Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA.
Department of Urology, SUNY Downstate Health Sciences University, New York, USA.
World J Urol. 2023 Dec;41(12):3713-3721. doi: 10.1007/s00345-023-04619-1. Epub 2023 Oct 17.
American Urological Association (AUA) guidelines suggest metabolic testing via 24-h urine studies in high-risk, interested first-time stone formers, and recurrent stone formers. If metabolic testing is not available or otherwise not feasible, clinicians may need to utilize empiric therapy. Debility and social barriers, particularly in the elderly population, may limit the practicality of metabolic testing, and therefore, empiric therapy is of particular importance. The aim of this study is to identify whether unique urinary metabolic abnormality profiles exist for octogenarians with calcium oxalate kidney stones, as this may guide empiric stone prevention therapy more precisely in this population.
Patients with calcium oxalate stones from a single academic kidney stone center in New York, NY, were retrospectively identified in our prospectively managed database. Patient data, including demographic, clinical information, and baseline 24-h urine studies, were collected before initiating any treatment. Subjects were stratified by age (≤ 40, 41-59, 60-79, and ≥ 80 years) to compare the metabolic urinary abnormality profiles between octogenarians and other age groups. Subgroup analyses were also performed to compare results by gender and by the presence of underlying kidney dysfunction. Comparative statistical analysis was carried out using Chi-square tests, Mann-Whitney U tests, and t-tests where appropriate.
Hypocitraturia, low urine pH, and low urine volume were most common in older patients, particularly in octogenarians. Hypercalciuria, hypernatriuria, and hyperuricosuria were more apparent in younger groups.
With increasing age, hypocitraturia, low urine pH, and low urine volume were more prevalent on 24-h urine metabolic testing. We hypothesize increased comorbidity, including medical renal disease, polypharmacy, and dehydration are possible factors contributing to this unique profile. We suggest that empiric therapy targeted towards this profile is important in very elderly stone formers in whom 24-h urine testing may not be possible. Increased hydration, increased fruit and vegetable intake, and low-dose alkali therapy are easy measures to accomplish this.
美国泌尿外科学会（AUA）指南建议对高风险、有兴趣的首次结石形成者和复发性结石形成者进行 24 小时尿液研究进行代谢检测。如果无法进行代谢检测或其他方法不可行，临床医生可能需要使用经验性治疗。虚弱和社会障碍，特别是在老年人群中，可能会限制代谢检测的实用性，因此，经验性治疗尤为重要。本研究的目的是确定 80 岁以上患有草酸钙肾结石的患者是否存在独特的尿代谢异常特征，因为这可能更准确地指导该人群的经验性结石预防治疗。
从纽约州纽约市的一家学术肾结石中心的回顾性确定了患有草酸钙结石的患者在我们前瞻性管理的数据库中。收集了包括人口统计学、临床信息和基线 24 小时尿液研究在内的患者数据，然后在开始任何治疗之前。根据年龄（≤40、41-59、60-79 和≥80 岁）将患者分层，以比较 80 岁以上患者和其他年龄组之间的代谢尿液异常特征。还进行了亚组分析，以比较性别和潜在肾功能障碍存在时的结果。使用卡方检验、Mann-Whitney U 检验和 t 检验进行比较统计学分析，在适当的情况下。
低柠檬酸尿症、低尿 pH 值和低尿量在老年患者中最为常见，尤其是 80 岁以上的患者。高钙尿症、高钠尿症和高尿酸尿症在年轻组中更为明显。
随着年龄的增长，低柠檬酸尿症、低尿 pH 值和低尿量在 24 小时尿液代谢检测中更为常见。我们假设增加的合并症，包括医学肾脏疾病、多种药物治疗和脱水，可能是导致这种独特特征的因素。我们建议，对于无法进行 24 小时尿液检测的非常老年结石形成者，针对这种特征的经验性治疗很重要。增加水分摄入、增加水果和蔬菜摄入以及低剂量碱治疗是实现这一目标的简单措施。
