Introduction:
Nephrolithiasis, or renal calculi, is a common morbidity among adults. On the basis of composition urinary stones can be classified as calcium oxalate (60%), phosphate (30%), uric acid (5-10%) and cystine (1-3%).Multiple factors can influence development of urinary stones which includes diet, environment, genetic and metabolic disturbances.
Patients with recurrent, bilateral, or multiple nephrolithiasis have been observed to have various metabolic abnormalities which include hypercalcemia, hyperuricemia, hyperphosphatemia, hyperparathyroidism, hypercalciuria, hyperoxaluria, hypocitraturia, hyperuricosuria and hypomagnesuria.
Methods:
Study Area: Tertiary hospital in New Delhi
Study Design: Prospective observational study
Study Duration: 2 years
Study Population: Patients with radiologically proven recurrent, bilateral, or multiple nephrolithiasis
Inclusion criteria
Male and female patients between age 18-60 years
Exclusion criteria
-Congenital abnormalities of kidney and urinary tracts
-Chronic kidney disease on dialysis
-Refusal to participate in study
Outcome measures
Type of metabolic abnormality
1.Hypercalcemia
2.Hyperuricemia
3.Hyperphosphatemia
4.Hyperparathyroidism
5.Hypercalciuria
6.Hyperuricosuria
7.Hyperoxaluria
8.Hypocitraturia
9.Hypomagnesuria
Results:
Total of 50 patients were included in the study. The patient underwent serum total calcium, creatinine, phosphorous, uric acid, intact parathyroid hormone (iPTH) and vitamin D and 24hour urine for oxalate, uric acid, phosphorous, magnesium, calcium and citrate.
Out of 50 patient abnormality was detected in 19 patients. Hyperoxaluria was the most common in 8 patients followed by hypomagnesuria in 5 patients. Hypercalciuria was present was present in 3 patients followed by hypocitraturia in 2. Hyperuricosuria was detected in one patient. The yield of the study was 38% which was consistent with the past studies showing prevalence between 3%-65 %. Statistically significant association was found between number of episodes of recurrence with hyperoxaluria and number of stones with hypomagnesuria. iPTH in serum was elevated in 5 patients.
Conclusions:
There are few studies in North India addressing the prevalence of metabolic abnormalities in recurrent, bilateral, or multiple renal stones. This study highlights the metabolic abnormalities in urine and serum and further can help in making the dietary changes and treatment strategies in these strata of patients.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.