Prevention of urolithiasis: what should we do? / 中华泌尿外科杂志

Urolithiasis is a common chronic disease with high recurrence rate,which has world widely impacted on the human health.Comprehensive metabolic evaluation followed by appropriate dietary and pharmacological management is of paramount importance for preventing recurrence.This article reviewed the progress in the prevention of urolithiasis based on the latest guidelines of urolithiasis.

Prevention of urolithiasis: what should we do? / 中华泌尿外科杂志

Urolithiasis is a common chronic disease with high recurrence rate,which has world widely impacted on the human health.Comprehensive metabolic evaluation followed by appropriate dietary and pharmacological management is of paramount importance for preventing recurrence.This article reviewed the progress in the prevention of urolithiasis based on the latest guidelines of urolithiasis.

Urinary lithiasis and idiopathic hypercalciuria: the importance of dietary intake evaluation

PUSPOSE: To evaluate food intake of patients with urinary lithiasis and idiopathic hypercalciuria (IH). MATERIALS AND METHODS: Between August 2007 and June 2008, 105 patients with lithiasis were distributed into 2 groups: Group 1 (n = 55) - patients with IH (urinary calcium excretion > 250 mg in women and 300 mg in men with normal serum calcium); Group 2 (n = 50) - normocalciuria (NC) patients . Inclusion criteria were: age over 18, normal renal function (creatinine clearance = 60 mL/min), absent proteinuria and negative urinary culture. Pregnant women, patients with some intestinal pathology, chronic diarrhea or using corticoids were excluded. The protocol of metabolic investigation was based on non-consecutive collection of two 24-hour samples for dosages of: calcium, sodium, uric acid, citrate, oxalate, magnesium and urinary volume. Food intake was evaluated through the quantitative method of Dietary Register of three days. RESULTS: Urinary excretion of calcium (433.33 ± 141.92 vs. 188.93 ± 53.09), sodium (280.08 ± 100.94 vs. 200.44.93 ± 65.81), uric acid (880.63 ± 281.50 vs. 646.74 ± 182.76) and magnesium (88.78 ± 37.53 vs. 64.34 ± 31.84) was significantly higher in the IH group in comparison to the NC group (p < 0.05). As regards the nutritional composition of food intake of IH and NC groups, there was no statistical significant difference in any nutrient evaluated. CONCLUSION: In our study, no difference was observed in the food intake of patients with urinary lithiasis and IH or NC.

Evaluación de parámetros litogénicos en pacientes con urolitiasis que concurrieron al Instituto de Investigaciones en Ciencias de la Salud en el año 2009 / Evaluation of lithogenic parameters in urolithiasis patients attending the Instituto de Investigaciones en Ciencias de la Salud in 2009

Los cálculos renales se forman cuando la concentración de los componentes de la orina alcanzan un nivel en el cual es posible la cristalización. Aunque las manifestaciones clínicas de todos los cálculos son similares, los mismos difieren en su composición, patogénesis y tratamiento. El trasfondo metabólico está asociado a la urolitiasis y la evaluación metabólica es fundamental para establecer un tratamiento específico y evitar las recidivas. En este estudio, observacional descriptivo, de corte trasverso sedeterminaron los valores de analitos con potencial litogénico o inhibidor de cristalización, en muestras de sangre y orina de 40 pacientes de ambos sexos con diagnóstico de urolitiasis que concurrieron al Laboratorio de Análisis Clínicos del IICS de junio a octubredel 2009, así como describir las manifestaciones clínicas más frecuentes. El protocolo del estudio fue aprobado por los comités científico y ético del IICS y durante su ejecución serespetaron principios éticos y científicos. Del total de pacientes, 52,5% fueron niños (n=21, edad media 9±4 años) y 47,5% adultos (n=19, edad media 35±17 años). Sedetectaron alteraciones en los valores de parámetros con potencial litogénico en el 48% de los niños y 87% de los adultos litiásicos. La hipocitraturia y la hipercalciuria fueron los desarreglos metabólicos más frecuentes en ambos grupos. Los síntomas más frecuentesreferidos por los pacientes fueron: cólicos, hematuria y fiebre. La mitad de los pacientes presentaron antecedentes familiares de litiasis renal. El 58% de los pacientes adultos estaba excedido de peso. La ingesta de agua fue inferior a 2 litros en 90% y el 47% de niños y adultos respectivamente. Estos hallazgos señalan la importancia de la evaluación metabólica como herramienta para orientar el diagnóstico y tratamiento adecuado.

Kidney stones are formed when concentration of urinary components reach such a level in which crystallization is possible. Although clinical manifestations of all kidney stones are similar, they differ in composition, pathogenesis and treatment. Metabolic background is associated to urolithiasis and metabolic evaluation is essential to establish specific treatment and avoid recurrences. In this cross-sectional observational descriptive study,we determined the levels of analytes with lithogenic or crystallization inhibitor potential in blood and urine samples of 40 patients, male and female, with diagnosis of urolithiasisthat attended the Department of Clinical Analysis of the IICS from June to October, 2009. Additionally, we describe the most frequent clinical manifestations present in these patients. The study protocol was submitted and approved by the IICS scientific and ethic committees. Of the total number of patients, 52.5% were children (n=21, 9±4 years old) and 47.5% adults (n=19, 35±17 years old). Alterations in the values of the potentially lithogenic parameters were detected in 48% of the children and 87% of the adults. The most frequent metabolic abnormalities were hypocitraturia and hypercalciuria in both groups. The most frequent symptoms were colics, hematuria and fever. Half of the patients referred a family history of urolithiasis. Overweight was detected in 58% of the adult patients. Water intake lower than 2 litres per day was referred by 90% of children and 47% of adults respectively. These findings point out the importance of the metabolic evaluation as a tool to orient adequate diagnosis and treatment.

Comparison of Urinary Lithogenic Risk Factors According to Age and Sex in Stone Formers / 대한비뇨기과학회지

PURPOSE: The present study was performed to assess differences of urinary risk factors for urolithiasis according to age, in men and women stone formers. MATERIALS AND METHODS: This study comprised 599 patients who presented consecutively with one or more episodes of urinary stone from September 1997 to January 2000. They were divided into 4 groups by stratified age, consisting of group 1 (104 patients) aged =50. Twenty-four hour urinary parameters including total volume, and levels/concentrations/expressions of sodium, uric acid, creatinine, phosphorus, calcium, magnesium, oxalate and citrate, as well as frequencies of metabolic abnormalities, were compared among the 4 groups in each sex. RESULTS: For men, urinary sodium excretion was significantly lower in group 4 and citrate excretion was significantly lower in group 1 than in the other groups. For women, the excretion of citrate in group 2 was significantly higher than in the other groups and phosphorus excretion in group 4 was significantly lower than in the other groups. When the frequencies of metabolic abnormalities were compared, hypocitraturia of groups 1 and 2, and lower hypernatriuria and higher hypomagnesuria of group 4 were noted among men. The men in group 4 had significantly lower frequencies of metabolic abnormalities. Except for the lower frequency of hyperuricosuria in group 1, no significant differences of metabolic abnormalities were found among the female groups. CONCLUSIONS: Although multiple lithogenic factors can be responsible for urolithiasis, this study showed that hypocitraturia was the most important risk factor and could play the vital role in stone development, especially in young men and elderly women.

Analysis of chemical composition of urinary stones and evaluation of metabolic disturbance in 284 patients / 中华泌尿外科杂志

Objective To study the relationship between chemical composition of urinary stones and metabolic disturbance. Methods 284 urinary stone patients who had undergone analysis of stone composition were evaluated;of them 191 patients had entire blood biochemistry results and 24-h urine analysis results.The relationship between stone composition and metabolic disturbance was analyzed using ?2 test. Results Calcium oxalate stones were found in 195 cases (68.7%),infection stones in 41 cases ( 14.4%),uric stones in 38 cases (13.4%),phosphate stones in 6 cases (2.1%) and cystine stones in 4 cases (1.4%).Metabolic disturbance was found in 176 (92.1%) of 191 patients with entire blood biochemistry results and 24-h urine analysis results.Among the 176 patients,hypercalciuria occurred in 27 cases (14.1%),hyperuricosuria in 54 cases (28.3%),hyperoxluria in 41 cases (21.5%),hyperphophauria in 55 cases (28.8%),hypocitraturia in 128 cases (67.0%),hypomagnesiuria in 80 cases (41.9%),24-h urine volume

Metabolic Abnormalities of 24-hour Urinary Lithogenic Factors in Recurrent Stone Formers / 대한비뇨기과학회지

PURPOSE: To determine the metabolic characteristics of recurrent stone formers (RSF), we investigated urinary lithogenic factors. MATERIALS AND METHODS: The 24-hour urine samples of 151 RSF (114 men, 37 women) and 70 normal controls (33 men, 37 women) were analyzed for excretion rate differences of lithogenic and inhibitory constituents such as volume, sodium, phosphorus, uric acid, calcium, magnesium, oxalate, and citrate. The incidence and spectrum of metabolic abnomality in REF were aldo determined. RESULTS: The RSF showed significantly increased excretion of phosphorus (p=0.004), uric acid (p=0.003), and calcium (p=0.007) and decreased in that of citrate (p=0.044). No significant differences were found between the RSF and normal controls with regard to the excretions of sodium, magnesium, oxalate, and volume. The most frequent metabolic abnormality in RSF was hypocitraturia (43.7%), followed by hypernatriuria (41.7%), hypercalciuria (23.2%), and hyperuricosuria (20.5%). At least one metabolic abnormality was found in 118 of out of 151 RSF (78.1%). CONCLUSIONS: Our results showed that RSF had different urinary excretions of citrate as well as phophorus, uric acid, and calcium compared to the normal subjects and metabolic abnomalities were found up to 80% of them. The 24-hour urine study would be an effective means for metabolic evaluation in RSF although diagnostic accuracy increases with repeated examination.