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.
Description
Keywords
Stone chemical , Urinary biochemical , Abnormalities , Urinary tract stone