Role of Stone Analysis in Metabolic Evaluation and Medical Treatment of Nephrolithiasis

Kourambas, John; Aslan, Peter; Teh, Chu Leong; Mathias, Barbara J.; Preminger, Glenn M.

doi:10.1089/089277901750134548

Cited by 74 publications

(49 citation statements)

References 19 publications

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“…[2,14] Variation in composition of stone from initial sample may occur over time, and subsequent stone may be of still another composition; therefore, analysis should be repeated in recurrent cases. [15,16] Stone analysis can reveal risk factors for stone disease, as well as identify treatment targeted to prevent stone formation or dissolve an existing stone (litholysis). [10] Stones containing brushite (CaHPO 4 .2H 2 O), uric acid, and urate signal high risk for recurrence.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Efficacy of Chemical Method to Determine Urinary Tract Stone Composition

Kara¹,

Malkoç²,

Tonyalı³

et al. 2017

South Clin Ist Euras

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Objective: The present study evaluated use of chemical method to determine components and category of urinary stones described in current stone disease guidelines.Methods: Chemical analysis of total of 198 urinary stones was performed between March 2014 and September 2015. Calcium, oxalate, uric acid, magnesium, phosphate, cysteine, ammonium, and carbonate were among components detected in stone composition. Stones were divided into groups based on presence of 1, 2, or 3 or more components. Composition results were compared with stone composition data provided in global guidelines.Results: Sixty-five (32.9%) samples consisted of 1 mineral and 133 (67.1%) contained more than 1. Of the total, 107 (54%) compositions were included in European Association of Urology (EAU) guidelines. The 107 samples included 45 (22.7%) with components of calcium oxalate, 22 (11.6%) of calcium phosphate, 11 (6.1%) of calcium and uric acid, 10 (5%) of uric acid, 7 (3.5%) of cysteine, 7 (3.5%) of carbonate apatite, 4 (2%) of ammonium urate, and 1 (0.5%) of magnesium, ammonium, and phosphate. However, 91 (46%) stones consisted of components that are not in current EAU guidelines. Conclusion:Chemical analysis was found insufficient to categorize stone types and components seen in EAU guidelines. There is also a lack of information on the process in the literature. It was concluded that chemical analysis is not the best method to evaluate urinary stones.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the Efficacy of Chemical Method to Determine Urinary Tract Stone Composition

Kara¹,

Malkoç²,

Tonyalı³

et al. 2017

South Clin Ist Euras

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“…Stone analysis is warranted in all patients and may provide guidance for the therapeutic treatment. Kourambas et al [17] stated that non calcareous stone forming patients reflected specific metabolic disorders. The authors suggested that compositional stone analysis should be an integral part of the metabolic evaluation of patients with nephrolithiasis and stone analysis alone may provide guidance for therapeutic treatment and obviate a formal metabolic evaluation.…”

Section: Discussionmentioning

confidence: 99%

The Use of Simple Metabolic Evaluation in Determining the Etiology of Recurrent Stone Formers

Gökhan-Köse¹

2017

UNOAJ

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With the approval of Institutional Board and Local Ethic Committee (KA/0250), 53 patients (28 male, 25 female) of 268 patients (149 males, 119 females) regarded as high risk cases for stone recurrences were evaluated for 5 years, prospectively. These 53 patients attended routine controls in the 5 year period. The mean age of the patients was 46 (3-71) years. The patients underwent SWL, URS, PNL, open surgery or passed the stone spontaneously. One month later, all of the patients were checked for stone-free status by performing non-contrast spiral computerized tomography or intravenous urography. Stones were analysed by using X-ray diffractometry method. At the initial visit the patients were queried about the stone episodes, history of any surgery (gastrointestinal or genitourinary surgery), systemic diseases such as osteoporosis, sarcoidosis, etc., family history for urolithiasis, dietary methods and fluid intake, stone analysis, the age at the first episode and medication (Vit-D, calcium, etc).All of the cases were informed about the risks and recurrence rates of urolithiasis. The patients taking any drugs liable to cause urinary calculi; who have a history of any bowel surgery, Research ArticleUrol Nephrol Open Access J 2017, 5(1): 00156 AbstractObjectives: Recurrence rates in urolithiasis may reach to 50% after 5-10 years. Simple metabolic evaluation (SE) is commonly used for evaluating patients with low risk for recurrence. In the present study, patients with high risk to develop for stone recurrence were evaluated by single sample of urine collected in 24 hours urination with standard diet.Methods: Two hunderd and sixty eight cases who were supposed to be patients with high risk for stone recurrence were evaluated. Fifty three patients who had routine follow up for 5 years were investigated. Calcium, sodium, potassium, magnesium, creatinine, BUN, uric acide, parathormone in blood and calcium, uric acide, magnesium, citrate, urine volume and oxalate in the sample of urine collected in 24 hours urination with standard diet were checked.Results: Metabolic abnormalities were determined in 87% of the patients. During the five years, more than 3 parameters corrupted in 9 (17%) and less than three parameters corrupted in 12 (23%) patients. In 5 (1%) patients the same parameters never changed. In 14 (26%) patients all of the parameters improved whereas at least one parameter recovered in 13 (25%) patients. Stone recurrence was seen in 2 (4%) patients. Conclusion:Metabolic evaluation and preventive medical therapy are supplementary steps in the treatment of urolithiasis. We conclude that, although SE seems to be safe, inexpensive and easy to perform in the evaluation of patients with high risk to develop stone recurrence, the compliance of the patients may be the restrictive parameter for the success.

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“…Medical treatment, metaflaxi and modifications in dietary habits can help to prevent recurrence of urinary stones. Medical treatment should be based on assessing 24h urinary metabolic abnormalities (13). Drug treatment is advised after a high fluid intake (>3 L/day).…”

Section: Discussionmentioning

confidence: 99%

The impact of metabolic risk management on recurrence of urinary stones

Akın

Yücel

Danışman

et al. 2012

JHSCI

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Introduction: Urinary stone disease is a common urologic problem and recurrence in stone formation is a very familiar issue to urologists. Although recurrence in stone formation has been linked to metabolic abnormalities, it can be accessible by metabolic risk analysis studies. Methods: Herein, we present our experience in metabolic risk management on recurrence of urinary stones for 10 years in Akdeniz University School of Medicine department of Urology. We retrospectively analyzed Akdeniz University Urinary Stone Database between dates of January 2000 and December 2010. We found over 3500 patients who were managed by SWL (shock wave lithotripsy) or PCNL (percutaneus nephrolithotripsy) or URS (Ureterorenoscopic lithotripsy) or open surgery. Results: 525 patients' metabolic risk analysis was ordered due to recurrent urinary stone disease. Only 134 (25.5 %) current metabolic analysis were returned. Mean patient age was 32.2 years (range: 19-82 years). Patients were 103 male and 31 female. Stone analysis results were CaOx monohydrate in 48 (35.8 %), CaOx dihydrate in 8 (5.9 %), CaOx mono and dihydrate in 70 (52.2 %), uric acid in 3, CaOx monohydrate and uric acid in 2, cystine in 2, and struvite in 1 patient, respectively. The metabolic risk analysis showed some abnormality in 54 (40.2 %) patients. Conclusion: Although compliance to metabolic risk analysis studies is low among recurrent urinary stone formers, some significant metabolic abnormalities could be detected in those who are effectively screened. Recurrence of urinary stones in patients who are started on appropriate metabolic management can be prevented.

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Role of Stone Analysis in Metabolic Evaluation and Medical Treatment of Nephrolithiasis

Abstract: Compositional stone analysis should be an integral part of the metabolic evaluation of patients with nephrolithiasis. Moreover, stone analysis alone may provide guidance for therapeutic treatment and obviate a formal metabolic evaluation.

Cited by 74 publications

References 19 publications

Evaluation of the Efficacy of Chemical Method to Determine Urinary Tract Stone Composition

Evaluation of the Efficacy of Chemical Method to Determine Urinary Tract Stone Composition

The Use of Simple Metabolic Evaluation in Determining the Etiology of Recurrent Stone Formers

The impact of metabolic risk management on recurrence of urinary stones

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