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Jia S, Liao J, Wang Y, Zheng W, Jin J, Xu W, Zheng Q. Prevalence of osteoporosis in patients with nephrolithiasis and vice versa: a cumulative analysis. Front Endocrinol (Lausanne) 2023; 14:1180183. [PMID: 37469974 PMCID: PMC10352837 DOI: 10.3389/fendo.2023.1180183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/24/2023] [Indexed: 07/21/2023] Open
Abstract
Purpose Nephrolithiasis is thought to be a risk factor for osteoporosis, but data assessing if osteoporosis predisposes to the risk of nephrolithiasis are lacking. The present study aims to investigate whether patients with nephrolithiasis have a prominently higher prevalence of osteoporosis than the controls and vice versa via a cumulative analysis. Methods Four databases were used to detect the eligible studies. We calculated the relative risk (RR) with a 95% confidence interval (CI) to assess the combined effect. The methodologies for conducting this study followed the PRISMA guidelines and were registered in the PROSPERO (ID: CRD42023395875). Results Nine case-control or cohort studies with a total of 454,464 participants were finally included. Combined results indicated that there was a significantly higher prevalence of osteoporosis in patients with nephrolithiasis as compared to the general population without nephrolithiasis (overall RR from six studies= 1.204, 95%CI: 1.133 to 1.28, P< 0.001; heterogeneity: I2 = 34.8%, P= 0.162). Conversely, osteoporosis was significantly correlated to an increased risk of nephrolithiasis as compared to the controls without osteoporosis (overall RR from four studies= 1.505, 95%CI: 1.309 to 1.731, P< 0.001; I2 = 89.8%, P< 0.001). Sensitivity analysis on the two categories validated the above findings. No significant publication bias was identified in this study. Conclusions The present study highlighted a significantly high prevalence of osteoporosis in patients with nephrolithiasis and vice versa. This reciprocal association reminded the clinicians to conduct a regular follow-up assessment when managing patients with nephrolithiasis or osteoporosis, especially for the elderly. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#searchadvanced, identifier CRD42023395875.
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Affiliation(s)
- Shunjie Jia
- Department of Orthopedics, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Jian Liao
- Department of Nephrology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, Zhejiang, China
| | - Yucheng Wang
- Department of Orthopedics, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Wenbiao Zheng
- Department of Orthopedics, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Jinghua Jin
- Department of Orthopedics, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Weifang Xu
- Department of Orthopedics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Qi Zheng
- Department of Orthopedics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
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Courbebaisse M, Prot-Bertoye C, Daudon M. [Nephrolithiasis: From mechanisms to preventive medical treatment]. Nephrol Ther 2020; 16:65-75. [PMID: 32122798 DOI: 10.1016/j.nephro.2020.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renal lithiasis is a frequent pathology (prevalence ranging from 10 to 12% in France) and a recurrent condition. It is associated with chronic kidney disease and is responsible for 2 to 3% of cases of end-stage renal disease, especially if it is associated with nephrocalcinosis and/or is part of a monogenic disease (1.6% of lithiasis in adults, including 1% of cystinuria). In order to understand the pathophysiology of the nephrolithiasis, the analysis of stones (morphological and by infrared spectrophotometry) as well as a minimal biological evaluation including crystalluria must be carried out. Calcium nephrolithiasis is the most common form (more than 80%). Its preventive medical treatment relies on simple hygienic dietetics: non-alkaline hyperdiuresis greater than 2liters/day, normalization of calcium intakes (1g/day to be distributed over the three meals), restriction of sodium intakes (6g/day) and of protein intakes (0.8-1g/kg of theoretical weight/day), and avoidance of foods rich in oxalate. If there is a hypercalciuria (greater than 0.1mmol/kg of theoretical weight/day with normal calcium intakes), its mechanism should be explored with an oral calcium load test. In the absence of primary hyperparathyroidism, thiazide diuretics can be prescribed, taking care to prevent hypokalemia and iatrogenic hypocitraturia. The treatment of uric acid lithiasis includes alkaline hyperdiuresis (urinary pH 6.2 to 6.8). Allopurinol is only justified if the urinary excretion of uric acid exceeds 4mmol/day. With a well-managed medical treatment, more than 80% of recurrent lithiasis can be stopped, making nephrolithiasis one of the kidney diseases the more accessible to the preventive medical treatment.
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Affiliation(s)
- Marie Courbebaisse
- Service de physiologie-explorations fonctionnelles, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Université de Paris, 75006 Paris, France; Inserm, U1151, 149, rue de Sèvres, 75015 Paris, France; CNRS, UMR 8253, 149, rue de Sèvres, 75015 Paris, France; Institut Necker-Enfants malades, 149, rue de Sèvres, 75015 Paris, France.
| | - Caroline Prot-Bertoye
- Service de physiologie-explorations fonctionnelles, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Université de Paris, 75006 Paris, France; Centre de recherche des cordeliers, Inserm UMRS1138, 75006 Paris, France; Sorbonne université, Paris, France; CNRS, ERL8228, 75006 Paris, France
| | - Michel Daudon
- Service de physiologie-explorations fonctionnelles, hôpital Tenon, AP-HP, 75020 Paris, France
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Dissayabutra T, Kalpongkul N, Rattanaphan J, Boonla C, Srisa-Art M, Ungjaroenwathana W, Tosukhowong P. Urinary stone risk factors in the descendants of patients with kidney stone disease. Pediatr Nephrol 2018; 33:1173-1181. [PMID: 29594505 DOI: 10.1007/s00467-018-3927-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Evidence has indicated that immediate family members of nephrolithiasis patients had high opportunity to develop stones. However, they are usually not regarded to be at risk, since it is unclear if there are any lithogenic abnormalities found in non-stone-forming nephrolithiasis relatives. Our aim was to investigate urinary metabolic abnormalities in the children of nephrolithiasis patients, compared with the general population. METHODS The 24-h urinary metabolic profile was studied for 28 calcium oxalate nephrolithiasis patients (NL) and 46 of their descendants (ND), as well as 40 non-stone-forming volunteers (V) and 34 of their descendants (VD). RESULTS There was no difference between age, gender, and serum creatinine between NL vs. V (parental groups) and ND vs. VD (descendant groups). High urinary oxalate in nephrolithiasis and urinary calcium in their descendants was detected. In addition, an elevated urinary excretion rate of calcium, phosphate, protein, and albumin, along with low citrate excretion and high urinary supersaturation was observed in both the nephrolithiasis patients and their descendants. Approximate 17.8-24.4% of the nephrolithiasis descendants had a urinary supersaturation higher than the nephrolithiasis level, but none was found in VD group. The level of urinary supersaturation index was correlated with urinary protein and albumin excretion in nephrolithiasis family. CONCLUSION It was demonstrated that nephrolithiasis offspring carried several urinary metabolic risks predisposing to stone formation which are similar to their parents, and about one in every five nephrolithiasis children had nephrolithiasis level urinary supersaturation.
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Affiliation(s)
- Thasinas Dissayabutra
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10150, Thailand.
| | - Nuttiya Kalpongkul
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10150, Thailand
| | - Jakkhaphan Rattanaphan
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10150, Thailand
| | - Chanchai Boonla
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10150, Thailand
| | - Monpicha Srisa-Art
- Department of Chemistry, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
| | | | - Piyaratana Tosukhowong
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10150, Thailand
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Lucato P, Trevisan C, Stubbs B, Zanforlini BM, Solmi M, Luchini C, Girotti G, Pizzato S, Manzato E, Sergi G, Giannini S, Fusaro M, Veronese N. Nephrolithiasis, bone mineral density, osteoporosis, and fractures: a systematic review and comparative meta-analysis. Osteoporos Int 2016; 27:3155-3164. [PMID: 27289533 DOI: 10.1007/s00198-016-3658-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/27/2016] [Indexed: 01/14/2023]
Abstract
UNLABELLED Our meta-analysis demonstrates that people with nephrolithiasis have decreased bone mineral density, an increased odds of osteoporosis, and potentially an elevated risk of fractures. INTRODUCTION People with nephrolithiasis might be at risk of reduced bone mineral density (BMD) and fractures, but the data is equivocal. We conducted a meta-analysis to investigate if patients with nephrolithiasis have worse bone health outcomes (BMD), osteoporosis, and fractures versus healthy controls (HCs). METHODS Two investigators searched major databases for articles reporting BMD (expressed as g/cm2 or a T- or Z-score), osteoporosis or fractures in a sample of people with nephrolithiasis, and HCs. Standardized mean differences (SMDs), 95 % confidence intervals (CIs) were calculated for BMD parameters; in addition odds (ORs) for case-control and adjusted hazard ratios (HRs) in longitudinal studies for categorical variables were calculated. RESULTS From 1816 initial hits, 28 studies were included. A meta-analysis of case-control studies including 1595 patients with nephrolithiasis (mean age 41.1 years) versus 3402 HCs (mean age 40.2 years) was conducted. Patients with nephrolithiasis showed significant lower T-scores values for the spine (seven studies; SMD = -0.69; 95 % CI = -0.86 to -0.52; I 2 = 0 %), total hip (seven studies; SMD = -0.82; 95 % CI = -1.11 to -0.52; I 2 = 72 %), and femoral neck (six studies; SMD = -0.67; 95 % CI = --1.00 to -0.34; I 2 = 69 %). A meta-analysis of the case-controlled studies suggests that people with nephrolithiasis are at increased risk of fractures (OR = 1.15, 95 % CI = 1.12-1.17, p < 0.0001, studies = 4), while the risk of fractures in two longitudinal studies demonstrated trend level significance (HR = 1.31, 95 % CI = 0.95-1.62). People with nephrolithiasis were four times more likely to have osteoporosis than HCs (OR = 4.12, p < 0.0001). CONCLUSIONS Nephrolithiasis is associated with lower BMD, an increased risk of osteoporosis, and possibly, fractures. Future screening/preventative interventions targeting bone health might be indicated.
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Affiliation(s)
- P Lucato
- Department of Medicine - DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - C Trevisan
- Department of Medicine - DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - B Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, Box, SE5 8 AF, London, UK
| | - B M Zanforlini
- Department of Medicine - DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - M Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
- Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy
| | - C Luchini
- Department of Pathology and Diagnostics, Verona University and Hospital Trust, Verona, Italy
- Azienda Provinciale per i Servizi Sanitari (APSS) Trento, Trento, Italy
| | - G Girotti
- Department of Medicine - DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - S Pizzato
- Department of Medicine - DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - E Manzato
- Department of Medicine - DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
- National Research Council, Aging Branch, Institute of Neuroscience, Padova, Italy
| | - G Sergi
- Department of Medicine - DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - S Giannini
- Department of Medicine, Clinica Medica I, University of Padova, Padova, Italy
| | - M Fusaro
- National Research Council (CNR), Neuroscience Institute, Padova, Italy
| | - N Veronese
- Department of Medicine - DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
- Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy.
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[Nephrolithiasis of adult: From mechanisms to preventive medical treatment]. Rev Med Interne 2016; 38:44-52. [PMID: 27349612 DOI: 10.1016/j.revmed.2016.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/23/2016] [Indexed: 01/06/2023]
Abstract
Nephrolithiasis is a very common (prevalence around 10 to 12% in France) and recurrent disorder. Nephrolithiasis is associated to chronic kidney disease and is responsible for 2 to 3% of cases of end-stage renal disease, mainly if it is associated to nephrocalcinosis or to a monogenic disorder (1.6% of nephrolithiasis in adults, among them 1% of cystinuria). To understand the underlying pathophysiological processes, stone analysis (morphology and using infrared spectrophotometry) as well as minimal biological assessment including urine crystal research are required. The calcic nephrolithiasis is the more frequent subtype (>80%). Its medical treatment relies on simple dietary rules: non-alkaline hyperdiuresis>2 liters/day, calcium intake normalization (1 gram per day divided between the three principal meals), normalization of sodium (6 to 7 grams per day) and protein intake (1g/kg of theoretical body weight/day), and eviction of foods rich in oxalate. In case of persistent hypercalciuria (>0.1mmol/kg of theoretical body weight/day on free diet), a thiazide diuretic can be started while being aware to correct iatrogenic decrease in plasma potassium and urine citrate excretion. Measurement of bone mineral density must systematically be performed in patients with high 24 h-urinary calcium excretion. The medical treatment of uric acid nephrolithiasis relies on alkaline hyperdiuresis (goal of urine pH: 6.2 to 6.8). The use of allopurinol is justified only if urine uric acid is over 4mmol/day. Thanks to a well-managed preventive medical treatment, one can expect to stop the activity of nephrolithiasis in more than 80% of cases, making it one of the most accessible renal pathologies to preventive medical treatment.
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Rull MAOH, Cano-García MDC, Arrabal-Martín M, Arrabal-Polo MA. The importance of urinary calcium in postmenopausal women with osteoporotic fracture. Can Urol Assoc J 2015; 9:E183-6. [PMID: 26085877 DOI: 10.5489/cuaj.2695] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Calcium stones are associated with osteoporosis and manifested mainly by elevated fasting urinary calcium/creatinine ratio. The objective of this study is to demonstrate the presence of abnormal metabolism of calcium and calciuria in women with osteoporotic fracture with no previously known renal lithiasis compared to women without osteoporosis and without renal lithiasis. METHODS In total, 87 women were included in the study. They were divided into two groups: Group 1 with 55 postmenopausal women with osteoporotic fracture and without renal lithiasis; and Group 2 with 32 postmenopausal women without osteoporosis and without history of renal lithiasis. The following parameters of phospho-calcium metabolism were analyzed: calciuria 24-hour, oxaluria 24-hour, uricosuria 24-hour, and citraturia 24-hour. The presence of hypercalciuria, hyperoxaluria, hyperuricosuria, and hypocitraturia was compared between groups. Statistical significance was set at p ≤ 0.05. RESULTS The mean age was 70.1 ± 13.8 in Group 1 and 56.7 ± 6.4 in Group 2 (p = 0.0001). Women in Group 1 had higher levels of serum alkaline phosphatase (p < 0.05) and fasting urinary calcium/creatinine ratio (p < 0.05). The percentage of patients with hypercalciuria in Group 1 (40%) was higher compared to Group 2 (18.8%) and statistically significant (p = 0.04). There were no statistically significant differences in the percentage of hyperoxaluria, hyperuricosuria, and hypocitraturia between groups. This study has its limitations including its cross-sectional nature at a unique centre and its low number of patients. CONCLUSION The determination of urinary calcium and fasting calcium/creatinine ratio in postmenopausal women with osteoporotic fracture without renal lithiasis may facilitate individualization of medical therapy and decreasing lithogenic risk.
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Affiliation(s)
| | | | - Miguel Arrabal-Martín
- Urology Department, Complejo Hospitalario Universitario Granada, Instituto IBS Granada, Granada, Spain
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Calcium nephrolithiasis and bone demineralization: pathophysiology, diagnosis, and medical management. Curr Opin Urol 2015; 24:633-8. [PMID: 25188231 DOI: 10.1097/mou.0000000000000111] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To establish the relationship between calcium nephrolithiasis, bone densitometry scoring, and bone mineral density (BMD) loss according to bone turnover markers (BTMs) and urinary metabolites. RECENT FINDINGS Patients with recurrent calcium nephrolithiasis and idiopathic fasting hypercalciuria (urinary calcium/creatinine ratio >0.11) are more likely to have BMD loss that may lead to osteopenia or osteoporosis. In these patients, BTMs may be used as a surrogate for both bone health and stone recurrence. Suspect higher lithogenic states when calcium stone formers have serum beta-crosslaps (resorptive marker) greater than 0.311 ng/ml, serum osteocalcin (formative marker) greater than 13.2 ng/ml, and beta-crosslaps/osteocalcin ratio greater than 0.024. SUMMARY Patients with recurrent calcium nephrolithiasis and fasting hypercalciuria have a higher incidence of osteopenia and osteoporosis, measured by the dual-energy X-ray absorptiometry. These patients present not only with hypercalciuria and increased BTMs (mainly resorptive), but also up to 30% have hypocitraturia and increased urinary calcium/citrate ratio (>0.25). On the basis of these results, a diagnostic algorithm was created, classifying hypercalciurics according to their fasting calcium/creatinine and calcium/citrate ratio. Medical therapy for these patients is aimed at improving the dietary habits (normocalcemic, low salt, low animal protein diet), prescribing combinations of potassium citrate, thiazides, and bisphosphonates, and correcting bone and urinary abnormalities that may lower future skeletal and kidney stone risk.
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Ochoa-Hortal Rull MÁ, Cano-García MC, Arrabal Martín M, Cano Gea R, Reyes García R, Arrabal-Polo MA. Calcium and phosphorus metabolism and lithogenic factors in patients with osteoporotic fracture. Actas Urol Esp 2015; 39:279-82. [PMID: 25709002 DOI: 10.1016/j.acuro.2014.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 12/10/2014] [Accepted: 12/12/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To demonstrate the attendance of mineral metabolism disorders and lithogenic factors in patients' urine with osteoporotic fracture without previously known stones MATERIAL AND METHODS 67 patients with osteoporotic fractures surgically treated in trauma service are included. The area of the fracture site, fracture mechanism and the presence of osteoporosis were the factors taken into account to diagnose osteoporotic fracture. Mineral metabolism, calciuria, oxaluria, uricosuria and citraturia in 24hours urine were analyzed. The presence of abnormal calcium and phosphorus metabolism was proved comparing hypercalciuria patients with normocalciuria ones. RESULTS 12 men and 55 women with mean age 68.8±14.5 years old were included. Mean Body Mass Index (BMI) was 27.4±4.1kg/m2. 42% of patients showed hypercalciuria, 34% hyperoxaluria, 34% hypocitraturia and 7% hyperuricosuria. Statistically significant differences were observed only in fasting calcium/creatinine ratio (0.17 vs. 0.08; P<.0001) when comparing patients with hypercalciuria with those with normocalciuria. CONCLUSIONS Patients with osteoporotic fractures show different lithogenic factors in urine, mainly hypercalciuria, always in fasting conditions.
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Affiliation(s)
- M Á Ochoa-Hortal Rull
- Servicio de Cirugía, Ortopedia y Traumatología, Hospital Rafael Méndez, Lorca, España
| | - M C Cano-García
- UGC Urología Intercentros, Hospital La Inmaculada, Huércal Overa, España
| | - M Arrabal Martín
- UGC Urología Intercentros, Hospital San Cecilio, Granada, España
| | - R Cano Gea
- Servicio de Cirugía, Ortopedia y Traumatología, Hospital Rafael Méndez, Lorca, España
| | - R Reyes García
- Servicio de Endocrinología y Nutrición Clínica, Hospital Rafael Méndez, Lorca, España
| | - M A Arrabal-Polo
- UGC Urología Intercentros, Hospital La Inmaculada, Huércal Overa, España.
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Arrabal-Polo MA, Girón-Prieto MS, Cano-García MDC, Poyatos-Andujar A, Quesada-Charneco M, Abad-Menor F, Arias-Santiago S, Zuluaga-Gomez A, Arrabal-Martin M. Retrospective review of serum and urinary lithogenic risk factors in patients with osteoporosis and osteopenia. Urology 2015; 85:782-5. [PMID: 25817102 DOI: 10.1016/j.urology.2015.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/06/2015] [Accepted: 01/16/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To analyze differences in bone remodeling markers, lithogenic factors and bone densitometry among the 3 groups of patients (controls, patients with relapsing calcium renal lithiasis, and patients with loss of bone mineral density without lithiasis). MATERIAL AND METHODS This is a cross-sectional study including 203 patients who were divided in 3 groups: group 1 (controls), group 2 (patients with relapsing calcium renal lithiasis), and group 3 (patients with osteopenia and/or osteoporosis in the lumbar spine or hip). Bone densitometry, calcium-phosphorous and bone metabolism analysis, and analysis of lithogenic risk factors in fasting urine samples and 24-hour urine samples were performed. Statistical analysis was performed with SPSS 17.0. A P ≤.05 was considered statistically significant. RESULTS Patients in group 2 presented greater calcium excretion and a lower citrate excretion in 24-hour urine samples as compared with the other 2 groups. The proportion of hypercalciuria and hypocitraturia was higher in group 2. In addition, patients in group 2 presented a lower loss of bone mineral density as well as altered bone remodeling markers as compared with those in group 1. Patients in group 3 also presented alterations in urine calcium and citrate excretion with respect to the control group, with elevated fasting calcium and citrate levels and calcium-to-citrateratio. CONCLUSION Lithogenic risk factors are altered in patients with osteopenia and/or osteoporosis without renal lithiasis although to a lesser extent than patients with calcium renal lithiasis.
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Affiliation(s)
| | - María Sierra Girón-Prieto
- Centro de Salud de Atarfe, Spain; Programa de Doctorado de Medicina Clínica y Salud Pública, Universidad de Granada, Spain
| | | | | | | | - Felix Abad-Menor
- Servicio de Urología, Hospital Universitario San Cecilio, IBS Granada, Granada, Spain
| | | | - Armando Zuluaga-Gomez
- Servicio de Urología, Hospital Universitario San Cecilio, IBS Granada, Granada, Spain
| | - Miguel Arrabal-Martin
- Servicio de Urología, Hospital Universitario San Cecilio, IBS Granada, Granada, Spain
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10
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Arrabal-Martin M, Poyatos-Andujar A, Cano-García MDC, Quesada-Charneco M, Abad-Menor F, Girón Prieto MS, de Haro Muñoz T, Arrabal-Polo MA. The importance of calciuria as lithogenic factors in patients with osteopenia/osteoporosis. Int Urol Nephrol 2015; 47:445-9. [PMID: 25652872 DOI: 10.1007/s11255-015-0918-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/22/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE Recurrent kidney stones are associated with bone mineral density loss, altered bone remodeling markers, hypercalciuria and increased in fasting calcium/creatinine ratio. The objective was to determine biochemical alterations in urine in patients with osteopenia/osteoporosis without calcium kidney stones compared with patients with calcium kidney stones. METHODS This is a cross-sectional study including 142 patients who were divided in two groups: Group 1 (patients with recurrent calcium kidney stones) and Group 2 (patients with osteopenia/osteoporosis in the lumbar spine or hip). Analyses of bone mineral density, calcium-phosphorous and bone metabolism and lithogenic risk factors in fasting urine samples and 24-h urine samples were performed. Statistical analysis was carried out with SPSS 17.0. A p ≤ 0.05 was considered statistically significant. RESULTS Patients in Group 2 presented greater loss of bone mineral density and more elevated alkaline phosphatase, iPTH, phosphorous and β-crosslaps levels, as compared to patients in Group 1. However, Group 1 presented greater urine calcium, oxalate and uric acid and a higher proportion of hypocitraturia, hypercalciuria and hyperoxaluria, as compared to Group 2. Multivariate analysis revealed that advanced age and β-crosslaps levels are risk factors for bone mineral density loss, while low urinary calcium excretion was protective against bone demineralization. CONCLUSION Patients with osteopenia/osteoporosis without lithiasis present some urinary biochemical alterations. This would explain the lack of lithogenic activity, although low calcium excretion in 24-h urine samples is a protective factor against the loss of bone mineral density.
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Chou PS, Kuo CN, Hung KS, Chang WC, Liao YC, Chi YC, Chou WP, Tsai SJ, Liu ME, Lai CL, Chou YH, Chang WP. Osteoporosis and the risk of symptomatic nephrolithiasis: a population-based 5-year follow-up study in Taiwan. Calcif Tissue Int 2014; 95:317-22. [PMID: 25118878 DOI: 10.1007/s00223-014-9895-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
Abstract
This study estimates the risk of symptomatic nephrolithiasis within 5 years of newly diagnosed osteoporosis in a Taiwan population. This cohort study consisted of patients with a diagnosis of osteoporosis between Jan. 2003 and Dec. 2005 (N = 1634). Four age- and gender- matched patients for every patient in the study cohort were selected using random sampling as the comparison cohort (N = 6536). All patients were tracked for 5 years from the date of cohort entry to identify whether they developed symptomatic nephrolithiasis. Cox proportional hazard regressions were performed to evaluate the 5-year nephrolithiasis-free survival rates. During the 5-year follow-up period, 60 osteoporosis patients (3.7%) and 165 non- osteoporosis patients (2.5%) developed symptomatic nephrolithiasis. The adjusted HR of symptomatic nephrolithiasis was 1.38 times greater risk for patients with osteoporosis than for the comparison cohort (95% confidence interval (CI) 1.03-1.86; P < .05). Osteoporosis is very likely to be an independent risk factor for subsequent diagnosis of symptomatic nephrolithiasis.
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Affiliation(s)
- Ping-Song Chou
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abstract
PURPOSE OF REVIEW To review the recent publications describing the link between pediatric nephrolithiasis and bone metabolism. RECENT FINDINGS Nephrolithiasis incidence is increasing in children and is associated with low bone mineral density (BMD). Affected children are conceptually at risk for fractures and osteoporosis. In addition to abnormal calcium metabolism, inflammation, genetic makeup and dietary habits are being recognized as important factors in the pathophysiology of nephrolithiasis and low bone density. Findings from retrospective reviews suggest that low BMD in children may be improved with citrate or thiazide treatment. SUMMARY The healthcare burden from low BMD with subsequent osteoporosis and fracture risk is immense with potential far-reaching effects in patient quality of life and healthcare expense. Bone mass is acquired in the pediatric age range, thus it is important to identify and treat at-risk children. Retrospective reviews in pediatric patients indicate that citrate or thiazide diuretic treatment may improve BMD. We now understand that a relationship exists between nephrolithiasis and low BMD. To improve healthcare for our current patients as well as protect their future health it is important to identify low BMD and initiate strategies to improve BMD in 'at-risk' children.
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Arrabal-Polo MÁ, Sierra Girón-Prieto M, Orgaz-Molina J, Zuluaga-Gómez A, Arias-Santiago S, Arrabal-Martín M. Calcium renal lithiasis and bone mineral density. Importance of bone metabolism in urinary lithiasis. Actas Urol Esp 2013; 37:362-7. [PMID: 23411066 DOI: 10.1016/j.acuro.2012.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 10/25/2012] [Indexed: 12/14/2022]
Abstract
CONTEXT Calcium Nephrolithiasis is a multifactorial disease; in its pathophysiology is involved various minerals and metabolic factors that may be altered, including bone and phosphor-calcium metabolism. OBJECTIVE To establish the scientific evidence and demonstrate the relationship between calcium nephrolithiasis and bone mineral density loss, through the use of bone turnover markers, serum and urinary metabolites. EVIDENCE ACQUISITION We performed a PubMed literature review using different MeSH Terms like "Nephrolithiasis", "Bone mineral density", "Urinary stones", "Calcium", Bone resorption" and "Bone formation", with different combinations. We only selected articles with abstracts in English or Spanish and discarded clinical cases and articles with inappropriate statistical study. A total of 40 articles were selected. EVIDENCE SYNTHESIS In different studies reviewed have been observed that patients with hypercalciuria have a higher bone mineral density loss with respect to normocalciuric. Among patients with calcium stones (normocalciuric or hypercalciuric), there is loss of bone mineral density, being more evident in patients with stones and hypercalciuria. This mineral density loss is marked and important in patients with recurrent calcium stones. Increased markers like fasting calcium/creatinine and β-CrossLaps are determinant of nephrolithiasis and mineral density loss in these patients. CONCLUSION We recommend perform markers of bone turnover and fasting calcium/creatinine in patients with recurrent calcium stones by the significant presence of bone mineral density loss, with a level of evidence III.
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Affiliation(s)
- M Á Arrabal-Polo
- Servicio de Urología, Hospital Universitario San Cecilio, Granada, España.
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