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Renal Phosphate Control as a Reliable Predictive Factor of Stone Recurrence

2009; Lippincott Williams & Wilkins; Volume: 181; Issue: 6 Linguagem: Inglês

10.1016/j.juro.2009.01.101

1527-3792

Yong‐June Kim, Tae‐Hwan Kim, Seok Joong Yun, Min Eui Kim, Wun‐Jae Kim, Sang‐Cheol Lee,

Magnesium in Health and Disease

No AccessJournal of UrologyAdult Urology1 Jun 2009Renal Phosphate Control as a Reliable Predictive Factor of Stone Recurrence Yong-June Kim, Tae-Hwan Kim, Seok-Joong Yun, Min Eui Kim, Wun-Jae Kim, and Sang-Cheol Lee Yong-June KimYong-June Kim Department of Urology, Chungbuk National University College of Medicine, Cheongju, South Korea More articles by this author , Tae-Hwan KimTae-Hwan Kim Kyungpook University College of Medicine, Daegu, South Korea More articles by this author , Seok-Joong YunSeok-Joong Yun Department of Urology, Chungbuk National University College of Medicine, Cheongju, South Korea More articles by this author , Min Eui KimMin Eui Kim Soonchunhyang University College of Medicine, Bucheon, South Korea More articles by this author , Wun-Jae KimWun-Jae Kim Department of Urology, Chungbuk National University College of Medicine, Cheongju, South Korea More articles by this author , and Sang-Cheol LeeSang-Cheol Lee Department of Urology, Chungbuk National University College of Medicine, Cheongju, South Korea More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2009.01.101AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Recent studies have suggested a defect in phosphate balance as a significant underlying cause of calcium urolithiasis. In this study we assessed the influence of decreased renal phosphate reabsorption capacity on urinary metabolic abnormalities as well as on stone recurrence. Materials and Methods: A database of patient history, and serum and urine chemistry studies was analyzed for 950 consecutive stone formers and 91 normal controls. The maximal reabsorption of phosphate by the glomerular filtration rate was calculated, and the effect of maximal reabsorption of phosphate by the glomerular filtration rate on stone metabolites and stone recurrence was determined. A value of maximal reabsorption of phosphate by the glomerular filtration rate lower than 1.83 mg/dl was defined as a low rate. Of the stone formers 266 (28.0%) who had been followed for more than 36 months (median 49, range 2 to 152) were included in the recurrence analysis. Results: Maximal reabsorption of phosphate by the glomerular filtration rate was significantly less in stone formers compared to normal controls, and was negatively correlated with the urinary excretion of uric acid, calcium and phosphate. Of the stone formers 13.1% (124 of 950) had a low maximal reabsorption of phosphate by the glomerular filtration rate as well as a higher prevalence of hypercalciuria and hyperuricosuria than individuals with normal maximal reabsorption of phosphate by the glomerular filtration rate. The multivariate Cox regression model revealed that the low maximal reabsorption of phosphate by the glomerular filtration rate (hazards ratio 1.685, 95% CI 1.040–2.730, p = 0.034) was a strong predictor of stone recurrence in stone formers. Conclusions: This study demonstrated that the renal phosphate reabsorption capacity was significantly decreased in stone formers compared to normal controls, and that a low maximal reabsorption of phosphate by the glomerular filtration rate was associated with hypercalciuria and hyperuricosuria. Furthermore, renal phosphate handling was an independent predictive determinant for recurrence in stone formers. References 1 : Incidence of upper urinary tract stones. Miner Electrolyte Metab1987; 13: 220. Google Scholar 2 : The hypercalciurias: Causes, parathyroid functions, and diagnostic criteria. J Clin Invest1974; 54: 387. Google Scholar 3 : The pathogenesis and treatment of kidney stones. N Engl J Med1992; 327: 1141. Google Scholar 4 : Inappropriate phosphate excretion in idiopathic hypercalciuria: the key to a common cause and future treatment?. J Clin Pathol1996; 49: 881. 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Volume 181Issue 6June 2009Page: 2566-2572 Advertisement Copyright & Permissions© 2009 by American Urological AssociationKeywordsurolithiasisrecurrencephosphatesMetricsAuthor Information Yong-June Kim Department of Urology, Chungbuk National University College of Medicine, Cheongju, South Korea More articles by this author Tae-Hwan Kim Kyungpook University College of Medicine, Daegu, South Korea More articles by this author Seok-Joong Yun Department of Urology, Chungbuk National University College of Medicine, Cheongju, South Korea More articles by this author Min Eui Kim Soonchunhyang University College of Medicine, Bucheon, South Korea More articles by this author Wun-Jae Kim Department of Urology, Chungbuk National University College of Medicine, Cheongju, South Korea More articles by this author Sang-Cheol Lee Department of Urology, Chungbuk National University College of Medicine, Cheongju, South Korea More articles by this author Expand All Advertisement PDF downloadLoading ...