Department of Urology, San Cecilio University Hospital, Granada, Spain.
Urology. 2012 Jan;79(1):48-54. doi: 10.1016/j.urology.2011.07.1382. Epub 2011 Sep 9.
To analyze the biochemical alterations in plasma and the urine determinants of severe lithogenic activity in patients with idiopathic calcium nephrolithiasis.
We performed a cross-sectional study of 120 patients divided into 2 groups: group 1, 60 patients without nephrolithiasis; and group 2, 60 patients with severe and/or recurrent calcium nephrolithiasis. In all patients, a study of renal function, calcium metabolism, and bone remodeling markers, and a study of the lithogenic factors were performed in urine after fasting and in 24-hour urine samples.
We observed greater values for phosphorus in group 1 than in group 2 (P=.03). Also, we found greater values for intact parathyroid hormone (P=.01), osteocalcin (P=.000), and β-crosslaps (P=.000) in group 2 than in group 1. In the 24-hour urine samples, significant differences were found between groups 1 and 2 in calciuria (11.7 vs 17.4 mg/dL; P=.000), citraturia (50.6 vs 33.5 mg/dL; P=.002), calcium/creatinine quotient (0.14 vs 0.20; P=.001), calcium/citrate quotient (0.05 vs 0.13; P=.04), and calcium/creatinine quotient after fasting (0.09 vs 0.16; P=.000).
We consider the determinants of severe and/or recurrent calcium lithiasis to be hypercalciuria and hypocitraturia and a calcium/citrate quotient>0.06. As risk markers we can consider phosphatemia<2.9 mg/dL, phosphate/chlorine quotient>35, alkaline phosphatase>80 U/L, intact parathyroid hormone>60 pg/mL, osteocalcin>16 ng/mL, β-crosslaps>0.400 ng/mL, and β-crosslaps/osteocalcin quotient>0.028.
分析特发性钙肾结石患者血浆生化改变和尿液中严重成石活性的决定因素。
我们进行了一项横断面研究，共纳入 120 名患者，分为 2 组：第 1 组 60 例无肾结石患者；第 2 组 60 例严重和/或复发性钙肾结石患者。所有患者均进行肾功能、钙代谢和骨重塑标志物研究，并在空腹和 24 小时尿液样本中进行成石因素研究。
我们观察到第 1 组的磷值高于第 2 组（P=.03）。此外，我们发现第 2 组的完整甲状旁腺激素（P=.01）、骨钙素（P=.000）和 β-胶原交联（P=.000）值均高于第 1 组。在 24 小时尿液样本中，第 1 组和第 2 组之间的尿钙排泄量（11.7 与 17.4 mg/dL；P=.000）、枸橼酸盐排泄量（50.6 与 33.5 mg/dL；P=.002）、钙/肌酐比值（0.14 与 0.20；P=.001）、钙/枸橼酸盐比值（0.05 与 0.13；P=.04）和空腹后钙/肌酐比值（0.09 与 0.16；P=.000）均有显著差异。
我们认为严重和/或复发性钙结石的决定因素是高钙尿症和低枸橼酸尿症，以及钙/枸橼酸盐比值>0.06。作为风险标志物，我们可以考虑血磷<2.9 mg/dL、磷/氯比值>35、碱性磷酸酶>80 U/L、完整甲状旁腺激素>60 pg/mL、骨钙素>16 ng/mL、β-胶原交联>0.400 ng/mL 和 β-胶原交联/骨钙素比值>0.028。
