Metabolic assessment of elderly men with urolithiasis

OBJECTIVE: To assess the presence of metabolic disorders in elderly men with urolithiasis. METHODS: We performed a case-control study. The inclusion criteria were as follows: (1) men older than 60 years of age and either (2) antecedent renal colic or an incidental diagnosis of urinary lithiasis after age 60 (case arm) or (3) no antecedent renal colic or incidental diagnosis of urolithiasis (control arm). Each individual underwent an interview, and those who were selected underwent all clinical protocol examinations: serum levels of total and ionized calcium, uric acid, phosphorus, glucose, urea, creatinine and parathyroid hormone, urine culture, and analysis of 24-hour urine samples (levels of calcium, citrate, creatinine, uric acid and sodium, pH and urine volume). Each case arm patient underwent two complete metabolic urinary investigations, whereas each control arm individual underwent one examination. ClinicalTrials.gov: NCT01246531. RESULTS: A total of 51 subjects completed the clinical investigation: 25 in the case arm and 26 in the control arm. In total, 56% of the case arm patients had hypocitraturia (vs. 15.4% in the control arm; p = 0.002). Hypernatriuria was detected in 64% of the case arm patients and in 30.8% of the controls (p = 0.017). CONCLUSION: Hypocitraturia and hypernatriuria are the main metabolic disorders in elderly men with urolithiasis.

Avaliação metabólica de homens idosos portadores de litíase urinária / Metabolic assessment of aging men with urolithiasis

OBJETIVOS: O aumento da expectativa de vida tem gerado um envelhecimento populacional global, fazendo com que a proporção de indivíduos com mais de 60 anos de idade cresça mais rapidamente do que as demais faixas etárias. A incidência de litíase urinária em indivíduos idosos tem aumentado nos últimos anos, principalmente em nações industrializadas. Aspectos particulares do envelhecimento orgânico aumentam a morbidade associada à litíase urinária em idosos, tornando a prevenção e o tratamento clínico ainda mais relevantes nessa faixa etária. Nosso objetivo é analisar a avaliação metabólica de homens idosos portadores de cálculos renais. MATERIAIS E MÉTODOS: Realizamos um estudo clínico tipo caso-controle. Os critérios de inclusão foram: indivíduos do sexo masculino com mais de 60 anos de idade, com antecedente de cólica renal ou diagnóstico incidental de litíase urinária após os 60 anos (grupo caso); no grupo controle foram incluídos pacientes da mesma faixa etária sem antecedente de cólica renal ou diagnóstico incidental de litíase renal. Todos os participantes foram submetidos à anamnese e aqueles selecionados realizaram perfil metabólico para diagnóstico de litíase urinária: dosagem sérica de cálcio total, cálcio ionizado, ácido úrico, fósforo, glicemia, uréia, creatinina e paratormônio (PTH); coleta de urina para urocultura e pH urinário, e amostras de urina de 24 horas para quantificação do volume e dosagem de cálcio, citrato, creatinina, ácido úrico e sódio. Foram também submetidos à radiografia simples de abdome e ultrassonografia do aparelho urinário. Os indivíduos do grupo caso realizaram dois perfis metabólicos completos de urina de 24 horas, enquanto os do grupo controle somente um perfil. Os resultados foram submetidos à análise estatística...

PURPOSES: Rise in life expectancy has caused a global populational ageing and people older than 60-years have increased more than any other age group. The incidence of urinary lithiasis in aging people has increased during the last years, mainly in developed nations. Some aspects concerning organic ageing increase morbidity related to urolithiasis in older individuals making prevention and medical management of urinary stones relevant in this age group. Our objective is to evaluate metabolic parameters in men older than 60 years with urinary stones. MATERIALS AND METHODS: A case-control study was performed. Inclusion criteria were: men older than 60- years old with renal pain episodes or incidental diagnosis of urinary lithiasis beginning after 60-years old (case arm). Control group was constituted by patients older than 60 years without renal colic past or diagnosis of urolithiasis. Patients were recruited from a database from the Urologic Clinic at University of São Paulo Medical School Hospital. Each individual was submitted to anamnesis and those selected underwent a metabolic evaluation for urinary stones: serum dosages of total and ionized calcium, uric acid, phosphorus, glucose, urea, creatinine and parathyroid hormone (PTH); urine culture and urinary pH. Twenty four hour urine samples were obtained for volume quantification and for calcium, citrate, creatinine, uric acid and sodium dosages. An abdominal x-ray and ultrasonography were performed in all patients. Case arm patients underwent two complete metabolic urinary investigations while control arm individuals to only one. All results were submitted to statistical analysis. RESULTS: One hundred and ten individuals were called up for initial evaluation and 70 were selected. Fifty-one individuals concluded the whole clinical investigation: 25 in the case arm and 26 in the control arm...