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Comparative Study
. 2017 Jun;197(6):1465-1471.
doi: 10.1016/j.juro.2017.01.057. Epub 2017 Jan 20.

Temporal Changes in Kidney Stone Composition and in Risk Factors Predisposing to Stone Formation

Li Hao Richie Xu  1 , Beverley Adams-Huet  2 , John R Poindexter  1 , Naim M Maalouf  3 , Orson W Moe  4 , Khashayar Sakhaee  5
Affiliations
Comparative Study

Temporal Changes in Kidney Stone Composition and in Risk Factors Predisposing to Stone Formation

Li Hao Richie Xu et al. J Urol. 2017 Jun.

Abstract

Purpose: The prevalence of kidney stones has increased globally in recent decades. However, studies investigating the association between temporal changes in the risk of stone formation and stone types are scarce. We investigated temporal changes in stone composition, and demographic, serum and urinary parameters of kidney stone formers from 1980 to 2015.

Materials and methods: We retrospectively analyzed the records of 1,516 patients diagnosed with either calcium or uric acid stones at an initial visit to a university kidney stone clinic from 1980 to 2015.

Results: From 1980 to 2015, the proportion of uric acid stones in all stone formers increased from 7% to 14%. While age and body mass index increased with time in both uric acid and calcium stone formers, uric acid stone formers were consistently older and had a higher body mass index and lower urinary pH than calcium stone formers. The proportion of females with stones has increased over time but the increase in female gender was more prominent among calcium stone formers. Urinary pH, phosphorus, oxalate and sodium increased with time in calcium stone formers but remained unchanged in uric acid stone formers. After accounting for various parameters of stone risk, the strongest clinical discriminant of uric acid vs calcium stones was urinary pH. Limitations of this study include the retrospective single center design and the available number of patients with stone analysis.

Conclusions: From 1980 to 2015, the proportion of uric acid stones increased significantly. With time, there were proportionately more female calcium stone formers but not uric acid stone formers. Urinary pH is the most prominent factor distinguishing uric acid from calcium stones.

Keywords: calcium; hydrogen-ion concentration; kidney calculi; uric acid; urine.

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Figures

Figure 1
Figure 1
A) Proportion of UASF/CaSF at different time periods; B) Female percentage among UASF/CaSF at different time periods.
Figure 2
Figure 2
A) Age trends of UASF/CaSF at different time periods; B) BMI trends of UASF/CaSF at different time periods. P-value at the top of each figure compares UASF vs. CaSF group effect, while p-values to the right of each line corresponds to test for linear trend across time periods within each group. Asterisk (*) indicates p<0.05 between for CaSF vs. UASF at corresponding time period.
Figure 3
Figure 3
A) Urinary pH trends of UASF/CaSF at different time periods; B) Urinary uric acid trends of UASF/CaSF at different time periods; P-value at the top of each figure compares UASF vs. CaSF group effect, while p-values to the right of each line corresponds to test for linear trend across time periods within each group. Asterisk (*) indicates p<0.05 between for UASF vs. CaSF at corresponding time period.
Figure 4
Figure 4
A) Urinary oxalate trends of UASF/CaSF at different time periods; B) Urinary calcium trends of UASF/CaSF at different time periods. C) Urinary sodium trends of UASF/CaSF at different time periods. D) Urinary phosphorus trends of UASF/CaSF at different time periods. P-value at the top of each figure compares UASF vs. CaSF group effect, while p-values to the right of each line corresponds to test for linear trend across time periods within each group. Asterisk (*) indicates p<0.05 between for UASF vs. CaSF at corresponding time period.
Figure 5
Figure 5
Receiver Operating Characteristic (ROC) analysis and areas under the curves (AUC) for clinical predictors of uric acid stone formation. Multivariable full model includes: urinary pH, BMI, time period, gender, and creatinine clearance. Urinary pH and BMI from univariable analysis are shown. Asterisks (*) indicate variables that are not shown on the figure.
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