Objective
To examine the relationship between GFR and 24-hour urine composition in patients
with nephrolithiasis to understand how renal function may affect stone risk. Alterations
in glomerular filtration rate (GFR) are associated with a number of physiological
changes.
Methods
A retrospective, institutional review board–approved review of patients from 2 metabolic
stone clinics was performed. One-way analysis of variance and multivariate linear
regression models were used to evaluate the relationship between GFR quintile and
24-hour urine composition.
Results
A total of 403 patients (241 male, 162 female) with a mean age of 52.6 ± 14.2 years
were included in the study. On univariate analysis, decreasing GFR by quintile was
associated with significant reductions in urine calcium, citrate, supersaturation
of calcium oxalate, and supersaturation of calcium phosphate (P < .05 for each). In multivariate linear regression models, decreasing GFR by quintile
was associated with significant decreases in urine calcium (β = −11.2, 95% CI = −18.3
to 4.01), urine citrate (β = −32.4, 95% CI = −54.1 to 10.8), oxalate (β = −1.83, 95%
CI = −2.85 to 0.81), supersaturation of calcium oxalate (β = −0.58, 95% CI = 0.84
to 0.33) and supersaturation of calcium phosphate (β = −0.09, 95% CI = 0.17 to 0.02),
as well as an increase in urine magnesium (β = 3.40, 95% CI = 0.7 to 6.1).
Conclusion
Reduction in GFR is associated with decreased urine calcium, oxalate, and citrate,
and increased urine magnesium. These findings have implications for treatment of patients
with stone disease and impaired renal function.
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Article info
Publication history
Published online: May 21, 2012
Accepted:
December 12,
2011
Received:
September 20,
2011
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
