Abu-Ghanem Yasmin, Shvero Asaf, Kleinmann Nir, Winkler Harry Z, Zilberman Dorit E
Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.
Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Int Urol Nephrol. 2018 Jul;50(7):1243-1247. doi: 10.1007/s11255-018-1902-1. Epub 2018 Jun 6.
A 24-h urine metabolic profile (24-UMP) is an integral part of nephrolithiasis work-up. We aimed to explore whether it can be waived under certain circumstances.
We reviewed our prospective registry database of patients seen at our outpatient clinic for nephrolithiasis between the years 2010 and 2017. Data included: gender, age at first stone, body mass index (BMI), self-reported comorbidities and family history of nephrolithiasis. A 24-UMP was obtained from each patient under random diet. The following were recorded: urine volume, urinary levels of sodium, calcium, uric acid, oxalate and citrate. Presence of at least one comorbidity (i.e., hypertension/diabetes/hyperlipidemia) was defined as "associated comorbidities" (AC). Their absence was defined as "no comorbidities" (NC). Subjects were divided into two subgroups: first-time and recurrent stone formers, which were further divided into two subgroups: 1st + AC; 1st + NC; recurrent + AC; recurrent + NC. 24-UMPs have been compared between the four groups.
Four hundred and fifty-seven patients were included in the study. In the AC groups, patients demonstrated higher BMI levels (p = 0.001), and were statistically significantly obese (BMI > 30, p = 0.001) and older at first stone event (p = 0.001). First formers, either with AC or NC were more likely to have low urine volume (LUV) compared with recurrent formers (72.5 vs. 59.5%, p = 0.005). In the remaining metabolic abnormalities, no such differences were observed.
First-time stone formers, either with or without AC are likely to demonstrate LUV as their primary metabolic abnormality in 24-UMP. Therefore, 24-UMP may be postponed until recurrent stone event.
24小时尿液代谢谱（24-UMP）是肾结石检查的一个重要组成部分。我们旨在探讨在某些情况下是否可以省略该项检查。
我们回顾了2010年至2017年间在我们门诊就诊的肾结石患者的前瞻性登记数据库。数据包括：性别、首次结石发作时的年龄、体重指数（BMI）、自我报告的合并症以及肾结石家族史。在随机饮食情况下，从每位患者获取24-UMP。记录以下指标：尿量、尿钠、钙、尿酸、草酸盐和柠檬酸盐水平。至少有一种合并症（即高血压/糖尿病/高脂血症）的存在被定义为“相关合并症”（AC）。不存在合并症被定义为“无合并症”（NC）。受试者分为两个亚组：首次结石形成者和复发性结石形成者，这两个亚组又进一步分为两个亚组：首次结石形成者+AC；首次结石形成者+NC；复发性结石形成者+AC；复发性结石形成者+NC。对四组之间的24-UMP进行了比较。
457名患者纳入研究。在AC组中，患者表现出更高的BMI水平（p = 0.001），且在统计学上显著肥胖（BMI>30，p = 0.001），首次结石发作时年龄更大（p = 0.001）。与复发性结石形成者相比，无论是有AC还是NC的首次结石形成者更有可能出现低尿量（LUV）（72.5%对59.5%，p = 0.005）。在其余代谢异常方面，未观察到此类差异。
无论是有还是没有AC的首次结石形成者，在24-UMP中都可能以LUV作为其主要代谢异常表现。因此，24-UMP检查可推迟至复发性结石发作时进行。
