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Open access

Thasinas Dissayabutra, Wattanachai Ungjaroenwathana, Chanatee Bunyaratavej, Kriengsak Prasopsanti and Piyaratana Tosukhowong

Abstract

Background: The transurethral resection syndrome TUR syndrome is the most serious complication following transurethral resection of prostate (TURP).

Objective: We compared 5% dextrose in water with sterile water as an irrigating solution and evaluated postoperative intravascular hemolysis.

Methods: A prospective, randomized, controlled trial of 41 benign prostatic hypertrophy (BPH) patients who underwent TURP. The differences between preoperative and postoperative free plasma hemoglobin were measured by using a spectrophotometric method to determine the degree of intravascular hemolysis. Serum glucose and electrolytes were measured preoperatively and postoperatively. Signs and symptoms of TUR syndrome were recorded. Prostatic tissues were weighed. Volumes of irrigating fluid were recorded.

Results: Free plasma hemoglobin was significantly increased in the sterile water group (n = 21) and higher than in the 5% dextrose in water group (n = 20) (p < 0.001). The postoperative plasma glucose was higher in the 5% dextrose in water group (p = 0.007). None of patients developed a TUR syndrome. There was no difference in other serum electrolytes between both groups.

Conclusion: Intravascular hemolysis can be prevented by using 5% dextrose in water instead of sterile water. No correlation between hemolysis and TUR syndrome was found in TURP patients with postoperative stable serum sodium.

Open access

Julin Opanuraks, Chanchai Boonla, Chawalit Saelim, Wipawee Kittikowit, Pichet Sumpatanukul, Chavalit Honglertsakul and Piyaratana Tosukhowong

Abstract

Background: Increased production and release of sialic acid have been reported in many malignant conditions including bladder cancer. 8-hydroxydeoxyguanosine (8-OHdG) and malondialdehyde (MDA) have been widely used as oxidative stress biomarkers. Objective: Determine urinary levels of total sialic acid (TSA), 8-OHdG, and MDA in patients with urinary bladder cancer, and evaluate their clinical relevance. Patients and methods: Forty-five patients with histologically proven bladder cancer and 41 healthy subjects were recruited for the study. Morning urine samples were collected from all participants for measurements of TSA, 8-OHdG and MDA using thiobarbituric assay, competitive ELISA and spectrophotometry methods, respectively. Histological examination was performed for all patients. Results: Bladder cancer patients excreted urinary TSA, 8-OHdG, and MDA significantly higher than healthy controls. Based on receiver operating characteristic curve analysis, urinary TSA had adequate diagnostic potential to distinguish patients from healthy populations, and its cutoff value was chosen at 95.26 μg/g creatinine. Sensitivity, specificity, and accuracy of urinary TSA determination were 75.6%, 75.6%, and 75.6%, respectively. Both in patient and healthy groups, urinary TSA was linearly correlated with urinary 8-OHdG. Patients with highseverity grade (n=27) excreted urinary TSA significantly greater than those with low-severity grade (n=18). Conclusion: Urinary TSA, 8-OHdG, and MDA increased in patients with bladder cancer. The elevated urinary TSA was associated with enhanced oxidative stress. In addition, urinary TSA increased with progressiveness of the tumor.

Open access

Natthaya Chuaypen, Chanchai Boonla, Thasinas Dissayabutra, Chagkrapan Predanon, Preecha Ruangvejvorachai, Uraiwan Waiwijit and Piyaratana Tosukhowong

Abstract

Background: Low urinary excretion of citrate is a major risk in Thai kidney stone patients. Reabsorption of citrate at renal proximal tubules requires sodium-dicarboxylate cotransporter-1 (NaDC-1).

Objectives: We investigated the expression of NaDC-1 in stone-containing kidneys and evaluated the association of NaDC-1 expression with urine pH. Expression of NaDC-1 protein in acid-treated human proximal renal cells (HK-2 cells) was also studied.

Methods: Twenty-four patients with nephrolithiasis aged 50.61 ± 13.30 years (9 males, 15 females) were recruited. Twenty-four hours urine samples were collected from all patients. Expression of NaDC-1 in renal tissues and HK-2 cells was determined by immunohistochemistry and Western blotting, respectively.

Results: NaDC-1 was expressed mainly in proximal renal tubular cells. Tubular cells in the medullary region were weakly positive for NaDC-1. The intensity of NaDC-1 expression varied among nephrolithic renal tissues and was categorized into weak (6/24, 25%), intermediate (10/24, 42%), and high (8/24, 33%) expression. A trend of decreased urine pH in patients with increased NaDC-1 expression was observed. When the expression of NaDC-1 was recategorized into low (16/24) and high (8/24) expression, patients with high NaDC-1 expression had significantly lower urine pH than those with low NaDC-1 expression. Acid-treated HK-2 cells (pH 6.8) showed significantly higher expression of NaDC-1 compared with the control nontreated cells (pH 7.4). Significant association between urinary citrate and urine pH was not found. Also, significant association between urinary citrate and intrarenal NaDC-1 expression was not revealed.

Conclusion: NaDC-1 was principally expressed in proximal renal tubules of stone-bearing kidneys. High expression of NaDC-1 was associated with low urine pH. To our knowledge, this is the first report of NaDC-1 expression in the kidneys of nephrolithiasis patients. We experimentally confirmed that acid conditions upregulated the expression of NaDC-1 in the human proximal tubular cells.

Open access

Thasinas Dissayabutra, Jakkapan Rattanapan, Nuttiya Kalpongnukul, Supawadee Mingmongkol, Wattanachai Ungchareonwattana, Chanchai Boonla and Piyaratana Tosukhowong

Abstract

Background

Patients with urolithiasis usually have increased urinary protein excretion.

Objectives

To compare the urinary protein, including albumin, excretion by patients with urolithiasis and their children, and identify the urinary proteins that are excreted more than they are by the normal population.

Materials and Methods

We recruited 28 patients with urolithiasis after stone removal (G1) and their nonstone-forming children (G2), and 30 healthy volunteers who lived in the same region (G3) and their children (G4). Medical history and 24 h urine were analyzed. Total urinary proteins and albumin were measured, and the urine proteome analyzed by two-dimensional SDS–polyacrylamide gel electrophoresis and mass spectrophotometry.

Results

Age, sex, body mass index, and amount of smoking and alcohol drinking were not different between G1 and G3, or G2 and G4. G1 patients had more prevalent underlying diseases than participants in the other groups. Urinary protein and albumin levels were highest in G1 participants, and were higher in G2 compared with G4. Preliminary proteomics showed elevated urinary Tamm–Horsfall protein, albumin, κ- and λ-2 light chain immunoglobulin excretion.

Conclusions

Patients with urolithiasis and their children had elevated excretion of urinary protein, including albumin, compared with the normal population, even though the levels were not clinically important. Leakage of these proteins suggest a tubular cell reabsorption defect that might associate with the pathogenesis of stone formation.