Advertisement

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

      Abstract

      Objective

      To investigate the effect of kidney function on stone composition and urinary mineral excretion in patients undergoing surgical intervention for nephrolithiasis.

      Methods

      Using our institutional kidney stone database, we performed a retrospective review of stone patients who underwent surgical intervention between 2004 and 2015. Patients’ demographic information, 24-hour urinary mineral excretion, and stone characteristics were reported. The patients’ estimated glomerular filtration rates (eGFR) were compared with their stone compositions and 24-hour urine mineral excretions.

      Results

      A statistically significant difference was noted between the groups, with uric acid stones being associated with lower eGFR and calcium phosphate stones associated with higher eGFR. No relationship could be demonstrated between eGFR and calcium oxalate or struvite stones. Patients with lower eGFR also demonstrated a statistically significant association with lower urinary pH as well as lower urinary excretion of calcium and citrate.

      Conclusion

      While various factors have been found to play significant roles in kidney stone formation and composition, our findings demonstrate a definite relationship between these and renal function. This paper highlights the fact that renal function evaluation should be considered an important component in the evaluation, counseling, and management of patients with nephrolithiasis.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Keddis MT
        • Rule AD.
        Nephrolithiasis and loss of kidney function.
        Curr Opin Nephrol Hypertens. 2013; 22: 390-396https://doi.org/10.1097/MNH.0b013e32836214b9
        • Marangella M
        • Bruno M
        • Cosseddu D
        • et al.
        Prevalence of chronic renal insufficiency in the course of idiopathic recurrent calcium stone disease: risk factors and patterns of progression.
        Nephron. 1990; 54: 302-306https://doi.org/10.1159/000185884
        • Kadlec AO
        • Greco KA
        • Fridirici ZC
        • Gerber D
        • Turk TMT
        Effect of renal function on urinary mineral excretion and stone composition.
        Urology. 2011; 78: 744-747https://doi.org/10.1016/j.urology.2011.04.007
        • Levey AS
        • Bosch JP
        • Lewis JB
        • Greene T
        • Rogers N
        • Roth D
        A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. modification of diet in renal disease study group.
        Ann Intern Med. 1999; 130 (doi: 199903160-00002): 461-470
      1. Chapter 1: definition and classification of CKD.
        Kidney Int Suppl. 2013; 3: 19-62https://doi.org/10.1038/kisup.2012.64
        • Levey AS
        • de Jong PE
        • Coresh J
        • et al.
        The definition, classification, and prognosis of chronic kidney disease: a KDIGO controversies conference report.
        Kidney Int. 2011; 80: 17-28https://doi.org/10.1038/ki.2010.483
        • Chen J
        • Muntner P
        • Hamm LL
        • et al.
        The metabolic syndrome and chronic kidney disease in US adults.
        Ann Intern Med. 2004; 140: 167-174
        • Gershman B
        • Sheth S
        • Dretler SP
        • et al.
        Relationship between glomerular filtration rate and 24-hour urine composition in patients with nephrolithiasis.
        Urology. 2012; 80: 38-42
        • Parks JH
        • Worcester EM
        • Coe FL
        • Evan AP
        • Lingeman JE
        Clinical implications of abundant calcium phosphate in routinely analyzed kidney stones.
        Kidney Int. 2004; 66: 777-785https://doi.org/10.1111/j.1523-1755.2004.00803.x
        • Abate N
        • Chandalia M
        • Cabo-Chan AV
        • Moe OW
        • Sakhaee K
        The metabolic syndrome and uric acid nephrolithiasis: novel features of renal manifestation of insulin resistance.
        Kidney Int. 2004; 65: 386-392https://doi.org/10.1111/j.1523-1755.2004.00386.x
        • Semins MJ
        • Shore AD
        • Makary MA
        • Magnuson T
        • Johns R
        • Matlaga BR
        The association of increasing body mass index and kidney stone disease.
        J Urol. 2010; 183: 571-575https://doi.org/10.1016/j.juro.2009.09.085
        • Abou-Elela A.
        Epidemiology, pathophysiology, and management of uric acid urolithiasis: a narrative review.
        J Adv Res. 2017; 8: 513-527
        • Spiegel DM
        • Brady K.
        Calcium balance in normal individuals and in patients with chronic kidney disease on low- and high-calcium diets.
        Kidney Int. 2012; 81: 1116-1122https://doi.org/10.1038/ki.2011.490
        • Castle SM
        • Cooperberg MR
        • Sadetsky N
        • Eisner BH
        • Stoller ML
        Adequacy of a single 24-hour urine collection for metabolic evaluation of recurrent nephrolithiasis.
        J Urol. 2010; 184: 579-583https://doi.org/10.1016/j.juro.2010.03.129
        • Healy KA
        • Hubosky SG
        • Bagley DH
        24-hour urine collection in the metabolic evaluation of stone formers: is one study adequate.
        J Endourol. 2013; 27: 374-378https://doi.org/10.1089/end.2012.0216