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Metabolic abnormalities associated with calyceal diverticular stones.

Abstract

OBJECTIVE

To review the metabolic analyses of patients with calyceal diverticular stones who had surgical treatment of their calculi and to examine the effect of selective medical therapy on stone recurrence, as recent reports suggest that metabolic abnormalities contribute to stone development.

PATIENTS AND METHODS

In all, 37 patients who had endoscopic treatment of symptomatic calyceal diverticular calculi were retrospectively reviewed. Stone composition and initial 24-h urine collections (24-h urinary volumes, pH, calcium, sodium, uric acid, oxalate, citrate, and the number of abnormalities/patient per collection) were compared with 20 randomly selected stone-forming patients (controls) with no known anatomical abnormalities. Stone formation rates before and after the start of medical therapy were calculated in the patients available for follow-up.

RESULTS

Twelve of the diverticulum patients (five men and seven women) had complete 24-h urine collections, all of whom had at least one metabolic abnormality. Seven patients had hypercalciuria, four had hyperuricosuria and three had mild hyperoxaluria. The most common abnormality was a low urine volume; 11 of the 12 patients had urine volumes of <2000 mL/day (range 350-1950). Ten patients had hypocitraturia in at least one of the two 24-h urine samples; seven had low urinary citrate levels (172-553 mg/day) on both samples. The findings were similar in the control group. The diverticulum patients had 3.1 abnormalities/patient, and the controls had 2.9 abnormalities/patient (P > 0.05). No patients had gouty diathesis and none developed cystine stones. Stone analyses were similar in the two groups; both developed either calcium oxalate or mixed calcium oxalate/calcium phosphate stones. Six patients were followed for a mean of 23.1 months while on selective medical therapy; only one passed any additional stones, thought to be existing calculi, for a remission rate of five of six (83%).

CONCLUSIONS

All patients with symptomatic calyceal diverticular stones who had comprehensive metabolic evaluation had metabolic abnormalities. There were similar abnormalities in the control random stone-formers. The abnormalities were corrected with selective medical therapy, as shown by the high remission rate. We recommend that, for patients with symptomatic calyceal diverticular calculi, a metabolic evaluation should be considered to determine stone forming risk factors.

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  • Authors+Show Affiliations

    ,

    Department of Urology, Naval Medical Center, San Diego, CA, USA.

    , , ,

    Source

    BJU international 97:5 2006 May pg 1053-6

    MeSH

    Adult
    Calcium
    Diverticulum
    Female
    Humans
    Hyperoxaluria
    Kidney Calculi
    Male
    Middle Aged
    Recurrence
    Retrospective Studies
    Uric Acid

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    16643491

    Citation

    Auge, Brian K., et al. "Metabolic Abnormalities Associated With Calyceal Diverticular Stones." BJU International, vol. 97, no. 5, 2006, pp. 1053-6.
    Auge BK, Maloney ME, Mathias BJ, et al. Metabolic abnormalities associated with calyceal diverticular stones. BJU Int. 2006;97(5):1053-6.
    Auge, B. K., Maloney, M. E., Mathias, B. J., Pietrow, P. K., & Preminger, G. M. (2006). Metabolic abnormalities associated with calyceal diverticular stones. BJU International, 97(5), pp. 1053-6.
    Auge BK, et al. Metabolic Abnormalities Associated With Calyceal Diverticular Stones. BJU Int. 2006;97(5):1053-6. PubMed PMID: 16643491.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Metabolic abnormalities associated with calyceal diverticular stones. AU - Auge,Brian K, AU - Maloney,Michaella E, AU - Mathias,Barbara J, AU - Pietrow,Paul K, AU - Preminger,Glenn M, PY - 2006/4/29/pubmed PY - 2006/6/10/medline PY - 2006/4/29/entrez SP - 1053 EP - 6 JF - BJU international JO - BJU Int. VL - 97 IS - 5 N2 - OBJECTIVE: To review the metabolic analyses of patients with calyceal diverticular stones who had surgical treatment of their calculi and to examine the effect of selective medical therapy on stone recurrence, as recent reports suggest that metabolic abnormalities contribute to stone development. PATIENTS AND METHODS: In all, 37 patients who had endoscopic treatment of symptomatic calyceal diverticular calculi were retrospectively reviewed. Stone composition and initial 24-h urine collections (24-h urinary volumes, pH, calcium, sodium, uric acid, oxalate, citrate, and the number of abnormalities/patient per collection) were compared with 20 randomly selected stone-forming patients (controls) with no known anatomical abnormalities. Stone formation rates before and after the start of medical therapy were calculated in the patients available for follow-up. RESULTS: Twelve of the diverticulum patients (five men and seven women) had complete 24-h urine collections, all of whom had at least one metabolic abnormality. Seven patients had hypercalciuria, four had hyperuricosuria and three had mild hyperoxaluria. The most common abnormality was a low urine volume; 11 of the 12 patients had urine volumes of <2000 mL/day (range 350-1950). Ten patients had hypocitraturia in at least one of the two 24-h urine samples; seven had low urinary citrate levels (172-553 mg/day) on both samples. The findings were similar in the control group. The diverticulum patients had 3.1 abnormalities/patient, and the controls had 2.9 abnormalities/patient (P > 0.05). No patients had gouty diathesis and none developed cystine stones. Stone analyses were similar in the two groups; both developed either calcium oxalate or mixed calcium oxalate/calcium phosphate stones. Six patients were followed for a mean of 23.1 months while on selective medical therapy; only one passed any additional stones, thought to be existing calculi, for a remission rate of five of six (83%). CONCLUSIONS: All patients with symptomatic calyceal diverticular stones who had comprehensive metabolic evaluation had metabolic abnormalities. There were similar abnormalities in the control random stone-formers. The abnormalities were corrected with selective medical therapy, as shown by the high remission rate. We recommend that, for patients with symptomatic calyceal diverticular calculi, a metabolic evaluation should be considered to determine stone forming risk factors. SN - 1464-4096 UR - https://www.unboundmedicine.com/medline/citation/16643491/Metabolic_abnormalities_associated_with_calyceal_diverticular_stones_ L2 - https://doi.org/10.1111/j.1464-410X.2006.06134.x DB - PRIME DP - Unbound Medicine ER -