Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
BJU Int. 2021 May;127(5):538-543. doi: 10.1111/bju.15250. Epub 2020 Oct 4.
To determine the clinical utility of blood tests as a screening tool for metabolic abnormalities in patients with kidney stone disease.
Clinical and biochemical data from 709 patients attending the Oxford University Hospitals NHS Foundation Trust for assessment and treatment of kidney stones were prospectively collected between April 2011 and February 2017. Data were analysed to determine the utility of serum calcium, parathyroid hormone (PTH), urate, chloride, bicarbonate, potassium and phosphate assays in screening for primary hyperparathyroidism, normocalcaemic hyperparathyroidism, hyperuricosuria, distal renal tubular acidosis (dRTA) and hypercalciuria.
An elevated serum calcium level was detected in 2.3% of patients. Further investigations prompted by this finding resulted in a diagnosis of primary hyperparathyroidism in 0.2% of men and 4.6% of women for whom serum calcium was recorded. An elevated serum PTH level in the absence of hypercalcaemia was detected in 15.1% of patients. Of these patients, 74.6% were vitamin D-insufficient; no patients were diagnosed with normocalcaemic hyperparathyroidism. Hyperuricosuria was present in 21.6% of patients and hypercalciuria in 47.1%. Hyperuricaemia was not associated with hyperuricosuria, nor was hypophosphataemia associated with hypercalciuria. No patient was highlighted as being at risk of dRTA using serum chloride and bicarbonate as screening tests.
This study indicates that individuals presenting with renal calculi should undergo metabolic screening with a serum calcium measurement alone. Use of additional blood tests to screen for metabolic disorders is not cost-effective and may provide false reassurance that metabolic abnormalities are not present. A full metabolic assessment with 24-h urine collection should be undertaken in recurrent stone formers and in those at high risk of future stone disease to identify potentially treatable metabolic abnormalities.
确定血液检查作为肾结石患者代谢异常筛查工具的临床实用性。
2011 年 4 月至 2017 年 2 月期间，前瞻性收集了在牛津大学医院 NHS 基金会信托基金会就诊评估和治疗肾结石的 709 名患者的临床和生化数据。对数据进行分析，以确定血清钙、甲状旁腺激素（PTH）、尿酸、氯、碳酸氢盐、钾和磷测定在筛查原发性甲状旁腺功能亢进症、血钙正常甲状旁腺功能亢进症、高尿酸血症、远端肾小管酸中毒（dRTA）和高钙尿症中的作用。
2.3%的患者血清钙水平升高。进一步的检查结果发现，记录血清钙的男性中 0.2%和女性中 4.6%患有原发性甲状旁腺功能亢进症。15.1%的患者血清 PTH 水平升高而血钙正常。这些患者中，74.6%维生素 D 不足；没有患者被诊断为血钙正常甲状旁腺功能亢进症。高尿酸血症见于 21.6%的患者，高钙尿症见于 47.1%的患者。高尿酸血症与高尿酸血症无关，低磷血症与高钙尿症无关。使用血清氯和碳酸氢盐作为筛查试验，没有患者提示有发生远端肾小管酸中毒的风险。
本研究表明，有肾结石的患者应单独进行血清钙测量代谢筛查。使用其他血液检查来筛查代谢紊乱不仅不经济，而且可能会错误地认为不存在代谢异常。应在复发性结石形成者和未来结石病高危者中进行全面的代谢评估和 24 小时尿液收集，以发现潜在的可治疗的代谢异常。
