Korean J Urol.  2006 Oct;47(10):1093-1098. 10.4111/kju.2006.47.10.1093.

Comparison of the Lithogenic Risk Factors for First Time and Recurrent Stone-formers

• Kwon OJ
• Ahn SH

• KMID: 2139811
• DOI: http://doi.org/10.4111/kju.2006.47.10.1093

Abstract

PURPOSE: The lithogenic risk factors were compared between the first time stone patients and recurrent stone patients according to age and gender.
MATERIALS AND METHODS
We performed stone metabolic studies on first time stone formers (67 men and 42 women) and the recurrent stone formers (40 men and 20 women). We analyzed the groups' excretion differences for the lithogenic and inhibitory constituents such as calcium, uric acid, oxalate, sodium and citrate; we measured volume from the 24-hour urine samples and calcium, uric acid, sodium, potassium, chloride and phosphate from the serum samples. Hypercalciuria, hyperoxaluria, hypocitraturia and a low 24-hour urine volume (<1,500ml) were compared between the two groups according to age and gender.
RESULTS
Hypocitraturia was the most common metabolic abnormality in all the groups. The incidence of hypocitraturia was higher in the recurrent stone formers (50.0%) than in the first time stone formers (48.6%), but this was not statistically significant. A low urine volume was shown to have more significant association (p<0.05) for recurrent stone formers (33.3%) compared to the first time stone formers (18.3%).
CONCLUSIONS
Hypocitraturia was the most common lithogenic risk factor for stone patients. In the recurrent stone formers, a low urine volume is the risk factor that differentiates them from the first time stone formers.

Keyword

Urinary calculi; Citrate; Fluid therapy

MeSH Terms

Calcium
Citric Acid
Fluid Therapy
Humans
Hypercalciuria
Hyperoxaluria
Incidence
Male
Oxalic Acid
Potassium
Risk Factors*
Sodium
Uric Acid
Urinary Calculi
Calcium
Citric Acid
Oxalic Acid
Potassium
Sodium
Uric Acid

Reference

1. Leusmann DB, Blaschke R, Schmandt W. Results of 5,035 stone analyses: a contribution to epidemiology of urinary stone disease. Scand J Urol Nephrol. 1990. 24:205–210.

2. Johnson CM, Wilson DM, O'Fallon WM, Malek RS, Kurland LT. Renal stone epidemiology: a 25-year study in Rochester, Minnesota. Kidney Int. 1979. 16:624–631.

3. Tomson CR. Prevention of recurrent calcium stones: a rational approach. Br J Urol. 1995. 76:419–424.

4. Trinchieri A, Rovera F, Nespoli R, Curro A. Clinical observations on 2086 patients with upper urinary tract stone. Arch Ital Urol Androl. 1996. 68:251–262.

5. Herring LC. Observations on the analysis of ten thousand urinary calculi. J Urol. 1962. 88:545–562.

6. Francois B, Cahen R, Pascal B. Inhibitors of urinary stone formation in 40 recurrent stone formers. Br J Urol. 1986. 58:479–483.

7. Iguchi M, Takamura C, Umekawa T, Kurita T, Kohri K. Inhibitory effects of female sex hormones on urinary stone formation in rats. Kidney Int. 1999. 56:479–485.

8. Lee SY, Lee SC, Kim WJ. Metabolic abnormalities of 24-hour urinary lithogenic factors in recurrent stone formers. Korean J Urol. 2001. 42:69–74.

9. Brealau NA. Pathogenesis and management of hyperclciuric nephrolithiasis. Miner Electrolyte Metab. 1944. 20:328–339.

10. Yang CS, Moon YT. Comparison of metabolic risk factors in patients with 1st episode urolithiasis stratified according to age. Korean J Urol. 2005. 46:264–270.

11. Menon M, Krishman CS. Evaluation and medical management of the patient with calcium stone disease. Urol Clin North Am. 1983. 10:595–615.

12. Menon M, Mahle CJ. Oxalate metabolism and renal calculi. J Urol. 1982. 127:148–151.

13. Yagisawa T, Chandhoke PS, Fan J. Metabolic risk factors in patients with first-time and recurrent stone formations as determined by comprehensive metabolic evaluation. Urology. 1988. 52:750–755.

14. Yoshida O, Okada Y. Epidemiology of urolithiasis in Japan: a chronological and geographical study. Urol Int. 1990. 45:104–111.

15. Sarada B, Satyanarayana U. Influence of sex and age in the risk of urolithiasis a biochemical evaluation in Indian subjects. Ann Clin Biochem. 1991. 28:365–367.

16. Pak CY, Sakhaee K, Crowther C, Brinkley L. Evidence justifying a high fluid intake in treatment of nephrolithiasis. Ann Intern Med. 1980. 93:36–39.

17. Robertson WG. Brockis G, Finlayson B, editors. Risk factors in calcium stone disease. International urinary stone conference. 1979. Littleton, Massachusetts: PSG Publishing Co;12.

18. Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol. 1996. 155:839–843.

19. Frank M, De Vries A. Prevention of urolithiasis. Education to adequate fluid intake in a new town situated in the Judean Desert Mountains. Arch Environ Health. 1966. 13:625–630.

20. Smith LH, Van Den Berg CJ, Wilson DM. Nutrition and urolithiasis. N Engl J Med. 1978. 298:87–89.

21. Pak CY. A critical evaluation of treatment of calcium stones. Adv Exp Med Biol. 1980. 128:451–465.