The relationship between stone chemical composition and urinary biochemical abnormalities in urinary tract stone formers in Kelantan

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Date
2004
Authors
Sadiq Bawer, Ssyed Mohammed (dr.)
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Abstract
Urinary stone disease is often a manifestation of an underlying metabolic disorder in most patients. There is considerable variation in urinary stone incidence, composition and urinary biochemical profile in different communities. Determination of urinary abnormalities and the composition of urinary stone are required for appropriate management of urinary stone formers. Urinary metabolic abnormalities are caused by a number of genetic, environmental and dietary disorders. These abnormalities in stone formers have been reported in different population; however the association of these abnormalities has not been identified in Malaysian population. With this view we evaluated the urinary biochemical abnormalities in patients with stone disease in Kelantan, Malaysia to assess its relationship with stone composition. Methodology In this cross-sectional study, a total of 96 urinary stone formers were enrolled between September 2002 to October 2003. Subjects were patients attending urology out patient clinic of Hospital University Sains Malaysia and Hospital Kota Bharu. Basic demographic data obtained from the patients included age, gender, ethnicity, occupation, source of drinking water and location of residence. Samples of 24-hour urine and fragments of urinary stones were collected from each patient. The stone location (upper or lower urinary tract) was noted. Any patient in whom a methodological error occurred in any phase of the study was excluded from the statistical analysis, as were patients with chronic renal failure (creatinine clearance <30 mVmin/1. 73m2 ), children age :S13 and pregnant women. Results Out of 96 subjects, 79 (82.3 %) were male and 17 (17. 7 %) were female. Majority ofthe study population consisted of Malay (95.8%) subjects. The mean age of the patients was 56.45 (±13.43) years, with a range of 24 to 80 years. Among them, 44.8% were upper tract stone formers, 50.0% were lower tract stone formers and only 5.2% were having both upper and lower tract stones. The most common metabolic abnormality was hyperoxaluria, affecting 57 % of the male and 82 % of female stone formers. The other common urinary biochemical abnormalities in our patients were hypomagnesuria (59.4 %) and hypocitraturia (57.3 %). In this study only 15.2% male and 11.8% female had hypercalciuria, 19.5% subjects had hyperuricosuria and 12.5% had hyperphosphaturia. Majority of stones were composed ofCaOx (50.57 %) followed by CaP (26.44 %), AmnUrate (16.73 %), Struvite (4.99 %), and cystine (1.35 %). Only eight patients had pure CaOx stones while the remaining stones were heterogeneous in origin. Urinary pH was alkaline in approximately half (53.1 %) of patients and it was associated with CaP stone content. There was positive ~nd very weak correlation between urinary oxalate excretion and stone content of oxalate. A very weak negative correlation between urinary uric acid excretion and stone content of uric acid was also observed. However there was no correlation between the other biochemical parameters and stone chemical components. Conclusion The most common metabolic abnormality observed in our series was hyperoxaluria followed by hypomagnesuria and hypocitraturia. Hyperuricosuria, hypercalciuria and hyperphosphaturia occurred less frequently ( ~.ffecting <20 % of the patients). The major components of urinary stones were CaOx followed by CaP and AmnUrate. However there was no strong correlation between urinary biochemical parameters and stone chemical components.
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Keywords
Stone chemical , Urinary biochemical , Abnormalities , Urinary tract stone
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