An association between kidney stone composition and urinary metabolic disturbances in children

Kirejczyk, Jan K.; Porowski, Tadeusz; Filonowicz, Renata; Kazberuk, Anna; Stefanowicz, Magdalena; Wasilewska, Anna; Dębek, Wojciech

doi:10.1016/j.jpurol.2013.07.010

Cited by 43 publications

(21 citation statements)

References 22 publications

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“…Other researchers also observed higher urine output in children with nephrolithiasis and concomitant hypercalciuria comparing to healthy children [16]. In our earlier study, hypercalciuria coexisted in 60% of urolithiasis patients cohort [17]. We can expect that some natural mechanisms counteracting stone formation exist leading to increased thirst and urine volume.…”

Section: Discussionmentioning

confidence: 49%

Upper metastable limit osmolality of urine as a predictor of kidney stone formation in children

et al. 2018

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High fluid intake has been universally recommended for kidney stone prophylaxis. We evaluated 24-h urine osmolality regarded as the best biomarker of optimal hydration and upper metastable limit osmolality after water evaporation from urine sample to the onset of spontaneous crystallization and its usefulness as a new risk index that would describe an individual lithogenic potential. We collected 24-h urine from 257 pediatric patients with kidney stones and 270 controls. After volume and osmolality assessment, the urine samples were subjected to volume reduction in vacuum rotavapor continued to the onset of an induced urinary crystallization. The upper metastable limit osmolality of urine sample was calculated based on its initial osmolality value and the amount of water reduction. Pediatric stone formers presented with higher urine volume and lower urine osmolality than healthy controls. Despite that, their urine samples required much lower volume reduction to induce the spontaneous crystallization than those of controls. The ROC analysis revealed an AUC for the upper metastable limit osmolality of 0.9300 (95% CI 0.9104-0.9496) for distinguishing between stone formers and healthy subjects. At the cutoff of 2696 mOsm/kg, the test provided sensitivity and specificity of 0.8638 and 0.8189, respectively. 24-h urine osmolality provided the information about current hydration status, whereas evaporation test estimated the urinary potential to crystalize dependent on urine composition. Upper metastable limit osmolality may estimate the individual lithogenic capability and identify people at risk to stone formation when exposed to dehydration.

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Section: Discussionmentioning

confidence: 49%

Upper metastable limit osmolality of urine as a predictor of kidney stone formation in children

et al. 2018

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“…Other risk factors including anatomic abnormalities such as ureteropelvic junction obstruction, and rare genetic conditions such as cystinuria or primary hyperoxaluria (9, 35). Analyses of stone compositions in children have shown a similar breakdown to adults, with 70–80% of stones containing calcium oxalate, 10% containing calcium phosphate, 10–15% containing struvite, and 5% being pure uric acid (39). Nearly 70% of children have been found to have a metabolic derangement found on 24-hour urine collections that predisposes to stone formation (38).…”

Section: Kidney Stone Recurrencementioning

confidence: 98%

“…The specific therapies depend on the underlying metabolic abnormalities as detected on the stone composition and 24-hour urine collections (9, 35, 46, 49). In patients with calcium-based stones, which constitute the majority of children with nephrolithiasis (39), the underlying metabolic abnormalities often include hypocitraturia and hypercalciuria (38). Citrate is a known direct inhibitor of stone formation and furthermore alkalinizes urinary pH to increase the solubility of various crystals, including cystine and uric acid.…”

Section: Prevention and Medical Managementmentioning

confidence: 99%

Pediatric Kidney Stones—Avoidance and Treatment

Chu

Tasian

Copelovitch

2016

Curr Treat Options Peds

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Opinion Statement Pediatric stone disease is increasing in incidence and healthcare costs. With more years at-risk for stone recurrence during their lifetimes, children with nephrolithiasis constitute a high-risk patient population that requires focused intervention through both medical and surgical means. Through high-quality future studies to compare methods of stone prevention and treatment, the burden of stone disease on the youngest members of society may be ameliorated.

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“…50,52,53 Approximately 80% of kidney stones in children are comprised predominantly of calcium oxalate, which is similar to adults, but calcium phosphate stones are slightly more common and pure uric acid stones are less common in children. 55 Notably, the notion that stones that form during childhood are because of rare genetic causes and inborn errors of metabolism is no longer true.…”

Section: Chronic Kidney Diseasementioning

confidence: 99%