Serial crystalluria determination and the risk of recurrence in calcium stone formers
Serial crystalluria determination and the risk of recurrence in calcium stone formers
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DOI：
10.1111/j.1523-1755.2005.00292.x
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发表时间：
2005-05-01
影响因子：
19.6
通讯作者：
Jungers, P
中科院分区：
文献类型：
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作者：
Daudon, M;Hennequin, C;Jungers, P
背景尿结晶沉淀是肾结石形成的必要初始步骤。然而，晶体在结石形成者评价中的临床相关性存在争议。我们连续测定了181例特发性钙性肾结石患者的首次晨尿样本中的晶体，以及完整的24小时尿生化，这些患者至少形成了一个草酸钙结石，并在我们的护理下随访了至少3年。所有结石事件发生之前转诊，然后进入研究后记录。与109名随访期间无结石复发证据的患者相比，72名经历≥ 1次结石复发事件的患者每日尿量较低（1.74 +/- 0.06 vs 2.26 +/- 0.05 L/天（平均值+/- SEM）（P < 0.0001），尿钙、草酸盐浓度及每日钙排泄量均较高，晶体增多（68% vs. 23%）（P < 0.0001）。经多因素考克斯回归分析，结石复发的危险比为0.32（95% CI 0.16-0.62）每日尿量增加1 L，1.12（1.09-1.24）尿钙浓度增加1 mmol/L，尿草酸浓度升高0.1mmol/L时，尿草酸浓度升高1.24（1.02-1.50），尿结晶指数升高27.8（10.2-75.6）。这些数据提供的证据表明，当在清晨尿液样本中反复发现晶体时，高度预测钙结石患者结石复发的风险。连续寻找晶体，一个简单而廉价的方法，可能被提议作为一个有用的工具，监测钙结石形成者，除了尿生化。
Background. Urinary crystal precipitation is the necessary initial step in kidney stone formation. However, clinical relevance of crystalluria in the evaluation of stone formers is disputed.Methods. We serially determined crystalluria in first-voided morning urine samples, together with full 24-hour urine biochemistry, in 181 patients with idiopathic calcium nephrolithiasis who had formed at least one calcium-oxalate stone and were followed for at least 3 years under our care. All stone events which occurred prior to referral, then after entry in the study were recorded.Results. As compared with 109 patients who had no evidence of stone recurrence during follow-up, the 72 patients who experienced >= one recurrent stone event had a lower daily urine volume (1.74 +/- 0.06 vs. 2.26 +/- 0.05 L/day (mean +/- SEM) (P < 0.0001), higher urine calcium and oxalate concentrations, and daily calcium excretion, and they had more frequent crystalluria (68% vs. 23% of urine samples) (P < 0.0001). By multivariate Cox regression analysis, the hazard ratio for stone recurrence was 0.32 (95% CI 0.16-0.62) for 1 L increase in daily urine volume, 1.12 (1.09-1.24) for 1 mmol/L increase in urine calcium concentration, 1.24 (1.02-1.50) for 0.1 mmol/L increase in urine oxalate concentration and 27.8 (10.2-75.6) for crystalluria index.Conclusion. These data provide evidence that crystalluria, when repeatedly found in early morning urine samples, is highly predictive of the risk of stone recurrence in calcium stone formers. Serial search for crystalluria, a simple and cheap method, may be proposed as a useful tool for the monitoring of calcium stone formers, in addition to urine biochemistry.