Outpatient Evaluation of Patients with Calcium Urolithiasis

Drach, George W.; Perin, R. R.; Jacobs, Shannon

doi:10.1016/s0022-5347(17)56881-0

Cited by 32 publications

(7 citation statements)

References 11 publications

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“…This yields several advantages including more reliable insight in dietary habits of the patients, lower costs, less loss of work and better compliance. This contention is in agreement with other experienced laboratories and centers, which have followed a great number of patients with CaNL [9, 10, 11]. In order to improve the accuracy of metabolic studies some advise making three 24-hour urine collections and blood sampling.…”

Section: Laboratory Investigationssupporting

confidence: 78%

Idiopathic Calcium Nephrolithiasis

Marangella

Vitale²,

Bagnis³

et al. 1998

Nephron

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Calcium nephrolithiasis (CaNL) accounts for more than 70% of all renal stones, and its prevalence has increased in the last decades. Under this definition are included patients passing stones, composed of calcium oxalates and/or calcium phosphates. Current views of the pathogenesis of CaNL are based on the role of metabolic abnormalities which concur to render urines more conducive to crystallization. Therefore, the diagnostic approach is aimed at detecting these abnormalities, and the medical treatment assumes that a decrease in the risk of lithogenesis will result in remission or improvement of recurrences. The workup of the patients with CaNL begins with the analysis of passed stones and X-ray, sonography or other imaging techniques. Eligible patients, that is, both recurrent active stone formers and single-stone formers with individual risk factors, are considered for a metabolic evaluation, by which a number of blood and urine parameters are measured and others calculated. These include estimates of urine state of saturation with calcium and uric acid salts, net gastrointestinal alkali absorption, renal threshold of phosphate and other renal clearances and net acid and total nitrogen excretions. Basically, this screening is informative on renal function, metabolic abnormalities and their pathophysiology, risk of stone formation and dietary habits. During treatment it gives information about patient compliance and adverse effects of therapy. The cost of a comprehensive screening in Piedmont is 192,000 ITL (100 Euro) and rises to 300,000 ITL (154 Euro) if hormones and hydroxyproline are measured. In individual patients second- and third-level studies are performed, in order to detect systemic diseases which account for about 20% of CaNL in our series. Cost-to-benefit analysis has shown that the medical procedures for CaNL yield considerable saving in terms of difference between expenditure for drugs and testing and reduction of stone events. However, the current workup cannot be considered exhaustive, because misleading events may hamper the relation between laboratory findings and clinical outcome, and factors other than urine composition have appeared on the scenario of nephrolithiasis. These represent our challenge for the third millennium.

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Section: Laboratory Investigationssupporting

confidence: 78%

Idiopathic Calcium Nephrolithiasis

Marangella

Vitale²,

Bagnis³

et al. 1998

Nephron

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“…It is known that recurrences are common in patients who form calcium oxalate (CaOx) stones (Ljunghall, 1977;Johnson eta/., 1979;Sutherland, 1982) and it is accepted that prophylactic measures should be taken to prevent further stone formation or to reduce the recurrence rate (Rose, 1979;Drach et a/., 1979;Peacock and Robertson, 1980;Bach and Vahlensieck, 1980;Blomen and Bijvoet, 1983;Yendt, 1983).…”

mentioning

confidence: 99%

The Composition of Four‐hour Urine Samples from Patients with Calcium Oxalate Stone Disease

Berg

Larsson

Tiselius

1987

British Journal of Urology

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Urine collected during a 24-h period between 06.00 and 10.00 h from 25 patients with recurrent CaOx stone disease was analysed with respect to calcium, oxalate, magnesium, citrate and creatinine. Urinary excretion of oxalate in relation to creatinine was slightly higher in 24-h urine but the correlation between 24-h and 4-h values was good. Good correlations were also recorded for calcium and citrate, whereas a more variable result was obtained for magnesium. In terms of the risk of forming a supersaturated urine (CaOx risk index), a good correlation was observed between 24-h and 4-h urine samples, although the highest values were found in 24-h urine. As a result of a low mean urine flow between 06.00 and 10.00 h, the highest supersaturation in terms of the AP (CaOx) index was observed in these samples. When the risk of calcium oxalate crystallisation (CaOx-CR) was determined by means of the increment in oxalate concentration required for precipitation of CaOx, 7 of 11 samples had the highest values in the 4-h urine. Samples collected during a 4-h period might thus be useful in the evaluation and follow-up of CaOx stone formers and further studies will show to what extent they can replace 24-h urine collections.

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“…Since uri nary Ppi and GAG determinations are not routine for many clinicians [ 13] Various series showed that the average level for cal cium stone patients was above 2 mmol/24 h [3, 7-11], Our average of 1.3 mmol/24 h is markedly lower. On the other hand the incidence of citrate deficiency among stone patients varies between 29.2 and 63% [12,13], The overall incidence of hypocitraturic urolithiasis in our series is 46.56% and represents the highest rate for any etiological factor. It is also important to note that our patients with uric acid, infective stones and hypercalci uria showed an even higher hypocitraturia rate concomittantly.…”

mentioning

confidence: 55%

“…Yet this should be no reason for not determining at least some of them routinely or for preserving the determinations for recurrent stone pa tients as advocated by some authors [17,18]. Reports by Pak et al [ 19] and Drach et al [ 12] underline the impor tance of these measurements in delineating a very high number of patients in whom an augmentation type of prophylaxis is very effective in lowering new stone for mation. Additionally Pak [20] reported that all patients, including first-time stone formers, should undergo diag nostic evaluation because patients with single renal stone occurrence have equally severe biochemical abnormali ties as recurrent patients.…”

mentioning

confidence: 99%