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Differences in 24-hour urine composition between apatite and brushite stone formers.
Urology 2013; 82(4):768-72U

Abstract

OBJECTIVE

To determine the differences in 24-hour urine composition between apatite and brushite stone formers.

METHODS

We conducted a retrospective review of 110 calcium phosphate (CaP) stone formers with both stone composition analysis and 24-hour urinalysis available. Analysis of 24-hour urine constituents between apatite and brushite stone formers was performed using univariable t test and multivariable linear regression models, adjusting for clinical and demographic factors.

RESULTS

A total of 97 patients (88%) had predominantly apatite stones and 13 patients (12%) had predominantly brushite stones. In univariable analysis, brushite stone formers had significantly higher mean 24-hour urinary calcium excretion (apatite = 204.8 ± 103.5 mg vs brushite = 329.7 ± 136.6 mg, P = .007), higher mean super saturation (SS) CaP (apatite = 1.423 ± 0.867 vs brushite = 2.576 ± 0.171, P = .004) and lower mean SS uric acid (apatite = 0.688 ± 0.796 vs brushite = 0.345 ± 0.190, P <.001). Similarly in multivariable analysis, brushite stone formers had significantly higher mean 24-hour urinary calcium excretion (mean difference = 135.1 mg, P <.001) and higher mean SS CaP (mean difference = 1.14, P <.001) but similar mean SS uric acid (mean difference = -0.37, P = .103). All other factors analyzed including body-mass index, urinary pH, volume, oxalate, citrate, sodium, potassium, magnesium, phosphate, chloride, ammonium, sulfate, uric acid, and SS calcium oxalate were similar between both stone groups.

CONCLUSION

In a cohort of CaP stone formers, brushite stones were associated with higher urinary calcium excretion and higher urinary SS CaP when compared to apatite stones. Aggressive measures to reduce urinary calcium may be particularly helpful to prevent brushite stone formation.

Authors+Show Affiliations

The Arthur Smith Institute for Urology, Hosftra North Shore-LIJ School of Medicine, New Hyde Park, NY. Electronic address: dmoreira@nshs.edu.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23791217

Citation

Moreira, Daniel M., et al. "Differences in 24-hour Urine Composition Between Apatite and Brushite Stone Formers." Urology, vol. 82, no. 4, 2013, pp. 768-72.
Moreira DM, Friedlander JI, Hartman C, et al. Differences in 24-hour urine composition between apatite and brushite stone formers. Urology. 2013;82(4):768-72.
Moreira, D. M., Friedlander, J. I., Hartman, C., Elsamra, S. E., Smith, A. D., & Okeke, Z. (2013). Differences in 24-hour urine composition between apatite and brushite stone formers. Urology, 82(4), pp. 768-72. doi:10.1016/j.urology.2013.04.025.
Moreira DM, et al. Differences in 24-hour Urine Composition Between Apatite and Brushite Stone Formers. Urology. 2013;82(4):768-72. PubMed PMID: 23791217.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differences in 24-hour urine composition between apatite and brushite stone formers. AU - Moreira,Daniel M, AU - Friedlander,Justin I, AU - Hartman,Christopher, AU - Elsamra,Sammy E, AU - Smith,Arthur D, AU - Okeke,Zeph, Y1 - 2013/06/20/ PY - 2013/02/26/received PY - 2013/03/30/revised PY - 2013/04/19/accepted PY - 2013/6/25/entrez PY - 2013/6/25/pubmed PY - 2013/12/16/medline SP - 768 EP - 72 JF - Urology JO - Urology VL - 82 IS - 4 N2 - OBJECTIVE: To determine the differences in 24-hour urine composition between apatite and brushite stone formers. METHODS: We conducted a retrospective review of 110 calcium phosphate (CaP) stone formers with both stone composition analysis and 24-hour urinalysis available. Analysis of 24-hour urine constituents between apatite and brushite stone formers was performed using univariable t test and multivariable linear regression models, adjusting for clinical and demographic factors. RESULTS: A total of 97 patients (88%) had predominantly apatite stones and 13 patients (12%) had predominantly brushite stones. In univariable analysis, brushite stone formers had significantly higher mean 24-hour urinary calcium excretion (apatite = 204.8 ± 103.5 mg vs brushite = 329.7 ± 136.6 mg, P = .007), higher mean super saturation (SS) CaP (apatite = 1.423 ± 0.867 vs brushite = 2.576 ± 0.171, P = .004) and lower mean SS uric acid (apatite = 0.688 ± 0.796 vs brushite = 0.345 ± 0.190, P <.001). Similarly in multivariable analysis, brushite stone formers had significantly higher mean 24-hour urinary calcium excretion (mean difference = 135.1 mg, P <.001) and higher mean SS CaP (mean difference = 1.14, P <.001) but similar mean SS uric acid (mean difference = -0.37, P = .103). All other factors analyzed including body-mass index, urinary pH, volume, oxalate, citrate, sodium, potassium, magnesium, phosphate, chloride, ammonium, sulfate, uric acid, and SS calcium oxalate were similar between both stone groups. CONCLUSION: In a cohort of CaP stone formers, brushite stones were associated with higher urinary calcium excretion and higher urinary SS CaP when compared to apatite stones. Aggressive measures to reduce urinary calcium may be particularly helpful to prevent brushite stone formation. SN - 1527-9995 UR - https://www.unboundmedicine.com/medline/citation/23791217/Differences_in_24_hour_urine_composition_between_apatite_and_brushite_stone_formers_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-4295(13)00502-5 DB - PRIME DP - Unbound Medicine ER -