García Nieto Víctor M, Pérez Bastida Xochitl Illian, Salvador Cañibano María, García Rodríguez Victoria E, Monge Zamorano Margarita, Luis Yanes María Isabel
Sección de Nefrología Pediátrica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España.
Centro Medico Nacional La Raza, México.
Nefrologia (Engl Ed). 2018 May-Jun;38(3):267-272. doi: 10.1016/j.nefro.2017.07.004. Epub 2018 Feb 14.
Various genetic and environmental factors are involved in urolithiasis. The 2 most common metabolic abnormalities are the increase in urinary calcium and low urinary citrate excretion. The ratio calculated between the concentrations of both substances is a good risk marker for the formation of calcium stones.
To determine whether the risk of urinary calcium stone formation changes throughout the day in the same patient.
We studied 56 children (23V, 33M) to check if they had prelithiasis. Calcium, citrate, and creatinine concentrations were determined in two urine samples collected one before dinner and the other in the morning. It was collected if they had ultrasound stones and if there was a history of urolithiasis in first and/or second degree relatives.
In 25 patients (44.6%), renal ultrasound was positive for lithiasis (stones [n=9] and microlithiasis [n=16]). Forty of the 56 families (71.4%) had a history of urolithiasis. The percentage of abnormal urinary calcium (28.6%) concentrations and an abnormal calcium/citrate ratio (69.6%) was higher in the first urine of the day. The calcium/citrate ratio was the only studied parameter that was related to a family history of urolithiasis. There were no differences in urinary parameters between patients with and without ultrasound-confirmed kidney stones.
Urinary concentrations of calcium and the calcium/citrate ratio vary throughout the day. Urine produced at night has a higher risk of urinary calcium stone formation.
多种遗传和环境因素与尿石症有关。最常见的两种代谢异常是尿钙增加和尿枸橼酸盐排泄减少。两种物质浓度的比值是钙结石形成的良好风险标志物。
确定同一患者尿钙结石形成的风险在一天中是否会发生变化。
我们研究了56名儿童（23名男性，33名女性），以检查他们是否有结石前期症状。在晚餐前和早晨采集的两份尿液样本中测定钙、枸橼酸盐和肌酐的浓度。如果他们有超声检查发现的结石，以及一级和/或二级亲属中有尿石症病史，则采集样本。
25名患者（44.6%）的肾脏超声检查显示有结石（结石[n=9]和微结石[n=16]）。56个家庭中有40个（71.4%）有尿石症病史。一天中的第一次尿液中尿钙浓度异常（28.6%）和钙/枸橼酸盐比值异常（69.6%）的百分比更高。钙/枸橼酸盐比值是唯一与尿石症家族史相关的研究参数。超声确诊有肾结石和无肾结石的患者之间的尿液参数没有差异。
尿钙浓度和钙/枸橼酸盐比值在一天中会发生变化。夜间产生的尿液形成尿钙结石的风险更高。
