Nephrology Dialysis Transplantation, Vol 12, Issue 7 1362-1368, Copyright © 1997 by Oxford University Press
B Hess, U Hasler-Strub, D Ackermann and P Jaeger
BACKGROUND: Metabolic evaluation in recurrent idiopathic calcium renal
stone-formers (RCSF) was analysed with respect to the following questions:
(1) do three 24-h urines provide more diagnostic accuracy in 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
different from that at mid-week?; (4) what are the prevalences of the most
important risk factors (RF) of idiopathic 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 differ from females with respect to urinary RFs? METHODS: Seventy-five
RCSF (59 men, 16 women) collected three 24-h urines (U1-3) while on
free-choice diet. To account for possible variations in lifestyle and diet,
U1 and U3 had to be collected midweek and U2 at a weekend. RESULTS: When
considering all three urines together (U1 + U2 + U3), the number of RF
abnormalities/patient was 2.8 +/- 0.1, higher than numbers of any
combination of two urines or of any single urine (P = 0.0001 for all
comparisons). The number of RF abnormalities also rose with time after
stone event, from 0.8 +/- 0.1 (range 0-4) in U1 to 1.1 +/- 0.1 (range 0- 4)
in U3 (P = 0.011 vs U1). Whereas all other RF did not change between
collections, urine volume was lower in U2 (1793 +/- 90 ml) than in U1 (2071
+/- 97 ml, P = 0.0001 vs U2) and U3 (1946 +/- 97 ml, P = 0.046 vs U2). At
least 1 abnormality was found in 85.3% of all RCSF, and multiple
abnormalities occurred in 47%. The most frequent RF was HC (39%), followed
by HO and LV (32% each), Hypo-Cit (29%), HU (23%) and Hypo-Mg (19%). Males
more often had Hypo-Cit (P < 0.001) and Hypo-Mg (P < 0.01) than
females, whereas HO was more frequent in female RCSF (P < 0.025 vs
males). CONCLUSIONS: Diagnostic accuracy of metabolic evaluation in RCSF
increases both with the number of urines collected and the time passing
after a stone event. Urines collected at weekends differ from those of the
week only by their lower volumes. Abnormalities of RF for calcium
nephrolithiasis can be detected in 85.3% of RCSF, and HC is the most common
RF both in male and female RCSF.
ORIGINAL ARTICLES
Metabolic evaluation of patients with recurrent idiopathic calcium nephrolithiasis
Policlinic of Medicine, University Hospital, Berne, Switzerland.
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