The kidney stone and increased water intake trial in steel workers: results from a pilot study

Abstract

Preventing dehydration in subjects at risk may provide a means of primary prevention of kidney stones. The purpose of this pilot study was to assess the hydration status of an at-risk group of steel plant workers based on end-of-shift ('post-shift') spot urine osmolality and 24-h urinary stone risk parameters. 100 volunteers were recruited from Gerdau Midlothian steel mill in Texas on 11/14/14 and 12/5/14. Clinical data were recorded and post-shift spot urine sample was used to measure urine osmolality. Participants were invited to submit a 24-h urine sample within 4 weeks of enrollment. The mean age was 41 years and 95 % were men. The majority of subjects were white (75 %), followed by 10 % Hispanic and 9 % black. The mean body mass index was 30.1 kg/m and overall 16 % had a past history of stone disease. Mean post-shift urine spot osmolality was 704.5 mOsm (169-1165 mOsm) and was >800 and >700 mOsm in 39 and 57 %, respectively. Among 59 24-h urines samples, the mean volume was 1.89 ± 0.92 l/day, with 56 % < 2 L and 17 % < 1 L. Elevated levels of urinary analytes were found in 29 % of subjects for calcium (>250 mg/TV), 39 % for uric acid (>700 mg/TV), 25 % for oxalate (>45 mg/TV) and 50 % for sodium (>200 meq/TV). The prevalence of stone disease in this population of steel workers was higher than the published prevalence of stone disease in the general population. A significant number of workers had concentrated post-shift and 24-h urines and elevated levels of urinary analytes.

Assessing the risk of hypercalcemic crisis in patients with primary hyperparathyroidism

“…In general, adequate hydration is thought to prevent both nephrolithiasis and HC. Lotan and colleagues were able to show that the incidence of nephrolithiasis is greater in a population at risk of dehydration (20). Vomiting and diarrhea were common symptoms in our cohort of patients with HC.…”

Reducing major risk factors for chronic kidney disease

“…Where occupational exposure is detected as important, engagement with policy makers and employers is important to modify work conditions. 111 Maternal, fetal, and childhood health as CKD risk factors Low birth weight (LBW), small for gestational age, and preterm birth (PTB) impact the number of nephrons an individual starts life with and are increasingly being recognized as CKD risk factors. 112,113 In 2010, over 43 million babies in 139 LMICs were born too soon or too small, suggesting many children are born with a CKD risk.…”

Medical therapy for nephrolithiasis: State of the art

“…In a survey of healthcare professionals, physicians working in an operating room setting were found to have the highest prevalence of nephrolithiasis (17.4%) and reported lower fluid intake and higher stress levels [19] . A recent study of 100 steel workers noted a stone prevalence of 16%, with dehydration, defined as urine osmolality >700 mOsm, noted in 57% of workers by the end of their work shift [20] . Welders and spray painters have also been reported to have a higher risk of stone disease as a result of exposure to nephrotoxic agents contained in paint, such as cadmium and oxalic acid [10] .…”