Hess B, Hasler-Strub U, Ackermann D, Jaeger P
Policlinic of Medicine, University Hospital, Berne, Switzerland.
Nephrol Dial Transplant. 1997 Jul;12(7):1362-8. doi: 10.1093/ndt/12.7.1362.
Metabolic evaluation in recurrent idiopathic calcium renal stone-formers (RCSF) was analysed with respect to the following questions: (1) do three 24-h urines provide more diagnostic accuracy in the metabolic evaluation of RCSF than 1 or 2 urines?; (2) does time after stone event influence the diagnostic yield?; (3) is urine composition at weekends different from that at mid-week?; (4) what are the prevalences of the most important risk factors (RF) of idiopathic calcium nephrolithiasis, i.e. low volume (LV), hypercalciuria (HC), hyperoxaluria (HO), hyperuricosuria (HU), hypocitraturia (Hypo-Cit), and hypomagnesiuria (Hypo-Mg)?; and (5) do male RCSF differ from females with respect to urinary RFs?
Seventy-five RCSF (59 men, 16 women) collected three 24-h urines (U1-3) while on free-choice diet. To account for possible variations in lifestyle and diet, U1 and U3 had to be collected midweek and U2 at a weekend.
When considering all three urines together (U1 + U2 + U3), the number of RF abnormalities/patient was 2.8 +/- 0.1, higher than numbers of any combination of two urines or of any single urine (P = 0.0001 for all comparisons). The number of RF abnormalities also rose with time after stone event, from 0.8 +/- 0.1 (range 0-4) in U1 to 1.1 +/- 0.1 (range 0-4) in U3 (P = 0.011 vs U1). Whereas all other RF did not change between collections, urine volume was lower in U2 (1793 +/- 90 ml) than in U1 (2071 +/- 97 ml, P = 0.0001 vs U2) and U3 (1946 +/- 97 ml, P = 0.046 vs U2). At least 1 abnormality was found in 85.3% of all RCSF, and multiple abnormalities occurred in 47%. The most frequent RF was HC (39%), followed by HO and LV (32% each), Hypo-Cit (29%), HU (23%) and Hypo-Mg (19%). Males more often had Hypo-Cit (P < 0.001) and Hypo-Mg (P < 0.01) than females, whereas HO was more frequent in female RCSF (P < 0.025 vs males).
Diagnostic accuracy of metabolic evaluation in RCSF increases both with the number of urines collected and the time passing after a stone event. Urines collected at weekends differ from those of the week only by their lower volumes. Abnormalities of RF for calcium nephrolithiasis can be detected in 85.3% of RCSF, and HC is the most common RF both in male and female RCSF.
针对复发性特发性钙肾结石患者（RCSF）的代谢评估，分析了以下问题：（1）在RCSF的代谢评估中，三次24小时尿液检测是否比一次或两次尿液检测具有更高的诊断准确性？（2）结石事件后的时间是否会影响诊断阳性率？（3）周末的尿液成分与周中是否不同？（4）特发性钙肾结石最重要的危险因素（RF），即低尿量（LV）、高钙尿症（HC）、高草酸尿症（HO）、高尿酸尿症（HU）、低枸橼酸尿症（Hypo-Cit）和低镁尿症（Hypo-Mg）的患病率是多少？（5）男性RCSF与女性在尿液RF方面是否存在差异？
75例RCSF（59例男性，16例女性）在自由选择饮食的情况下收集了三次24小时尿液（U1 - 3）。为了考虑生活方式和饮食的可能差异，U1和U3必须在周中收集，U2在周末收集。
当将所有三次尿液（U1 + U2 + U3）综合考虑时，每位患者的RF异常数为2.8±0.1，高于任意两次尿液组合或任意一次尿液的异常数（所有比较P = 0.0001）。RF异常数也随着结石事件后的时间增加而上升，从U1中的0.8±0.1（范围0 - 4）增加到U3中的1.1±0.1（范围0 - 4）（与U1相比P = 0.011）。虽然其他所有RF在各次收集之间没有变化，但U2的尿量（1793±90 ml）低于U1（2071±97 ml，与U2相比P = 0.0001）和U3（1946±97 ml，与U2相比P = 0.046）。在所有RCSF中，85.3%至少发现1项异常，47%存在多项异常。最常见的RF是HC（39%），其次是HO和LV（各32%），Hypo-Cit（29%），HU（23%）和Hypo-Mg（19%）。男性比女性更常出现Hypo-Cit（P < 0.001）和Hypo-Mg（P < 0.01），而HO在女性RCSF中更常见（与男性相比P < 0.025）。
RCSF代谢评估的诊断准确性随着收集的尿液次数以及结石事件后的时间推移而提高。周末收集的尿液与周中收集的尿液仅在尿量上有所不同。85.3%的RCSF可检测到钙肾结石的RF异常，并且HC是男性和女性RCSF中最常见的RF。
