Ferraro Pietro Manuel, Spasiano Andrea, Gambaro Giovanni, Prezioso Domenico, Lapi Francesco, Piccinocchi Gaetano
Section of Nephrology, Department of Medicine, Università Degli Studi Di Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University, Naples, Italy.
J Nephrol. 2025 Sep 6. doi: 10.1007/s40620-025-02389-0.
Kidney stone formation is driven by an imbalance between lithogenic substances and crystallization inhibitors. Current guidelines recommend a 24-h urine collection in patients with kidney stone disease to assess the risk of stone formation and monitor therapy compliance. However, real-world data on adherence to these guidelines remain limited and outdated.
We used the Health Search Database to examine laboratory test data of patients with kidney stone disease between 2013 and 2022 in Italy. Adults with at least one episode of kidney or ureteral stones during this period were included. We used the prescription of urinary calcium, oxalate, and citrate levels as a proxy for full metabolic testing.
A total of 21,907 adult patients were identified (44.6% women). Only 4.8% (n = 1059) underwent 24-h urine testing, and just 0.6% had all three target measurements. Testing rates were slightly higher in recurrent stone formers (6.1%). The likelihood of receiving a test increased nearly sixfold after a nephrology visit (OR 6.09, 95% CI 5.27-7.05, p < 0.001), compared to a lower increase after urology visits (OR 1.95, 95% CI 1.71-2.23, p < 0.001). Nonetheless, fewer than 10% of kidney stone disease patients consulted a nephrologist, and only half of those with coexisting chronic kidney disease (CKD) had such a referral.
Awareness of 24-h urine testing and nephrology referral in stone formers remains low, despite their role in guiding personalized treatment. Promoting their use could enhance patient care by identifying urinary abnormalities and reducing the risk of recurrence and complications.
肾结石的形成是由致石物质与结晶抑制剂之间的失衡所驱动的。当前指南建议对肾结石患者进行24小时尿液收集，以评估结石形成风险并监测治疗依从性。然而，关于遵循这些指南的真实世界数据仍然有限且过时。
我们使用健康搜索数据库来检查2013年至2022年期间意大利肾结石患者的实验室检测数据。纳入在此期间至少有一次肾结石或输尿管结石发作的成年人。我们将尿钙、草酸盐和柠檬酸盐水平的处方作为全面代谢检测的替代指标。
共识别出21907名成年患者（44.6%为女性）。只有4.8%（n = 1059）进行了24小时尿液检测，仅有0.6%进行了所有三项目标测量。复发性结石形成者的检测率略高（6.1%）。与泌尿外科就诊后检测率的较低增幅相比，肾病就诊后接受检测的可能性增加了近六倍（OR 6.09，95%CI 5.27 - 7.05，p < 0.001）（OR 1.95，95%CI 1.71 - 2.23，p < 0.001）。尽管如此，不到10%的肾结石患者咨询过肾病专家，并且只有一半合并慢性肾脏病（CKD）的患者得到了这样的转诊。
尽管24小时尿液检测和肾病转诊在指导个性化治疗中发挥着作用，但结石形成者对其的知晓率仍然很低。推广其使用可以通过识别尿液异常并降低复发和并发症风险来提高患者护理水平。
