Association of Impaired Renal Function With Changes in Urinary Mineral Excretion and Stone Composition

Patel, Parth M.; Kandabarow, Alexander M.; Druck, Aleksander; Hart, Spencer; Blackwell, Robert H.; Kadlec, Adam; Farooq, Ahmer; Türk, Thomas; Baldea, Kristin G.

doi:10.1016/j.urology.2020.03.023

Cited by 10 publications

(12 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study found that patients with decreased eGFR had low urine pH, consistent with previous reports [ 31 ]. When urine pH is altered, renal clearance of creatinine may change dramatically.…”

Section: Discussionsupporting

confidence: 93%

Association of acidic urine pH with impaired renal function in primary gout patients: a Chinese population-based cross-sectional study

Xue

Terkeltaub

et al. 2022

Arthritis Res Ther

View full text Add to dashboard Cite

Background Patients with gout frequently have low urinary pH, which is associated with the nephrolithiasis. However, the specific distribution of urinary pH and potential relationship of acidic urine pH to broader manifestations of kidney disease in gout are still poorly understood. Methods A 2016–2020 population-based cross-sectional study was conducted among 3565 gout patients in the dedicated gout clinic of the Affiliated Hospital of Qingdao University to investigate the association between low urinary pH and kidney disease. We studied patients that we defined to have “primary gout”, based on the absence of > stage 2 CKD. All subjects underwent 14 days of medication washout and 3-day standardized metabolic diet. We obtained general medical information, blood and urine biochemistries, and renal ultrasound examination on the day of the visit. The primary readouts were urine pH, eGFR, nephrolithiasis, renal cysts, microhematuria, and proteinuria. Patients were assigned into 5 subgroups (urine pH ≤5.0, 5.0 <pH≤ 5.5, 5.5 <pH< 6.2, 6.2 ≤pH≤ 6.9, and pH >6.9), aligning with the clinical significance of urine pH. Results Overall, the median urine pH and eGFR of all patients was 5.63 (IQR 5.37~6.09), and 98.32 (IQR 86.03~110.6), with acidic urine in 46.5% of patients. The prevalence of nephrolithiasis, microhematuria, and proteinuria were 16.9%, 49.5%, and 6.9%, respectively. By univariate analysis, eGFR was significantly associated with age, sex, duration of gout, tophus, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, serum utare, hypertension, diabetes, and urine pH. On multivariable analysis, eGFR was associated with age, sex, diastolic blood pressure, serum uric acid, hypertension, diabetes, and urine pH. Acidic urine pH, especially urine pH < 5.0, was significantly associated with the prevalence of kidney disease, including > stage 1 CKD, nephrolithiasis, kidney cyst, and microhematuria. Patients with 6.2 ≤ urine pH ≤ 6.9 and SU ≤ 480 μmol/L had the highest eGFR with the lowest prevalence of nephrolithiasis, microhematuria, and proteinuria. Conclusions Approximately half of gout subjects had acidic urine pH. Urine pH < 5.0 was associated with significantly increased nephrolithiasis, renal cyst, microhematuria, and proteinuria. The results support prospective clinical investigation of urinary alkalinization in selected gout patients with acidic urine pH.

show abstract

Section: Discussionsupporting

confidence: 93%

Association of acidic urine pH with impaired renal function in primary gout patients: a Chinese population-based cross-sectional study

Xue

Terkeltaub

et al. 2022

Arthritis Res Ther

View full text Add to dashboard Cite

show abstract

“…The morpho-constitutional analysis of the various calculi of the series showed that the calcium oxalate is the main dominant component of the calculi, so that it plays a vital role in the genesis and growth of the majority of the lithiasis. The overall frequency of mineralogical distribution of calcium oxalate, calcium and magnesium phosphates, and uric acid are of the same order of magnitude as those observed in France 20 , in eastern India 21 , and in the United States 22 , and other Maghreb countries (Table 1). However, there are some differences with France, notably a reversal in the proportions of phosphatic and uric acid calculi, the latter being more frequent in our series.…”

Section: Morphological and Crystallographic Analysis Of Renal Calculisupporting

confidence: 54%

Morphological and crystallographic analysis of kidney stones in Eastern Morocco

guerrouj¹,

Bencheikh²,

Imtara

et al. 2020

Mediterr.J.Chem.,

View full text Add to dashboard Cite

Abstract: Renal lithiasis is a common disease in the eastern region of Morocco, as it threatens the public health because of its repetitive nature as well as the complications it can cause in the kidney. Objective: This study aims to investigate the morphological, molecular, and crystallographic characteristics of kidney stones affecting patients, specifically in the eastern region of Morocco.Methods: Morphological and constitutional analyses of 239 renal lithiases made it possible to identify the various crystalline forms present, to assess the structure of the stones and to determine the composition of their nucleation zone. Results: It appears that calcium oxalate is the main component of the analyzed stones. It represents 70.5 % of the stones, which 55.5 % are majority whewellite and 15 % in weddellite. In comparison, calcium phosphates and magnesium (carbapatite and struvite) are the majority in only 8.9 % of cases, uric acid in 19.8 % of stones, and ammonium acid urate in 0.8 %. Calcium oxalate is predominant in the core of 52.5 % of the stones, carbapatite in 24.1 %, and uric acid in 20.3 % and struvite in 2.9 %. Most of the stones analyzed consist of a mixture of different crystalline constituents. Only 9.3 % of the stones analyzed have a homogeneous composition. Several types of associations were identified, the main ones being whewellite-carbapatite and whewellite-weddellite-carbapatite. Conclusion: The present study shows that calcium oxalate is the most common compound in the samples studied, followed by the uric acid compound.

show abstract

“…Multiple studies have shown that the 24-h urine excretion of oxalate was higher in individuals with DM than in those patients without DM ( 3 , 4 ). Nephrolithiasis is a common comorbidity of DM, with calcium oxalate as the most common composition of stones ( 11 ). In a retrospective analysis of 462 patients with nephrolithiasis, patients with DM excreted greater urinary oxalate than those patients without DM ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

Acute oxalate nephropathy: A potential cause of acute kidney injury in diabetes mellitus—A case series from a single center

Bao

Wang

et al. 2022

Front. Med.

View full text Add to dashboard Cite

BackgroundAcute oxalate nephropathy (AON) is an uncommon condition that causes acute kidney injury (AKI), characterized by the massive deposition of calcium oxalate crystals in the renal parenchyma. In previous studies, urinary oxalate excretion has been found to be increased in patients with diabetes mellitus (DM). Here, we report a case series of diabetic patients with AKI with biopsy-proven AON, aiming to alert physicians to the potential of AON as a trigger of AKI in diabetic patients in clinical practice.Materials and methodsCases with pathological diagnosis of AON who presented with AKI clinically and had DM between January 2016 and December 2020 were retrospectively enrolled. Their clinical and pathological manifestations, treatment, and prognosis were collected.ResultsSix male patients with biopsy-proven AON out of a total of 5,883 native kidney biopsies were identified, aged 58.3 ± 9.1 years at the time of kidney biopsy. Only one patient who had received Roux-en-Y gastric bypass surgery took oxalate-rich food before the onset of the disease. None of them had clinical features of enteric malabsorption. Three patients were currently on renin-angiotensin system inhibitor treatment for hypertension, and 5 of them received non-steroidal anti-inflammatory drugs. Three patients presented with oliguria and 4 patients needed dialysis at the beginning with none requiring dialysis at discharge. Four patients received a course of corticosteroid treatment empirically. Among them, two patients had estimated glomerular filtration rate (eGFR) recovered to over 60 ml/min/1.73 m2, while the other two patients remained with kidney dysfunction at the last follow-up. In two patients without corticosteroid treatment, one patient fully recovered with eGFR over 90 ml/min/1.73 m2 and the other patient remained with kidney dysfunction at the last follow-up.ConclusionAON might be a rare but potentially trigger of AKI in patients with DM. A kidney biopsy could help physicians to make the correct diagnosis. The proper treatment to alleviate oxalate-induced injury needs to be further studied.

show abstract

Association of Impaired Renal Function With Changes in Urinary Mineral Excretion and Stone Composition

Cited by 10 publications

References 15 publications

Association of acidic urine pH with impaired renal function in primary gout patients: a Chinese population-based cross-sectional study

Association of acidic urine pH with impaired renal function in primary gout patients: a Chinese population-based cross-sectional study

Morphological and crystallographic analysis of kidney stones in Eastern Morocco

Acute oxalate nephropathy: A potential cause of acute kidney injury in diabetes mellitus—A case series from a single center

Contact Info

Product

Resources

About