J Korean Med Sci.  2014 Aug;29(8):1132-1137. 10.3346/jkms.2014.29.8.1132.

Effect of Renal Insufficiency on Stone Recurrence in Patients with Urolithiasis

• Kang HW
• Seo SP
• Kim WT
• Kim YJ
• Yun SJ
• Lee SC
• Kim WJ

• KMID: 2129610
• DOI: http://doi.org/10.3346/jkms.2014.29.8.1132

Abstract

The study was designed to assess the relationship between glomerular filtration rate (GFR) and urinary stone-forming constituents, and to assess the effect of renal insufficiency on stone recurrence risk in first stone formers (SF). Baseline serum creatinine levels were obtained, and renal insufficiency was defined as creatinine clearance < or =60 mL/min (Cockroft-Gault). This retrospective case-control study consists of 342 first SF; 171 SF with normal renal function were selected with 1:1 propensity scores matched to 171 SF with renal insufficiency. Urinary metabolic evaluation was compared to renal function. GFR was positively correlated with urinary calcium, uric acid, and citrate excretion. Subjects with renal insufficiency had significantly lower urinary calcium, uric acid, and citrate excretion than those with normal renal function, but not urine volume. With regard to urinary metabolic abnormalities, similar results were obtained. SF with renal insufficiency had lower calcium oxalate supersaturation indexes and stone recurrence rates than SF with normal renal function. Kaplan-Meier curves showed similar results. In conclusion, GFR correlates positively with urinary excretion of stone-forming constituents in SF. This finding implies that renal insufficiency is not a risk factor for stone recurrence.

Keyword

Urinary Calculi; Recurrence; Renal Insufficiency; Creatinine

MeSH Terms

Aged
Causality
Disease-Free Survival
Female
*Glomerular Filtration Rate
Humans
Incidence
Male
Middle Aged
Recurrence
Renal Insufficiency/*diagnosis/*epidemiology
Reproducibility of Results
Republic of Korea/epidemiology
Risk Assessment
Sensitivity and Specificity
Urolithiasis/*diagnosis/*epidemiology

Figure

• 

  Fig. 1 Correlation between estimated GFR and 24-hr urine constituents in the entire study population. (A) Calcium (P < 0.001), (B) Uric acid (P < 0.001), (C) Citrate (P = 0.003). r, partial correlation coefficient adjusted by age, sex and BMI.

• 

  Fig. 2 Stone-recurrence-free survival stratified by estimated GFR (GFR ≤ 60 mL/min vs. GFR > 60 mL/min).

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