Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

개인의 소득에 영향을 미치는 요인으로 교육수준, 숙련도, 개인의 능력 등 무수히 많은 요인들을 생각할 수 있다. 본 연구는 이러한 여러 요인들 중에서 특히 체형(Bodily shape)가 소득에 어느 정도 영향을 미치는가에 대한 정확한 인과관계를 고찰하고자 하였다. 본 논문에서는 체형에 대한 대리변수(Proxy variable)로 체질량지수(Body Mass Index: BMI)를 사용하였으며, BMI가 갖는 내생성을 통제하여 기존의 연구들이 정확히 고찰하지 못한 BMI가 소득에 얼마나 영향을 미치는 지에 대한 인과관계를 규명하려고 하였으며 이를 위해 Two stage estimation method를 사용하였다. 1단계 추정과정에서 식료품 소비자물가지수를 도구변수로 활용하여 BMI를 추정하였고, 이렇게 추정된 BMI를 2단계 추정과정에 사용하여 체형이 소득에 미치는 영향을 고찰하였다. 추정 결과, 전체 표본을 대상으로 한 분석에서 소득수준이 낮은 구간에서는 BMI로 표현된 체형이 소득수준에 미치는 영향이 유의하였으나, 소득수준이 높은 구간에서는 이러한 영향이 유의하지 않았다. 이를 성별로 구분하여 분석해본 결과, 여성의 경우에는 BMI가 과소체중 상태(Underweight) 및 과체중 상태(Overweight)에 해당될 경우 모두 정상체중 상태의 사람에 비해 해당소득구간 대비 고소득구간에 포함될 확률이 낮아진다는 사실을 알수 있었던 반면 남성의 경우에는 과소체중 상태의 사람들의 소득수준에 BMI의 음의 영향이 발견되었을 뿐, 과체중 상태에 있는 사람의 경우 음의 영향이 발견되지 않았다. 따라서 남성의 경우보다 여성의 경우 BMI의 소득에 미치는 영향력이 상대적으로 큰 것으로 나타났다.

BMI(Body Mass Index)가 소득에 미치는 영향

Urinary stone disease is a frequent challenge for the urologic practitioner. Stones are the only disease mentioned by name in the Hippocratic Oath and the removal of bladder stones was one of the earliest surgical procedures provided by the first surgeon-barbers. In the last century, as technology has continued to advance at a more rapid pace, our ability to treat nephrolithiasis has paralleled these developments.

Kidney Stone Disease

Evaluation and Medical Management of Kidney Stones in Children

Objective A genome-wide association study (GWAS) of gout and its subtypes was performed to identify novel gout loci, including those that are subtype-specific. Methods Putative causal association signals from a GWAS of 945 clinically defined gout cases and 1213 controls from Japanese males were replicated with 1396 cases and 1268 controls using a custom chip of 1961 single nucleotide polymorphisms (SNPs). We also first conducted GWASs of gout subtypes. Replication with Caucasian and New Zealand Polynesian samples was done to further validate the loci identified in this study. Results In addition to the five loci we reported previously, further susceptibility loci were identified at a genome-wide significance level (p −8 ): urate transporter genes ( SLC22A12 and SLC17A1 ) and HIST1H2BF-HIST1H4E for all gout cases, and NIPAL1 and FAM35A for the renal underexcretion gout subtype. While NIPAL1 encodes a magnesium transporter, functional analysis did not detect urate transport via NIPAL1, suggesting an indirect association with urate handling. Localisation analysis in the human kidney revealed expression of NIPAL1 and FAM35A mainly in the distal tubules, which suggests the involvement of the distal nephron in urate handling in humans. Clinically ascertained male patients with gout and controls of Caucasian and Polynesian ancestries were also genotyped, and FAM35A was associated with gout in all cases. A meta-analysis of the three populations revealed FAM35A to be associated with gout at a genome-wide level of significance (p meta =3.58×10 −8 ). Conclusions Our findings including novel gout risk loci provide further understanding of the molecular pathogenesis of gout and lead to a novel concept for the therapeutic target of gout/hyperuricaemia.

https://ard.bmj.com/content/annrheumdis/76/5/869.full.pdf

GWAS of clinically defined gout and subtypes identifies multiple susceptibility loci that include urate transporter genes

An association between kidney stone composition and urinary metabolic disturbances in children.

Background
Hypocitraturia is considered a major risk factor for calcium stone formation. However, there is no widely accepted reference database of urinary citrate excretion in children. The aim of our study was to determine the amount of citrate eliminated in the urine over a 24-h period in a pediatric cohort and to determine an optimal unit reflecting excretion.

https://link.springer.com/content/pdf/10.1007%2Fs00467-014-2806-7.pdf

Urinary citrate excretion in healthy children depends on age and gender

There are indications that obesity and hyperuricemia may influence the formation and composition of urinary stones. The aim of our study was to determine the effect of obesity and hyperuricemia on the urinary lithogenic risk profile in a large cohort of pediatric patients. The study population comprised 478 children with urolithiasis and 517 healthy children (reference group). We studied the effects of obesity on the lithogenic profile by dividing the patients with urolithiasis into two groups based on body mass index Z-score (patients who were overweight/obese vs. those with normal weight for age) and comparing the two groups. To study the effect of hyperuricemia on the lithogenic profile, we divided the patients with urolithiasis into two groups based on the presence or not of hyperuricemia (110 patients with urolithiasis accompanied by hyperuricemia vs. 368 patients with urolithiasis and normal serum uric acid levels) and compared the groups. Among the children and adolescents with urolithiasis and hyperuricemia, there was a significantly lower excretion of crystallization inhibitors (citrates, magnesium). We also found significantly negative correlations between serum uric acid levels and the urine citrate/creatinine ratio (citrate/cr.; r = −0.30, p < 0.01), as well as the magnesium/cr. ratio (Mg/cr.; r = −0.33, p < 0.01). There was no statistically significant differences in the urinary excretion of oxalates, citrates, calcium, phosphorus, magnesium and uric acid between children with urolithiasis who were either overweight or obese and children with urolithiasis who had a normal body weight. In our pediatric patient cohort, hyperuricemia was associated with a decrease in the excretion of crystallization inhibitors in the urine, but the clinical relevance of this observation needs to be confirmed in future studies. Obesity and overweight had no direct influence on the lithogenic risk profile in the urinary stone formers in our study, but there was an indication that higher serum uric acid may be associated with impairment in renal function, which in turn could influence the excretion of lithogenic parameters.

/pdf/does-obesity-or-hyperuricemia-influence-lithogenic-risk-3hn3harzlj.pdf

Does obesity or hyperuricemia influence lithogenic risk profile in children with urolithiasis

Aim

There is conflicting evidence about the role of obesity in paediatric nephrolithiasis. This Polish study explored the influence of nutritional status and lipid disturbances on urinary lithogenic factors and the risk of kidney stone formation in children and adolescents from three to 18 years of age.



Methods

We carried out serum lipid profile evaluations and 24-h urine chemistry analyses on 493 overweight/obese paediatric participants (mean age 13 years) without nephrolithiasis and 492 healthy normal weight sex and age-matched controls.



Results

A third (33%) of the study group had blood lipid disturbances, with more acidic urine, lower urinary citrate excretion and a higher fraction of ionised calcium and higher Bonn Risk Index than the controls. The participants' body mass index standard deviation score (BMI Z-score) was positively correlated with urinary oxalate and uric acid and negatively correlated with citrate excretion. Total cholesterol, low-density lipoprotein cholesterol and triglycerides correlated negatively with citraturia, while high-density lipoprotein cholesterol correlated positively.



Conclusion

The main factor that predisposed overweight and obese children to kidney stones was hypocitraturia. Urinary citrate excretion was related to both BMI Z-scores and all lipid fraction abnormalities. However, hypercholesterolaemia and particularly low-density lipoprotein hypercholesterolaemia seemed to play a major role.

Dyslipidaemia in overweight children and adolescents is associated with an increased risk of kidney stones.

Background
Hypercalciuria and hypocitraturia are considered the most important risk factors for urolithiasis. Citrate binds to urinary calcium to form a soluble complex which decreases the availability of ionized calcium (Ca2+) necessary for calcium oxalate formation and phosphate crystallization. The aims of this study were to assess the Ca2+ fraction in relation to total calciuria, citraturia and urinary pH and to determine whether urinary Ca2+ concentration is a helpful biomarker in metabolic evaluation of children with urolithiasis.

/pdf/correspondence-between-ca2-and-calciuria-citrate-level-and-4n2nzu2tin.pdf

Jan K. Kirejczyk

Papers

An association between kidney stone composition and urinary metabolic disturbances in children.

Urinary citrate excretion in healthy children depends on age and gender

Does obesity or hyperuricemia influence lithogenic risk profile in children with urolithiasis

Dyslipidaemia in overweight children and adolescents is associated with an increased risk of kidney stones.

Correspondence between Ca2+ and calciuria, citrate level and pH of urine in pediatric urolithiasis