Metabolic Risk Factors for Stone Formation in Patients with Cystic Fibrosis (original) (raw)
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Metabolic Evaluation of Patients With Recurrent Idiopathic Calcium Nephrolithiasis
Journal of Urology, 1998
urines collected and the time passing after a stone event. Urines collected at weekends diÂer from those Background. Metabolic evaluation in recurrent idiopathic calcium renal stone-formers (RCSF) was ana-of the week only by their lower volumes. Abnormalities of RF for calcium nephrolithiasis can be detected in lysed with respect to the following questions: (1) do three 24-h urines provide more diagnostic accuracy in 85.3% of RCSF, and HC is the most common RF both in male and female RCSF. the metabolic evaluation of RCSF than 1 or 2 urines?; (2) does time after stone event influence the diagnostic yield?; (3) is urine composition at weekends diÂerent Key words: hypercalciuria; hyperoxaluria; hypocitratufrom that at mid-week?; (4) what are the prevalences ria; idiopathic calcium nephrolithiasis; low urine of the most important risk factors (RF) of idiopathic volume; metabolic evaluation calcium nephrolithiasis, i.e. low volume (LV), hypercalciuria (HC), hyperoxaluria (HO), hyperuricosuria (HU), hypocitraturia (Hypo-Cit), and hypomagnesiuria (Hypo-Mg)?; and (5) do male RCSF diÂer from Introduction females with respect to urinary RFs? Methods. Seventy-five RCSF (59 men, 16 women) Renal stone formation is a common disorder: up to collected three 24-h urines (U1-3) while on free-choice 15% of the population will develop kidney stones over diet. To account for possible variations in lifestyle and a lifetime [1]. About 80% of all stones that are formed diet, U1 and U3 had to be collected midweek and U2 contain calcium, mainly in the form of calcium oxalate at a weekend. [2]. Since renal stone formation is the ultimate con-Results. When considering all three urines together sequence of increased urinary supersaturation with (U1+U2+U3), the number of RF abnormalities/ calcium salts and most therapeutic approaches focus patient was 2.8±0.1, higher than numbers of any on reducing supersaturation [3 ], metabolic evaluation combination of two urines or of any single urine (P= in clinical practice has primarily to consider risk factors 0.0001 for all comparisons). The number of RF abnorof increased urinary supersaturation. malities also rose with time after stone event, from The question whether all patients with nephrolithi-0.8±0.1 (range 0-4) in U1 to 1.1±0.1 (range 0-4) in asis, in particular those with a first renal colic, should U3 (P=0.011 vs U1). Whereas all other RF did not undergo thorough metabolic evaluation, has been change between collections, urine volume was lower in addressed by several authors. A meta-analysis of six U2 (1793±90 ml) than in U1 (2071±97 ml, P=0.0001 large retrospective studies [4 ] concluded that, given vs U2) and U3 (1946±97 ml, P=0.046 vs U2). At the relatively low morbidity associated with a first least 1 abnormality was found in 85.3% of all RCSF, stone episode and the rather high risk of side-eÂects and multiple abnormalities occurred in 47%. The most with so-called specific therapy, single stone-formers frequent RF was HC (39%), followed by HO and LV should not undergo elaborate testing of 24-h urines. (32% each), Hypo-Cit (29%), HU (23%) and Hypo-However, Drach [5] has strongly recommended more Mg (19%). Males more often had Hypo-Cit (P<0.001) elaborate evaluation also in single stone-formers when and Hypo-Mg (P<0.01) than females, whereas HO either a positive family history of stone disease or was more frequent in female RCSF (P<0.025 vs evidence for additional stones on radiographic evalumales). ation is present, or when specific economic pressure Conclusions. Diagnostic accuracy of metabolic evalu-(such as in the case of airline pilots) or the patient's ation in RCSF increases both with the number of simple desire to know more about the cause of his disease warrant a thorough diagnostic approach.
Kidney stones: Composition, frequency and relation to metabolic diagnosis
2016
Nephrolithiasis is one of the most frequent urologic diseases. The aim of this paper is to study the composition and frequency of 8854 patient kidney stones and in a subset of them their metabolic risk factors to be related to their type of calculi. Physicochemical and crystallographic methods were used to assess kidney stone composition. In a subset of 715 patients, we performed an ambulatory metabolic protocol with diagnostic purposes. From the total sample 79% of stones were made of calcium salts (oxalate and phosphate), followed by uric acid stones in 16.5%, calcium salts and uric acid in 2%, other salts in 1.9% and cystine in 0.6%. Male to female ratio was almost three times higher in calcium salts and other types of stones, reaching a marked male predominance in uric acid stones, M/F 18.8 /1.0. The major risk factors for calcium stones are idiopathic hypercalciuria, followed by unduly acidic urine pH and hyperuricosuria. In uric acid stones unduly acidic urine pH and less comm...
Metabolic Evaluation of Stone Disease Patients: A Practical Approach
Journal of Endourology, 1999
In the last three decades, minimally invasive techniques have progressed significantly, replacing traditional open surgery as the mainstay of stone disease surgical treatment. The challenge for the next millennium remains medical prevention of calcium urolithiasis, a field where less dramatic progress has been achieved during the same period of time. The purpose of this article is to provide the practicing urologist with current practical guidelines for the assessment and management of calcium urolithiasis patients. The recommendations are based on the latest available information regarding the pathogenesis, medical treatment options, and decision-making rationale when managing these challenging patients. Every urolithiasis patient should undergo a basic evaluation, which is considered the minimal essential diagnostic work-up, in order to rule out obvious, treatable systemic causes of urinary stone disease. All patients should be advised about conservative nonspecific preventive measures. High-risk stone patients should have a more extensive metabolic evaluation based on two 24-hour urine samples. Treatment protocols for each patient are tailored individually according to the metabolic evaluation findings.
Women’s Health Bulletin, 2019
Background: Nephrolithiasis is a worldwide health problem. Objectives: This study investigated the frequency of urinary and serum metabolic abnormalities and their association with demographic characteristics in patients with nephrolithiasis. Methods: In this cross-sectional study, we assessed 376 patients with nephrolithiasis who referred to Motahari Medical Center, Shiraz from March 2017 to June 2017. Patients' history, 24-hour urine analysis (for volume, calcium, uric acid, sodium, citrate, phosphate, and oxalate), and serum tests (for calcium, uric acid, and parathyroid hormone) were recorded in a data gathering sheet. P value < 0.05 was considered statistically significant. Results: The most common abnormality was a low volume of 24-hour urine (< 2000 mL), (73.7%), followed by hypercalciuria (23.9%), and hyperoxaluria (19.4%). Low 24-hour urine volume was more frequent in women (80.0% vs. 64.3%, P < 0.001), while hypercalciuria (37.0% vs. 18.3%, P < 0.001), and hyperphosphaturia (6.0% vs. 1.7%, P = 0.03) were more frequent in men. Moreover, hypercalciuria was more frequent in outdoor workers (39.7% vs. 21.1%, P = 0.003), whereas low urine volume was more frequent in indoor workers (79.0% vs. 61.1%, P = 0.006). Metabolic abnormalities were not different in terms of patients' family history. Conclusions: Multiple factors affect the frequency and type of nephrolithiasis. Since these parameters are also influenced by race, culture, and dietary habits; thus each region must determine its own demographic features of renal stone. Based on our results, women had lower urine volume and higher urine citrate than men. Moreover, water intake is one of the most important factors that correlate with renal stone formation.
Revista Médica da UFPR, 2015
Introdução: Apesar do avanço no conhecimento fisiopatológico da nefrolitíase, a avaliação do risco individual de formação e recorrência de cálculos renais por mensuração de fatores de risco na urina de 24 horas é muitas vezes difícil. Nosso objetivo é avaliar fatores de risco urinários associados à nefrolitíase, particularmente citraturia e a proporção cálcio/citrato em pacientes com cálculos renais recorrentes e naqueles sem litíase urinária. Método: 103 pacientes com nefrolitíase recorrente (30 homens e 73 mulheres) e 32 pacientes sem doença (11 homens e 21 mulheres) foram estudados retrospectivamente. Dados clínicos e laboratoriais foram colhidos de todos os pacientes. Resultados: Não houve diferença de idade entre os grupos (44,4±11,8 anos vs 43,3±17 anos). Na urina, houve aumento de volume, cálcio (189,6±98,7 vs. 150,7±107,3, p=0,029), sódio e oxalato (33,7±28,2 vs. 22,2±15,3, p=0,041) no grupo dos litiásicos, comparados ao grupo controle. A excreção urinária de ácido úrico e citrato foi similar entre os grupos, sem diferenças significativas. Houve correlação positiva entre a excreção de cálcio e citrato na urina dos pacientes litiásicos (r=0,41, p<0,001). Não foi possível utilizar a proporção cálcio/citrato para diferenciar os grupos, pois diferenças não foram encontradas. Conclusão: Em pacientes com nefrolitíase recorrente, os fatores de risco em urina de 24 horas necessitam ser interpretados como variáveis contínuas, e não intervaladas. Estudos prospectivos são necessários para determinar valores normais diários de citraturia e para avaliar o papel da hipocitraturia isolada na incidência, prevalência e curso clínico na formação de cálculos renais. Palavras-chave: citrato; nefrolitíase; cálculo renal; hipocitraturia.
Metabolic evaluation in patients with infected nephrolithiasis: Is it necessary?
Archivio Italiano di Urologia e Andrologia, 2016
Fifty-four patients with infected renal lithiasis underwent complete metabolic evaluation searching for underlying factors contributing to stone formation including urine analysis and culture. Metabolic abnormalities were significantly more present in patients with mixed infected stones (struvite+/-apatite and calcium oxalate) than in patients with pure infected stones (struvite+/-carbonate apatite): hypercalciuria in 40%, hyperoxaluria in 34% and hyperuricosuria in 28% (p < 0.05). Urinary excretion of citrate was low in both groups without statistically significant difference (238+/-117 mg/24 h vs 214+/-104 mg/24/h, t = 0.72, p = 0.5). The few metabolic abnormalities present in patients with pure infected stones should suggest that urinary tract infection could change the urine chemistry in a lithogenic direction and be only cause of stone formation.
Urological research, 2007
The purpose of the present study was to compare the clinical characteristics of "pure" uric acid (UA) stone formers with that of "pure" calcium oxalate (CaOx) stone formers and to determine whether renal handling of UA, urinary pH, and urinary excretion of promoters and inhibitors of stone formation were different between the two groups. Study subjects comprised 59 patients identified by records of stone analysis: 30 of them had "pure" UA stones and 29 had "pure" CaOx nephrolithiasis. Both groups underwent full outpatient evaluation of stone risk analysis that included renal handling of UA and urinary pH. Compared to CaOx stone formers, UA stone formers were older (53.3 +/- 11.8 years vs. 44.5 +/- 10.0 years; P = 0.003); they had higher mean weight (88.6 +/- 12.5 kg vs. 78.0 +/- 11.0 kg; P = 0.001) and body mass index (29.5 +/- 4.2 kg/m(2) vs. 26.3 +/- 3.5 kg/m(2); P = 0.002) with a greater proportion of obese subjects (43.3% vs. 16.1%; P = 0....
Risk factors of renal stone in patients with recurrent nephrolithiasis: A case-control study
Renal stone disease is common and caused by a variety of conditions. The overall lifetime rate of renal stone in the general population is approximately 5-12%. The aim of the present study was to determine the prevalence of recurrence rate and metabolic changes present in patients with urinary lithiasis. Patients with renal stone, who attended the nephrology clinics in Ahvaz, Iran, were enrolled into the study. One hundred and forty patients and 60 control cases were recruited to the study. Predominance observed for male gender, with 2.1:1 ratio. There were also 33 men and 27 women in control group. Mean age was 36.8±14.3 and 40.5 ± 14.5 years for patients and control group respectively. Frequency of diabetes mellitus (p = 0 .90), urinary tract infection (p = 0.125) and cystinuria (p = 0.181) did not significantly differ among patients and control cases. Mean body mass index, daily fluid intake, serum fasting glucose, potassium, sodium, magnesium, calcium, alkaline phosphates, parathormone and cholesterol show no statistically significant difference between patients and control group. Mean serum BUN, creatinine, phosphorus, uric acid, and triglyceride levels were significantly higher in patients compared to control group. Mean of 24-hour urine volume, excreted sodium, uric acid, and citrate were significantly higher in patients group too. We concluded that evaluation of recurrent stone formers by examining their blood and urine samples, especially 24-hour urine sample, is beneficial to find underlying metabolic disorder.
Biochemical evaluation in renal stone disease
Clinical cases in mineral and bone metabolism : the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases, 2008
Renal stone disease may ensue from either derangements of urine biochemistries or anatomic abnormalities of kidneys and urinary tract. Genetic, environmental and dietary factors may also cooperate in the pathophysiology of nephrolithiasis. An adequate metabolic evaluation should focus on the urinary excretion of promoters and inhibitors of stone formation as well as on the occurrence of systemic diseases potentially related to secondary nephrolithiasis (i.e., endocrine disturbances, malabsorption, bone diseases). Moreover, metabolic investigations should provide reliable information on patient's dietary habits, guide towards the best therapeutic approach and enable the physician to verify patient's compliance to prescribed therapies.AN EXTENSIVE METABOLIC EVALUATION IS RECOMMENDED IN PATIENTS WITH ACTIVE STONE DISEASE (NAMELY, AT LEAST ONE NEW STONE WITHIN THE LAST TWO YEARS), OR IN THOSE HAVING HAD A SINGLE STONE EPISODE OCCURRED IN PECULIAR CONDITIONS: familial history of ...