Predictive value of kidney stone composition in the detection of metabolic abnormalities

Charles Y Pak, John R. Poindexter, Beverley A Huet, Margaret S Pearle

Research output: Contribution to journalArticle

172 Citations (Scopus)

Abstract

PURPOSE: To determine if kidney stone composition can predict the underlying medical diagnosis, and vice versa. METHODS: We studied 1392 patients with kidney stones who underwent a complete ambulatory evaluation and who submitted one or more stones for analysis. We ascertained the associations between medical diagnosis and stone composition. RESULTS: The most common kidney stones were composed of calcium oxalate (n = 1041 patients [74.8%]), mixed calcium oxalate-calcium apatite (n = 485 [34.8%]), and calcium apatite alone (n = 146 [10.5%]). The most common medical diagnoses were hypocitraturia (n = 616 patients [44.3%]), absorptive hypercalciuria (n = 511 [36.7%]), and hyperuricosuria (n = 395 [28.4%]). Calcium apatite and mixed calcium oxalate-calcium apatite stones were associated with the diagnoses of renal tubular acidosis and primary hyperparathyroidism (odds ratios ≥2), but not with chronic diarrheal syndromes. As the phosphate content of the stone increased from calcium oxalate to mixed calcium oxalate-calcium apatite, and finally to calcium apatite, the percentage of patients with renal tubular acidosis increased from 5% (57/1041) to 39% (57/146), and those with primary hyperparathyroidism increased from 2% (26/1041) to 10% (14/146). Calcium oxalate stones were associated with chronic diarrheal syndromes, but not with renal tubular acidosis. Pure and mixed uric acid stones were strongly associated with a gouty diathesis, and vice versa. Chronic diarrheal syndromes and uric acid stones were associated with one another, and brushite stones were associated with renal tubular acidosis. As expected, there was a very strong association between infection stones and infection, and between cystine stones and cystinuria. CONCLUSION: Stone composition has some predictive value in diagnosing medical conditions, and vice versa, especially for noncalcareous stones.

Original languageEnglish (US)
Pages (from-to)26-32
Number of pages7
JournalAmerican Journal of Medicine
Volume115
Issue number1
DOIs
StatePublished - Jul 2003

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Apatites
Calcium Oxalate
Kidney Calculi
Renal Tubular Acidosis
Calcium
Primary Hyperparathyroidism
Uric Acid
Cystinuria
Hypercalciuria
Cystine
Disease Susceptibility
Infection
Odds Ratio
Phosphates

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Predictive value of kidney stone composition in the detection of metabolic abnormalities. / Pak, Charles Y; Poindexter, John R.; Huet, Beverley A; Pearle, Margaret S.

In: American Journal of Medicine, Vol. 115, No. 1, 07.2003, p. 26-32.

Research output: Contribution to journalArticle

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abstract = "PURPOSE: To determine if kidney stone composition can predict the underlying medical diagnosis, and vice versa. METHODS: We studied 1392 patients with kidney stones who underwent a complete ambulatory evaluation and who submitted one or more stones for analysis. We ascertained the associations between medical diagnosis and stone composition. RESULTS: The most common kidney stones were composed of calcium oxalate (n = 1041 patients [74.8{\%}]), mixed calcium oxalate-calcium apatite (n = 485 [34.8{\%}]), and calcium apatite alone (n = 146 [10.5{\%}]). The most common medical diagnoses were hypocitraturia (n = 616 patients [44.3{\%}]), absorptive hypercalciuria (n = 511 [36.7{\%}]), and hyperuricosuria (n = 395 [28.4{\%}]). Calcium apatite and mixed calcium oxalate-calcium apatite stones were associated with the diagnoses of renal tubular acidosis and primary hyperparathyroidism (odds ratios ≥2), but not with chronic diarrheal syndromes. As the phosphate content of the stone increased from calcium oxalate to mixed calcium oxalate-calcium apatite, and finally to calcium apatite, the percentage of patients with renal tubular acidosis increased from 5{\%} (57/1041) to 39{\%} (57/146), and those with primary hyperparathyroidism increased from 2{\%} (26/1041) to 10{\%} (14/146). Calcium oxalate stones were associated with chronic diarrheal syndromes, but not with renal tubular acidosis. Pure and mixed uric acid stones were strongly associated with a gouty diathesis, and vice versa. Chronic diarrheal syndromes and uric acid stones were associated with one another, and brushite stones were associated with renal tubular acidosis. As expected, there was a very strong association between infection stones and infection, and between cystine stones and cystinuria. CONCLUSION: Stone composition has some predictive value in diagnosing medical conditions, and vice versa, especially for noncalcareous stones.",
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