Abstract
Purpose
To determine if kidney stone composition can predict the underlying medical diagnosis,
and vice versa.
Methods
We studied 1392 patients with kidney stones who underwent a complete ambulatory evaluation
and who submitted one or more stones for analysis. We ascertained the associations
between medical diagnosis and stone composition.
Results
The most common kidney stones were composed of calcium oxalate (n = 1041 patients
[74.8%]), mixed calcium oxalate–calcium apatite (n = 485 [34.8%]), and calcium apatite
alone (n = 146 [10.5%]). The most common medical diagnoses were hypocitraturia (n
= 616 patients [44.3%]), absorptive hypercalciuria (n = 511 [36.7%]), and hyperuricosuria
(n = 395 [28.4%]). Calcium apatite and mixed calcium oxalate–calcium apatite stones
were associated with the diagnoses of renal tubular acidosis and primary hyperparathyroidism
(odds ratios ≥2), but not with chronic diarrheal syndromes. As the phosphate content
of the stone increased from calcium oxalate to mixed calcium oxalate–calcium apatite,
and finally to calcium apatite, the percentage of patients with renal tubular acidosis
increased from 5% (57/1041) to 39% (57/146), and those with primary hyperparathyroidism
increased from 2% (26/1041) to 10% (14/146). Calcium oxalate stones were associated
with chronic diarrheal syndromes, but not with renal tubular acidosis. Pure and mixed
uric acid stones were strongly associated with a gouty diathesis, and vice versa.
Chronic diarrheal syndromes and uric acid stones were associated with one another,
and brushite stones were associated with renal tubular acidosis. As expected, there
was a very strong association between infection stones and infection, and between
cystine stones and cystinuria.
Conclusion
Stone composition has some predictive value in diagnosing medical conditions, and
vice versa, especially for noncalcareous stones.
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References
- Urolithiasis.in: Glassock R. Bone R.C. Current Practice of Medicine. Vol 4. Current Medicine, Inc, Philadelphia, Pennsylvania1996: 13.3-13.4
- Role of stone analysis in metabolic evaluation and medical treatment of nephrolithiasis.J Endourol. 2001; 15: 181-186
- Long-term follow-up in 1003 extracorporeal shock wave lithotripsy patients.J Urol. 1988; 140: 479-483
- Struvite stones.Kidney Int. 1978; 13: 372-382
- Ambulatory evaluation of nephrolithiasis.Am J Med. 1980; 69: 19-30
- Graphic display of urinary risk factors for renal stone formation.J Urol. 1985; 134: 867-870
- Ambulatory evaluation of nephrolithiasis.Am J Med. 1995; 98: 50-59
- A simple test for the diagnosis of absorptive, resorptive and renal hypercalciurias.N Engl J Med. 1975; 292: 497-500
- The hypercalciurias.J Clin Invest. 1974; 54: 387-400
- Identification and characterization of a gene with base substitutions associated with the absorptive hypercalciuria phenotype and low spinal bone density.J Clin Endocrinol Metab. 2002; 87: 1476-1485
- Low urinary citrate excretion in nephrolithiasis.Urol. 1983; 21: 8-14
- Successful management of uric acid nephrolithiasis with potassium citrate.Kidney Int. 1986; 30: 422-428
- Biochemical profile of idiopathic uric acid nephrolithiasis.Kidney Int. 2001; 60: 757-761
- Prevention of recurrent calcium stone formation with potassium citrate therapy in patients with distal renal tubular acidosis.J Urol. 1985; 134: 20-23
- Hypocitraturia in patients with gastrointestinal malabsorption.N Engl J Med. 1980; 303: 657-661
- Applied Logistic Regression. Wiley & Sons, New York, New York1999
- Ammonium urate calculi.J Stone Dis. 1993; 5: 208-212
- Hyperoxaluria in patients with ileal resection.Gastroenterology. 1974; 66: 1114-1122
- Effect of citrate on calcium phosphate phase transitions.Min Electro Metab. 1980; 3: 207-216
- Alkali absorption and citrate excretion in calcium nephrolithiasis.J Bone Miner Res. 1993; 8: 787-792
- Hyperuricosuric calcium oxalate nephrolithiasis.Kidney Int. 1978; 13: 418-426
- Mechanism for calcium nephrolithiasis among patients with hyperuricosuria.J Clin Invest. 1977; 59: 426-431
- Physicochemical basis for the formation of renal stones of calcium phosphate origin.J Clin Invest. 1969; 48: 1914-1922
- Supersaturation and stone composition in a network of dispersed treatment sites.J Urol. 1998; 159: 1821-1825
- The spectrum of metabolic abnormalities in patients with cystine nephrolithiasis.J Urol. 1989; 141: 819-821
Article info
Publication history
Accepted:
February 25,
2003
Received:
February 20,
2002
Footnotes
☆This work was supported by NIH grants P01-DK20543 and M01-RR00633, and by institutional funds.
Identification
Copyright
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
