the alkalinity of tubular fluid and thereby limiting free radical production. Gurm said, “Six studies monitored the degree of alkalinization and all but one found a significant increase. Interestingly this one study did not find a benefit of sodium bicarbonate. Therefore, it could be hypothesized that the bicarbonate should be dosed to achieve urinary alkalinization”.

Sodium bicarbonatebased hydration prevents contrastinduced nephropathy a metaanalysis
Pascal Meier, Dennis T Ko, Akira Tamura, Umesh Tamhane and Hitinder S Gurm
BMC Medicine (in press) biomedcentral.com/bmcmed/

Source
Graeme Baldwin

A manuscript written by Drs. Stacy Tanaka and John Pope commented on the increasing prevalence of pediatric stone disease with a review of the diagnostic concerns specific to children, recent results from pediatric series regarding the expectant management and surgical treatment of stones, metabolic evaluation, and current research on the genetics of nephrolithiasis.

The rate of pediatric nephrolithiasis is rising exponentially worldwide. The highest rate of stone formation is occurring in the United States of America with a 10fold increase since 1995. The experience here at the Childrens Hospital of Philadelphia correlates with this national statistic. We typically see twenty patients per month in urology with the diagnosis of urinary calculi.

Operative intervention occurs in approximately 30% of these patients delineating the increased morbidity as compared to the adult population that typically have a 10% surgical rate. When genetic predisposition does not seem to play a significant role, the increase in pediatric cases has been hypothesized to be a combination of high salt intake, poor hydration, and infection. It has been my experience that if a child makes a stone, then there is a 50% chance that another stone will form in the patients lifetime. If a second stone forms, then the risk is almost 75% for a third stone, and after that it is a matter of time for the fourth.

Tanaka ST, Pope JC 4th
Curr Urol Rep. 2009 Mar;10(2)13843

Written by UroToday.com Medical Editor Pasquale Casale, MDUroToday the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go tourotoday.com