Symptomatic urinary stone disease affects approximately 900,000 persons in the United States each year, resulting in an estimated annual medical cost of $4.5 billion. Computed tomography (CT) is the established method for imaging urinary calculi and can provide accurate sub-millimeter details of the size and location of renal stones. However, in clinical routine, even the most modern CT system cannot reliably determine stone composition or quantify the amount of stone material. Our long term goal is to use advanced CT methodologies to quantitate the morphology and composition of urinary calculi for the purpose of directing clinical treatment and facilitating clinical investigation. We plan to use available and evolving technology to reliably detect the smallest possible stones and/or stone precursor plaques. Our objective in this application is to develop accurate and reproducible non-invasive CT imaging tools to stratify patients into treatment groups according to stone composition and burden. Based on our extensive preliminary results, our central hypothesis is that dual-energy CT can discriminate several types of renal stones (e.g., uric acid vs. cystine vs. struvite vs. calcium-based stones) and provide accurate quantification of stone burden. Furthermore, we hypothesize that this quantitative assessment of stone composition and burden can be performed using iodine-enhanced dual-energy CT data, which presents an opportunity to reduce patient radiation dose compared to a traditional CT urogram.
Our Specific Aims are:
Aim 1 : Develop a dual-energy CT imaging technique to discriminate between renal stones of different mineral composition.
Aim 2 : Reliably and accurately quantitate stone burden using dual-energy CT.
Aim 3 : Develop a method for stone characterization in the presence of iodinated contrast material. This proposal will develop imaging techniques that allow simultaneous identification of urinary stone type and quantification of stone burden, even in the presence of iodinated contrast material. The significance of this is that these advanced CT imaging techniques will allow physicians to more efficiently direct patient therapy and phenotype research subjects, potentially avoiding procedures associated with higher risk or cost.
Research completed via this Urology O'Brien Center will improve our ability to detect and monitor kidney stones, and increase understanding regarding the factors that make them develop. Studies will also increase understanding of the epidemiology of kidney stones and their ability to cause chronic kidney disease. Results will improve clinical care of patients with nephrolithiasis.
|Lieske, John C; Mehta, Ramila A; Milliner, Dawn S et al. (2015) Kidney stones are common after bariatric surgery. Kidney Int 87:839-45|
|Rodgers, Allen; Gauvin, Daniel; Edeh, Samuel et al. (2014) Sulfate but not thiosulfate reduces calculated and measured urinary ionized calcium and supersaturation: implications for the treatment of calcium renal stones. PLoS One 9:e103602|
|Wang, Xiangling; Krambeck, Amy E; Williams Jr, James C et al. (2014) Distinguishing characteristics of idiopathic calcium oxalate kidney stone formers with low amounts of Randall's plaque. Clin J Am Soc Nephrol 9:1757-63|
|Jepperson, Maria A; Thiel, David D; Cernigliaro, Joseph G et al. (2014) Case series demonstrating the clinical utility of dual energy computed tomography in patients requiring stents for urinary calculi. Can J Urol 21:7166-70|
|Islam, Zinia; Hayashi, Naoko; Inoue, Hana et al. (2014) Identification and lateral membrane localization of cyclin M3, likely to be involved in renal Mg2+ handling in seawater fish. Am J Physiol Regul Integr Comp Physiol 307:R525-37|
|Ito, Yusuke; Kato, Akira; Hirata, Taku et al. (2014) Na+/H+ and Na+/NH+4 activities of zebrafish NHE3b expressed in Xenopus oocytes. Am J Physiol Regul Integr Comp Physiol 306:R315-27|
|Lieske, John C; Turner, Stephen T; Edeh, Samuel N et al. (2014) Heritability of urinary traits that contribute to nephrolithiasis. Clin J Am Soc Nephrol 9:943-50|
|Li, Shanshan; Kato, Akira; Takabe, Souichirou et al. (2013) Expression of a novel isoform of Na(+)/H(+) exchanger 3 in the kidney and intestine of banded houndshark, Triakis scyllium. Am J Physiol Regul Integr Comp Physiol 304:R865-76|
|Liu, Yu; Qu, Mingliang; Carter, Rickey E et al. (2013) Differentiating calcium oxalate and hydroxyapatite stones in vivo using dual-energy CT and urine supersaturation and pH values. Acad Radiol 20:1521-5|
|Jepperson, M A; Cernigliaro, J G; Sella, D et al. (2013) Dual-energy CT for the evaluation of urinary calculi: image interpretation, pitfalls and stone mimics. Clin Radiol 68:e707-14|
Showing the most recent 10 out of 49 publications