Bargagli Matteo, Pinto Francesco, De Leonardis Rossella, Ragonese Mauro, Totaro Angelo, Recupero Salvatore, Vittori Matteo, Bassi PierFrancesco, Gambaro Giovanni, Ferraro Pietro Manuel
Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma; U.O.S. Terapia Conservativa della Malattia Renale Cronica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma.
U.O.C. Clinica Urologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma.
Arch Ital Urol Androl. 2023 Feb 22;95(1):10748. doi: 10.4081/aiua.2023.10748.
The aim of this study is to investi-gate the association between the urinary metabolic milieu and kidney stone recurrence with a validated papillary evaluation score (PPLA).
We prospectively enrolled 30 stone for-mers who underwent retrograde intrarenal surgery procedures. Visual inspection of the accessible renal papillae was performed to calculate PPLA score, based on the characterization of ductal plugging, surface pitting, loss of papillary contour and Randall's plaque extension. Stone compositions, 24h urine collections and kidney stone events during follow-up were collected. Relative supersaturation ratios (RSS) for calcium oxalate (CaOx), brushite and uric acid were calculated using EQUIL-2. PPLA score > 3 was defined as high.
Median follow-up period was 11 months (5, 34). PPLA score was inversely correlated with BMI (OR 0.59, 95% CI 0.38, 0.91, p = 0.018), type 2 diabetes (OR 0.04, 95% CI 0.003, 0.58, p = 0.018) and history of recurrent kidney stones (OR 0.17, 95%CI 0.04, 0.75, p = 0.019). The associations between PPLA score, diabetes and BMI were not confirmed after excluding patients with uric acid stones. Higher PPLA score was associated with lower odds of new kidney stone events during follow-up (OR 0.15, 95% CI 0.02, 1.00, p = 0.05). No other significant correla-tions were found.
Our results confirm the lack of efficacy of PPLA score in phenotyping patients affected by kidney stone disease or in predicting the risk of stone recurrence. Larger, long-term studies need to be performed to clarify the role of PPLA on the risk of stone recurrence.
本研究旨在通过验证的乳头评估评分（PPLA）来调查尿代谢环境与肾结石复发之间的关联。
我们前瞻性纳入了30例接受逆行肾内手术的结石形成者。基于导管堵塞、表面凹坑、乳头轮廓丧失和兰德尔斑扩展的特征，对可及的肾乳头进行目视检查以计算PPLA评分。收集结石成分、24小时尿液收集情况以及随访期间的肾结石事件。使用EQUIL-2计算草酸钙（CaOx）、透钙磷石和尿酸的相对过饱和率（RSS）。PPLA评分>3被定义为高。
中位随访期为11个月（5，34）。PPLA评分与BMI呈负相关（OR 0.59，95%CI 0.38，0.91，p = 0.018）、2型糖尿病（OR 0.04，95%CI 0.003，0.58，p = 0.018）以及复发性肾结石病史（OR 0.17，95%CI 0.04，0.75，p = 0.019）。排除尿酸结石患者后，PPLA评分、糖尿病和BMI之间的关联未得到证实。较高的PPLA评分与随访期间新的肾结石事件发生几率较低相关（OR 0.15，95%CI 0.02，1.00，p = 0.05）。未发现其他显著相关性。
我们的结果证实PPLA评分在对受肾结石疾病影响的患者进行表型分析或预测结石复发风险方面缺乏有效性。需要进行更大规模的长期研究以阐明PPLA在结石复发风险中的作用。
