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Background <p>Urolithiasis is a chronic, systemic condition, with a&#xa0;high prevalencet and rising incidence. It leads to a lower quality-of-life for patients affected by it—even though asymptomatic. Lithogenesis is a metabolic process&#xa0;where urinary chemical abnormalities promote stone formation in the urinary tract. As a consequence, there needs to be an assessment of urinary chemicals that may prevent stone formation. The purpose of this study was to observe changes in a 24-h urine collection for metabolites to suggest an intervention to reduce the risk of recurrence in stone formers (SFs).</p> Methods <p>An observational study performed at a tertiary care hospital, with a cohort of 40 stone formers—after 4&#xa0;weeks of any intervention and when found to be stone-free, were included in this prospective study. All patients underwent a basic metabolic work-up followed by a single 24-h urine collection which was evaluated for metabolites. Patients were categorized based on the risk for stone formation and critically analyzed.</p> Results <p>The mean age was 35&#xa0;years (range: 9–65). Risk stratification identified 17 (42.5%) as first-time stone formers and 23 (57.5%) as recurrent stone formers. Overall, 27 (67.5%) patients were categorized as high risk for stone formation. 17 (42.5%) had at least one abnormality, the most common (26/40, 65%) being hypocitraturia, with only isolated hypocitraturia in 18 (45%) stone formers. Low urine volume (<i>r</i> = 0.317, <i>p</i> = 0.046) was significantly co-related with low magnesium and citrate levels (<i>r</i> = 0.534, <i>p</i> = 0.001). A solitary patient was identified to have gouty diathesis with no abnormality identified in 12 (30%). The mean body mass index (BMI) was 24.3 ± 3.12&#xa0;kg/m<sup>2</sup> and a higher BMI was significantly associated with high-risk status (<i>χ</i><sup>2</sup> (2) = 17.43, <i>p</i> &lt; 0.001) for stone formation.</p> Conclusions <p>Clinicians should consider dietary modifications as the primary intervention for South-Asian patients with urolithiasis based on findings of hypocitraturia in 24-h urine collections. Future studies should validate dietary interventions to reduce stone recurrence and compare outcomes between South-Asian and Western populations.</p>

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Hypocitraturia and urolithiasis risk: Insights from a 24-h urinary metabolic evaluation in South-Asian stone formers

  • 期刊论文

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  • 发表日期：

    2025年2月15日

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  • N. Arjun,
  • N. Dhanshekar,
  • Nitin Kumar Kamble,
  • Jofin John Varghese,
  • Koustubh Jeevan Gaonkar,
  • Anoushka Gowda,
  • H. K. Nagaraj,
  • Tariq Iqbal

摘要

Background

Urolithiasis is a chronic, systemic condition, with a high prevalencet and rising incidence. It leads to a lower quality-of-life for patients affected by it—even though asymptomatic. Lithogenesis is a metabolic process where urinary chemical abnormalities promote stone formation in the urinary tract. As a consequence, there needs to be an assessment of urinary chemicals that may prevent stone formation. The purpose of this study was to observe changes in a 24-h urine collection for metabolites to suggest an intervention to reduce the risk of recurrence in stone formers (SFs).

Methods

An observational study performed at a tertiary care hospital, with a cohort of 40 stone formers—after 4 weeks of any intervention and when found to be stone-free, were included in this prospective study. All patients underwent a basic metabolic work-up followed by a single 24-h urine collection which was evaluated for metabolites. Patients were categorized based on the risk for stone formation and critically analyzed.

Results

The mean age was 35 years (range: 9–65). Risk stratification identified 17 (42.5%) as first-time stone formers and 23 (57.5%) as recurrent stone formers. Overall, 27 (67.5%) patients were categorized as high risk for stone formation. 17 (42.5%) had at least one abnormality, the most common (26/40, 65%) being hypocitraturia, with only isolated hypocitraturia in 18 (45%) stone formers. Low urine volume (r = 0.317, p = 0.046) was significantly co-related with low magnesium and citrate levels (r = 0.534, p = 0.001). A solitary patient was identified to have gouty diathesis with no abnormality identified in 12 (30%). The mean body mass index (BMI) was 24.3 ± 3.12 kg/m2 and a higher BMI was significantly associated with high-risk status (χ2 (2) = 17.43, p < 0.001) for stone formation.

Conclusions

Clinicians should consider dietary modifications as the primary intervention for South-Asian patients with urolithiasis based on findings of hypocitraturia in 24-h urine collections. Future studies should validate dietary interventions to reduce stone recurrence and compare outcomes between South-Asian and Western populations.