The Brazilian Multicentric Study of Nephrolithiasis (Multilit)
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Cited by 2 publications
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The progressive increase of the social cost for treating urolithiasis could be related to an increased incidence of the disease and/or to an increase of costs for diagnosing and treating renal stones. In the course of the last century, the incidence of renal stones has progressively increased in Europe, North America, and other industrialised countries. This has been explained in terms of changing social conditions and the consequent changes in eating habits. In contrast, renal stones were less frequent than in developing countries of the world but in the last 20 years investigators began to report high incidences of upper urinary stone disease also from some areas of the Third World concurring with the changing of economic and social conditions. Each stone episode involves the costs for emergency visits, diagnostic work up, and medical or surgical treatment. Furthermore, we have to consider the costs of follow-up visits and the costs of testing and drugs for stone prevention. In adjunct of direct costs for diagnosis and treatment, we should also take into account the indirect individual and social cost of workdays lost. Finally, we should estimate the costs of complications and outcomes of treatment with particular attention to the costs of chronic renal failure secondary to stone disease. The strategy of treatment of each stone centre involves different costs for the treatment of each single stone episode. On the other hand the choice of treatment can be driven by National Health Systems and insurance companies by their policy of reimbursement for different procedures. The trends of renal stone incidence will have different impact on health care systems in different countries. In Europe and North America, the peak of incidence has been probably reached but the increase of costs for diagnosing and treating each single stone episode will still increase the social cost for managing stone disease. For this reason the actual objective should be to optimise protocols avoiding redundant or expensive diagnostic procedures or inappropriate treatments. In developing countries, the incidence of stone disease is still increasing and it could reach peaks even higher as a consequence of hot climate in some geographical areas. In those countries the demand for treatment of symptomatic stones could dramatically increase involving a huge financial outlay.
The progressive increase of the social cost for treating urolithiasis could be related to an increased incidence of the disease and/or to an increase of costs for diagnosing and treating renal stones. In the course of the last century, the incidence of renal stones has progressively increased in Europe, North America, and other industrialised countries. This has been explained in terms of changing social conditions and the consequent changes in eating habits. In contrast, renal stones were less frequent than in developing countries of the world but in the last 20 years investigators began to report high incidences of upper urinary stone disease also from some areas of the Third World concurring with the changing of economic and social conditions. Each stone episode involves the costs for emergency visits, diagnostic work up, and medical or surgical treatment. Furthermore, we have to consider the costs of follow-up visits and the costs of testing and drugs for stone prevention. In adjunct of direct costs for diagnosis and treatment, we should also take into account the indirect individual and social cost of workdays lost. Finally, we should estimate the costs of complications and outcomes of treatment with particular attention to the costs of chronic renal failure secondary to stone disease. The strategy of treatment of each stone centre involves different costs for the treatment of each single stone episode. On the other hand the choice of treatment can be driven by National Health Systems and insurance companies by their policy of reimbursement for different procedures. The trends of renal stone incidence will have different impact on health care systems in different countries. In Europe and North America, the peak of incidence has been probably reached but the increase of costs for diagnosing and treating each single stone episode will still increase the social cost for managing stone disease. For this reason the actual objective should be to optimise protocols avoiding redundant or expensive diagnostic procedures or inappropriate treatments. In developing countries, the incidence of stone disease is still increasing and it could reach peaks even higher as a consequence of hot climate in some geographical areas. In those countries the demand for treatment of symptomatic stones could dramatically increase involving a huge financial outlay.
The aim of this study was to estimate uric acid renal stone prevalence rates of adults in different countries of the world. PubMed was searched for papers dealing with "urinary calculi and prevalence or composition" for the period from January 1996 to June 2016. Alternative searches were made to collect further information on specific topics. The prevalence rate of uric acid stones was computed by the general renal stone prevalence rate and the frequency of uric acid stones in each country. After the initial search, 2180 papers were extracted. Out of them, 79 papers were selected after the reading of the titles and of the abstracts. For ten countries, papers relating to both the renal stone prevalence in the general population and the frequency of uric stones were available. Additional search produced 13 papers that completed information on 11 more countries in 5 continents. Estimated prevalence rate of uric acid stones was >0.75% in Thailand, Pakistan, Saudi Arabia, Iran, South Africa (white population), United States and Australia; ranged 0.50-0.75% in Turkey, Israel, Italy, India (Southern), Spain, Taiwan, Germany, Brazil; and <0.50% in Tunisia, China, Korea, Japan, Caribe, South Africa (blacks), India (Northern). Climate and diet are major determinants of uric acid stone formation. A hot and dry climate increases fluid losses reducing urinary volume and urinary pH. A diet rich in meat protein causes low urinary pH and increased uric acid excretion. On the other hand, uric acid stone formation is frequently associated with obesity, metabolic syndrome and diabetes type 2 that are linked to dietary energy excess mainly from carbohydrate and saturated fat and also present with low urine pH values. An epidemic of uric acid stone formation could be if current nutritional trends will be maintained both in developed countries and in developing countries and the areas of greater climatic risk for the formation of uric acid stones will enlarge as result of the "global warming".
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