Short-Term Changes in Urinary Relative Supersaturation Predict Recurrence of Kidney Stones: A Tool to Guide Preventive Measures in Urolithiasis
Short-Term Changes in Urinary Relative Supersaturation Predict Recurrence of Kidney Stones: A Tool to Guide Preventive Measures in Urolithiasis
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DOI：
10.1016/j.juro.2018.06.029
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发表时间：
2018-11-01
影响因子：
6.6
通讯作者：
Gambaro, Giovanni
中科院分区：
文献类型：
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作者：
Ferraro, Pietro Manuel;Ticinesi, Andrea;Gambaro, Giovanni
目的：肾结石疾病的特点是复发率相对较高。在我们的研究中，我们分析了相对过饱和度与结石复发风险之间的关联。此外，我们还研究了治疗 1 周后复发风险与相对过饱和度和尿成分变化之间的关联。 材料和方法：我们对之前发表的一项随机对照试验的数据进行了事后分析，该试验比较了 120 名患有复发性草酸钙结石和高钙尿症的男性中两种饮食的效果。使用 EQUIL2、JESS 和 LithoRisk 计算机程序，使用基线和后续 24 小时尿液参数来计算草酸钙、磷酸钙和尿酸的相对过饱和度。 Cox 模型用于计算每个基线相对过饱和度、1 周变化与随访期间复发风险之间的估计关联。结果：在 5 年随访期间，35 名患者 (34%) 出现复发。使用 EQUIL2 计算，1 周时草酸钙相对过饱和度的降低与较低的复发风险显着相关（相对于基线 HR 每降低 10%，HR 0.92，95% CI 0.86-1.00，p = 0.044）。然而，与通过其他方法计算的相对过饱和度或其他盐的相对过饱和度没有关联。柠檬酸盐、钾和镁的 24 小时尿液排泄量的变化与复发风险显着相关。结论：在患有高钙尿症的复发性结石形成者中，基线值和草酸钙相对过饱和度的变化可能与复发风险相关。饮食干预后尿柠檬酸盐、钾和镁的变化也可能具有预测作用。
Purpose: Kidney stone disease is characterized by a relatively high rate of recurrence. In our study we analyzed the association between relative supersaturation and the risk of stone recurrence. Additionally, we examined the association between the risk of recurrence and changes in relative supersaturation and urinary composition after 1 week of medical treatment.Materials and Methods: We performed a post hoc analysis of data from a previously published randomized controlled trial comparing the effect of 2 diets in 120 men with recurrent calcium oxalate stones and hypercalciuria. Baseline and followup 24-hour urine parameters were used to calculate the relative supersaturation of calcium oxalate, calcium phosphate and uric acid using the EQUIL2, JESS and LithoRisk computer programs. Cox models were used to calculate the estimated association between each baseline relative supersaturation, and 1-week changes and the risk of recurrence during followup.Results: During a 5-year followup 35 patients (34%) experienced recurrence. A reduction in calcium oxalate relative supersaturation at 1 week was significantly associated with a lower risk of recurrence using the EQUIL2 calculation (for every 10% reduction from baseline HR 0.92, 95% CI 0.86-1.00, p = 0.044). However, there was no association for relative supersaturation calculated by other methods or for the relative supersaturation of other salts. Changes in the 24-hour urine excretion of citrate, potassium and magnesium were significantly associated with a risk of recurrence.Conclusions: In recurrent stone formers with hypercalciuria baseline values and changes in the relative supersaturation of calcium oxalate may be associated with the risk of recurrence. Changes in urinary citrate, potassium and magnesium following dietary intervention may also be predictive.