Ambulatory evaluation of nephrolithiasis: An update of a 1980 protocol1

https://doi.org/10.1016/S0002-9343(99)80080-1Get rights and content

Evaluations of 1,270 patients with recurrent nephrolithiasis in an outpatient setting were analyzed for the purpose of updating the classification of nephrolithiasis. All but 4% had abnormal urinary biochemistry that placed them into one or more of 20 etiologic categories. A single diagnosis was documented in 41.3% of patients. The remaining 58.7% had more than one diagnosis.

Hypercalciuric calcium (Ca) nephrolithiasis, encountered in 60.9% of patients, comprised six variants—absorptive hypercalciuria Type I and II, renal hypercalciuria, primary hyperparathyroidism, and unclassified hypercalciuria (renal phosphate leak and fasting hypercalciuria). Hyperuricosuria Ca nephrolithiasis (HUCN) and gouty diathesis (GD) accounted for 35.8% and 10.0% of patients, respectively. Distinguishing features were hyperuricosuria and normal urinary pH in HUCN, and normal urinary uric acid and low urinary pH (<5.5) in GD. Hyperoxaluric Ca nephrolithiasis, occurring in 8.1% of patients, was subdivided into enteric, primary, and dietary variants. Hypocitraturic Ca nephrolithiasis affected 28% of patients in its idiopathic variant. Many of these patients' problems were probably dietary in origin, while some could have had incomplete renal tubular acidosis. Hypocitraturia due to renal tubular acidosis or chronic diarrheal syndrome affected only 3.3% of patients. Hypomagnesiuric Ca nephrolithiasis, infection stones, and cystinuria were uncommon, accounting for 6.8%, 5.9%, and 0.9% of patients, respectively. The acquired problem of low urine volume (<1 L/d) was found in 15.3% of patients. The remaining 3.5% of patients were difficult to classify despite the presence of abnormal urinary biochemistry.

References (51)

  • McLeodRS et al.

    Urolithiasis complicating inflammatory bowel disease

    J Urol.

    (1992)
  • DobbinsJW et al.

    Effect of bile salts and fatty acids on the colonic absorption of oxalate

    Gastroenterology.

    (1976)
  • DanpureCJ

    Molecular and clinical heterogeneity in primary hyperoxaluria Type I

    Am J Kid Dis.

    (1991)
  • BuckalewVM

    Nephrolithiasis in renal tubular acidosis

    J Urol.

    (1989)
  • GriffithDP

    Struvite stones

    Kid Int.

    (1978)
  • MillinerDS

    Cystinuria

    Endocrinol Metab Clin North Am.

    (1990)
  • PakCYC et al.

    Graphic display of urinary risk factors for renal stone formation

    J Urol.

    (1985)
  • FiskeCH et al.

    The calorimetric determination of phosphorus

    J Biol Chem.

    (1925)
  • WelshmanSG et al.

    The estimation of citrate in serum and urine using a citrate lyase technique

    Clin Chim Acta.

    (1973)
  • NicarMJ et al.

    Low urinary citrate excretion in nephrolithiasis

    Urology.

    (1983)
  • SakhaeeK et al.

    The spectrum of metabolic abnormalities in patients with cystine nephrolithiasis

    J Urol.

    (1989)
  • PakCYC et al.

    Long-term persistence of metabolic abnormalities in absorptive or renal hypercalciuria

    Lancet

    (1981)
  • CoeFL et al.

    The pathogenesis and treatment of kidney stones

    NEJM

    (1992)
  • PakCYC

    Etiology and treatment of urolithiasis

    Am J Kid Dis.

    (1990)
  • SmithLH

    The pathophysiology and medical treatment of urolithiasis

  • Cited by (290)

    View all citing articles on Scopus
    1

    Supported by USPHS grants P01-DK20543 and M01-RR00633.

    View full text