Trastornos metabólicos renales en pacientes cubanos adultos con litiasis urinarias / Renal metabolic disturbances in Cuban adult patients with urinary lithiasis

INTRODUCCIÓN: las litiasis urinarias constituyen un problema de salud. La recurrencia de ellas hace necesario implementar estrategias preventivas, para lo cual es indispensable conocer la frecuencia de los diferentes trastornos metabólicos renales. OBJETIVOS: identificar los disturbios metabólicos más frecuentes en la enfermedad litiásica urinaria y la posible relación de estos con características de los pacientes. MÉTODOS: estudio observacional analítico, transversal. Se estudiaron 3 655 pacientes adultos con litiasis urinaria, que se realizaron estudio metabólico renal en el Instituto de Nefrología entre los años 2003 y 2009. Las determinaciones analíticas fueron realizadas por técnica espectrofotométrica, según las normas del servicio. Toda la información se procesó mediante el paquete estadístico SPSS versión 15.0. Se utilizó la técnica de análisis de distribución de frecuencias. Las relaciones entre las variables se identificaron mediante el test de independencia. RESULTADOS: los principales trastornos metabólicos encontrados fueron: hiperuricemia (48,2 %), hipercalciuria (45,1 %) e infección del tracto urinario (16,2 %). La hipercalciuria y la hiperuricosuria fueron menos frecuentes en los sujetos mayores de 42 años (p= 0,01). La hipercalciuria, la hiperoxaluria y la hiperuricosuria resultaron más frecuentes en los hombres (p= 0,00), mientras la hipocitraturia tuvo mayor frecuencia en las mujeres (p= 0,04). La hiperuricosuria se encontró con mayor frecuencia en pacientes sobrepesos y obesos (p= 0,00), y la hiperoxaluria fue más frecuente entre los sobrepesos (p= 0,01). CONCLUSIONES: en los pacientes con litiasis renal los trastornos metabólicos más frecuentes son hiperuricemia, hipercalciuria e infección del tracto urinario. Los menores de 43 años tienen más hipercalciuria e hiperuricosuria. Los hombres tienen mayor frecuencia de hipercalciuria, hiperoxaluria e hiperuricosuria y las mujeres, de hipocitraturia. La frecuencia de presentación de hiperoxaluria, hiperuricosuria e hipocitraturia se encuentra relacionada con el estado nutricional de los sujetos.

INTRODUCTION: the recurrence of urinary lithiasis is a health problem needing the implementation of preventive strategies, thus knowing the frequency of the different renal metabolic disorders is essential. OBJECTIVES: To identify the most common metabolic disorders in urinary lithiasic disease and their relationship with patient characteristics. METHODS: an analytical, cross-sectional study was conducted in 3655 adult patients with urolithiasis. A renal metabolic study was conducted at the Institute of Nephrology from 2003 to 2009. The analytical determinations were performed by spectrophotometric technique according to the standards of service. All information is processed using SPSS version 15.0. The technique of frequency distribution analysis was used. Relationships between variables were identified by the test of independence. RESULTS: The main metabolic disorders found were: hyperuricemia (48.2%), hypercalciuria (45.1%), and urinary tract infection (16.2 %). Hypercalciuria and hyperuricosuria were less frequent in subjects older than 42 years (p= 0.01). Hypercalciuria, hyperoxaluria and hyperuricosuria were more frequent in men (p= 0.00), while hypocitraturia was more frequent in women (p= 0.04). Hyperuricosuria was found more frequently in overweight and obese patients (p= 0.00), and hyperoxaluria was more frequent among overweight subjects (p= 0.01). CONCLUSIONS: In patients with renal lithiasis the most common metabolic disorders are hyperuricemia, hypercalciuria, and urinary tract infection. All subjects younger than 43 years suffered hypercalciuria and hyperuricosuria. Men have higher frequency of hypercalciuria, hyperuricosuria and hyperoxaluria. Women have higher frequency of hypocitraturia. The frequency of submission of hyperoxaluria, hyperuricosuria and hypocitraturia is related to the nutritional status of these subjects.

Update on pathogenesis of uric acid nephrolithiasis / 대한내과학회지

No abstract available.

Hypercalciuria and Hyperuricosuria in Adults with Microscopic Hematuria / 대한신장학회잡지

PURPOSE: We investigated the prevalence of hypercalciuria and hyperuricosuria in adults with microscopic hematuria and whether specific underlying diseases were associated with it. METHODS: A total of 36 patients with microscopic hematuria were divided into hypercalciuria or normocalciuria and hypercalciuria or normouricosuria and compared between groups in their clinical characteristics and laboratory findings. RESULTS: Of the 36 patients, 27 patients (75%) had normocalciuria but 9 (25%) had hypercalciuria. Twenty-eight patients (78%) had normouricosuria but 8(22%) had hyperuricosuria. All 8 patients in the hyperuricosuric group were male but 6 were male and 3 female in the hypercalciuric group. Other basal parameters and clinical characteristics were comparable between hypercalciuric and normocalciuric groups as well as between hyperuricosuric and normouricosuric groups except for significantly higher proteinuria in the latter. Underlying or associated diseases were hypertension (11), nephrolithiasis (5), simple renal cysts (3), hepatitis B carrier (3), diabetes mellitus (2), poststreptococcal glomerulonephritis (1), and membranous nephropathy (1). The degrees of calciuria and uricosuria were not different between patients with or without specific underlying or associated diseases but relative hypercalciuria in diabetic patients and hyperuricosuria in hepatitis B carriers were noted. CONCLUSION: We found a high prevalence of hypercalciuria and hyperuricosuria in adults with microscopic hematuria. In view of relatively higher proteinuria in hyperuricosuric patients in addition to some differences in clinical characteristics of patients with hypercalciuria or hyperuricosuria, a simple cost- effective examination of the degree of calciuria and uricosuria would be helpful in the clinical evaluation of microscopic hematuria.

Clinical Characteristics of Hypercalciuric Patients with Urinary Stone / 대한비뇨기과학회지

Hypercalciuria is the most important risk factor in stone formation, occuring in about 50% of patients with calcium containing stone. Also, it is thought that hypercalciuria is a heterogeneous disorder. We studied 408 hypercalciuria patients with urinary stone for the evaluation of clinical characteristics of hypercalciuric over eleven years from 1986 to 1996. Hyperuricosuria was found 26.3% in male and 10.8% in female, respectively. Incidence of hyperuricosuria in hypercalciuric patients with stone was significantly higher than that of patients with urinary stone. The frequency of recurrent stone was 43.1% (100/232) in male, 27.8% (49/176) in female. It was also significantly higher than that of patients with urinary stone, but there was no difference of urinary calcium between recurrence group and single episode group in hypercalciurics. As causes hypercalciuria, hypercalcemia was found in 36 patients, primary hyperparathyroidism in 17, immobilization syndrome in 8, hyperthyroidism in 4 and long term use of steroids in 1, repectively. As a result of oral calcium loading test, absorptive and renal leak type were found 6 patients (14.6%), respectively, resorptive type in 6 (14.6%) and 22 patients (53.7%) were not classified. Based on our experience, we also confirmed that idiopathic hypercalciuria was the heterogeneous sorder. High incidence of hyperuricosuria in urinary stone patients with hypercalciuria might be related with high intake of animal protein. Hypercalciuria was closely related with recurrence of stone but the degree of hypercalciuria was not related with its recurrence. Classification of idiopathic hypercalciuria by oral calcium loading test was available in half the cases.