Influence of Overweight on 24-hour Urine Chemistry Studies and Recurrent Urolithiasis in Children
TL;DR: Unlike in adults, in children, overweight adjusted for gender and age was not associated with 24-hour urine chemistry studies and was not a risk factor for recurrent UL.
Abstract: Results: A total of 125 patients were included. The age of the patients in the NBW group was older than that of patients in the LBW group, but 24-hour urine chemistry studies did not differ significantly between the three groups. Mean urine citrate levels were lower (0.273±0.218 mg/mg/d vs. 0.429±0.299 mg/mg/d, p＜0.05) and the incidence of hypocitraturia was higher (81.5% vs. 45.7%, p＜0.05)) in the recurrent stone former group. In the univariate analysis, hypocitraturia and acidic urinary pH were risk factors, but in the multivariate analysis, only hypocitraturia was a risk factor for stone recurrence (hazard ratio, 3.647; 95% confidence interval, 1.047 to 12.703). In the Kaplan-Meier curve, the hypocitraturia group showed higher recurrence than did the normocitraturia group (p＜0.05). Conclusions: Unlike in adults, in children, overweight adjusted for gender and age was not associated with 24-hour urine chemistry studies and was not a risk factor for recurrent UL. Hypocitraturia was the only risk factor for UL in children.
Citations
More filters
TL;DR: Overweight and obese stone forming children have decreased levels of urine citrate, phosphate and magnesium compared to patients with normal body mass index and the incidence of hypercalciuria is increased in overweight/obese patients.
Abstract: Purpose: The increasing incidence of pediatric nephrolithiasis is a growing concern and its association with obesity continues to be an area of debate. We present data on urine chemistries of overweight/obese children compared to those with a normal body mass index and history of urolithiasis treated at a single institution in the United States, and assess risk factors.Materials and Methods: We retrospectively identified 110 stone forming patients who underwent 24-hour urine collection and stratified them according to the Centers for Disease Control and Prevention definitions of overweight/obese (body mass index above 85th/95th percentile). Absolute urine collection quantities were compared between groups. Stone risk factors were analyzed according to Litholink® specified reference ranges.Results: Compared to patients with low or normal body mass index, overweight and obese patients had lower body surface area adjusted citrate (242 mg/1.73 m2 vs 315 mg/1.73 m2, p = 0.03), lower urine phosphate (12 mg/kg v...
19 citations
TL;DR: This Polish study explored the influence of nutritional status and lipid disturbances on urinary lithogenic factors and the risk of kidney stone formation in children and adolescents from three to 18 years of age.
Abstract: Aim
There is conflicting evidence about the role of obesity in paediatric nephrolithiasis. This Polish study explored the influence of nutritional status and lipid disturbances on urinary lithogenic factors and the risk of kidney stone formation in children and adolescents from three to 18 years of age.
Methods
We carried out serum lipid profile evaluations and 24-h urine chemistry analyses on 493 overweight/obese paediatric participants (mean age 13 years) without nephrolithiasis and 492 healthy normal weight sex and age-matched controls.
Results
A third (33%) of the study group had blood lipid disturbances, with more acidic urine, lower urinary citrate excretion and a higher fraction of ionised calcium and higher Bonn Risk Index than the controls. The participants' body mass index standard deviation score (BMI Z-score) was positively correlated with urinary oxalate and uric acid and negatively correlated with citrate excretion. Total cholesterol, low-density lipoprotein cholesterol and triglycerides correlated negatively with citraturia, while high-density lipoprotein cholesterol correlated positively.
Conclusion
The main factor that predisposed overweight and obese children to kidney stones was hypocitraturia. Urinary citrate excretion was related to both BMI Z-scores and all lipid fraction abnormalities. However, hypercholesterolaemia and particularly low-density lipoprotein hypercholesterolaemia seemed to play a major role.
17 citations
TL;DR: This study confirmed the primary hypothesis that obese pediatric patients presenting with nephrolithiasis have a different urinary mineral profile as evidenced by lower levels of citrate and potassium and low urine pH; however, obese patients did not exhibit significantly elevated urinary sodium and uric acid when normalized to weight, as described in the adult population.
Abstract: Summary Introduction The prevalence of pediatric nephrolithiasis has increased significantly in the past 20 years. Metabolic abnormalities predisposing adults to nephrolithiasis in obese patients include increased urinary sodium and uric acid excretion as well as low urine pH; however, limited data are available in the pediatric population. Objective The aim was to investigate whether obese pediatric patients presenting with nephrolithiasis have a unique metabolic profile similar to reported findings in obese adults with nephrolithiasis. Study design A retrospective chart review was performed in children aged 1–18 years seen at Kentucky Children's Hospital between 2010 and 2016. Inclusion criteria included all patients with documented stones confirmed by ultrasonography or computed tomography. Results A total of 111 patient charts were reviewed in the study with a mean age of 11.8 ± 4.2 years. Seventy patients (63%) had a normal BMI and 41 patients (37%) were considered overweight/obese. There was no statistically significant relationship between BMI and stone recurrence. Obese patients had significantly decreased levels of urinary citrate, oxalate, magnesium, and potassium with significant elevations of urinary urea nitrogen, ammonia, and low urine pH compared with normal weight patients (Summary Figure). Discussion Several groups have reported on metabolic findings within obese and non-obese pediatric patients. A Turkish study reported increased oxalate excretion and hypocitraturia in obese patients while a Korean study also reported increased rates of hypocitraturia in recurrent stone formers. Similar to these studies, we did find significant differences in citrate within our study population; however, we found significantly lower levels of urinary oxalate in obese patients. The majority of these studies do not report an association with BMI and urine pH although this has been reported in the adult population and our findings support an inverse relationship between body mass index (BMI) and pH. Our group found a higher level of calcium phosphate stones, supporting of Eisner's findings that high BMI is associated with increased supersaturation of calcium phosphate. Limitations of our study include being a single center and retrospective in nature. Conclusion Our study demonstrates differences in types of stones and urinary metabolites in an obese pediatric population suggestive of different metabolic profiles contributing to stone disease. We report similar association between BMI and urine pH, urinary potassium, and citrate. This study confirmed our primary hypothesis that obese pediatric patients would have a different urinary mineral profile as evidenced by lower levels of citrate and potassium and low urine pH; however, obese patients did not exhibit significantly elevated urinary sodium and uric acid when normalized to weight, as described in the adult population. Our study did not confirm our secondary hypothesis that stone composition would be associated with BMI status or stone recurrence. Download : Download high-res image (213KB) Download : Download full-size image Figure . Urinary Parameters A) 24-hour urinary excretion of metabolites. B) Supersaturation Index of Calcium Oxalate, Calcium Phosphate, and Uric Acid as well as urinary pH. Values are presented as medians with Mann–Whitney U test, Pearson chi-square test or Fisher exact test as appropriate. ∗p
13 citations
TL;DR: LDCT-IR, as a first-line imaging test, was non-inferior to SDCT with respect to diagnosis of ureter stones, and was clinically available for the evaluation of renal colic.
Abstract: PURPOSE To study the clinical application of low-dose unenhanced computed tomography with iterative reconstruction technique (LDCT-IR) on renal colic in the emergency department. MATERIALS AND METHODS We conducted a prospective, single-blinded, randomized, and non-inferiority study. From March 2014 to August 2015, 112 patients with renal colic were included, and were randomized to either LDCT-IR (n=46) or standard-dose unenhanced CT (SDCT) (n=66) groups. The accuracy of urolithiasis diagnosis was the primary endpoint of this study. Radiation dose, size and location of the stone, hydronephrosis, other diseases except urolithiasis, and results of treatment were analyzed between the two groups. RESULTS The average effective dose radiation of SDCT was approximately four times higher than that of LDCT-IR (6.52 mSv vs. 1.63 mSv, p<0.001). There was no significant difference in the accuracy of ureteral stone diagnosis between the two groups (LDCT-IR group: 96.97% vs. SDCT group: 98.96%, p=0.392). No significant difference was observed regarding the size and location of a stone, hydronephrosis, and diagnosis of other diseases, except urolithiasis. False negative results were found in two LDCT-IR patients and in one SDCT patient. In these patients, stones were misread as vascular calcification, and were difficult to diagnose because evidence of hydronephrosis and ureteral dilatation was not found. CONCLUSION LDCT-IR, as a first-line imaging test, was non-inferior to SDCT with respect to diagnosis of ureter stones, and was clinically available for the evaluation of renal colic.
6 citations
10 Sep 2019
TL;DR: In this article, the frecuencia de alteraciones urinarias presentes in ninos with urolitiasis segun estado nutricional was investigated.
Abstract: La urolitiasis es una enfermedad multifactorial. En los ultimos anos se ha observado un incremento a nivel mundial de la incidencia de la litiasis urinaria tanto en adultos como en ninos. Los cambios en los habitos alimentarios y un aumento en la prevalencia de exceso de peso podrian asociarse a este fenomeno. El objetivo del trabajo fue describir la frecuencia de alteraciones urinarias presentes en ninos con urolitiasis segun estado nutricional. En este trabajo observacional transversal se incluyeron 104 ninos litiasicos de ambos sexos divididos en dos grupos segun estado nutricional: 68 ninos con peso adecuado y 36 ninos con sobrepeso u obesidad considerando criterios de la OMS. Se determinaron en orina de 24 horas calcio, fosforo, sodio, acido urico, citrato y magnesio. Del total de pacientes participantes 54 (51.9%) fueron ninas y 50 (48,1%) fueron ninos. El 65,4% de los ninos presento peso normal y el 34,6% de los ninos sobrepeso u obesidad con edades medias de 10±4 anos y 8±4 anos respectivamente. El 80% de los ninos presento al menos una alteracion urinaria, siendo las mas frecuentes en ambos grupos la hipocitraturia e hiperuricosuria. Es llamativa la elevada frecuencia de alteraciones en las concentraciones de promotores e inhibidores de cristalizacion, en ambos grupos, indicando un riesgo aumentado de recidivas.
1 citations
Cites background from "Influence of Overweight on 24-hour ..."
...Estos resultados son similares a estudios en niños de Corea((19)), y con lo publicado en adultos a nivel nacional((20,21)), sin embargo, difieren con lo reportado por Bandari et al....
[...]
...Estos resultados son similares a estudios en niños de Corea(19), y con lo publicado en adultos a nivel nacional(20,21), sin embargo, difieren con lo reportado por Bandari et al. en Estados Unidos en el 2016 quienes reportaron disminución del magnesio y citrato y aumento de la concentración del calcio urinario en el grupo de niños litiásicos con exceso de peso donde encontraron diferencia significativa en las concentraciones de los analitos urinarios(6)....
[...]
References
More filters
TL;DR: Obesity and weight gain increase the risk of kidney stone formation, and the magnitude of the increased risk may be greater in women than in men.
Abstract: ContextLarger body size may result in increased urinary excretion of calcium,
oxalate, and uric acid, thereby increasing the risk for calcium-containing
kidney stones. It is unclear if obesity increases the risk of stone formation,
and it is not known if weight gain influences risk.ObjectiveTo determine if weight, weight gain, body mass index (BMI), and waist
circumference are associated with kidney stone formation.Design, Setting, and ParticipantsA prospective study of 3 large cohorts: the Health Professionals Follow-up
Study (N = 45 988 men; age range at baseline, 40-75 years),
the Nurses’ Health Study I (N = 93 758 older women; age
range at baseline, 34-59 years), and the Nurses’ Health Study II (N = 101 877
younger women; age range at baseline, 27-44 years).Main Outcome MeasuresIncidence of symptomatic kidney stones.ResultsWe documented 4827 incident kidney stones over a combined 46 years of
follow-up. After adjusting for age, dietary factors, fluid intake, and thiazide
use, the relative risk (RR) for stone formation in men weighing more than
220 lb (100.0 kg) vs men less than 150 lb (68.2 kg) was 1.44 (95% confidence
interval [CI], 1.11-1.86; P = .002 for
trend). In older and younger women, RRs for these weight categories were 1.89
(95% CI, 1.52-2.36; P<.001 for trend) and 1.92
(95% CI, 1.59-2.31; P<.001 for trend), respectively.
The RR in men who gained more than 35 lb (15.9 kg) since age 21 years vs men
whose weight did not change was 1.39 (95% CI, 1.14-1.70; P = .001 for trend). Corresponding RRs for the same categories
of weight gain since age 18 years in older and younger women were 1.70 (95%
CI, 1.40-2.05; P<.001 for trend) and 1.82 (95%
CI, 1.50-2.21; P<.001 for trend). Body mass index
was associated with the risk of kidney stone formation: the RR for men with
a BMI of 30 or greater vs those with a BMI of 21 to 22.9 was 1.33 (95% CI,
1.08-1.63; P<.001 for trend). Corresponding RRs
for the same categories of BMI in older and younger women were 1.90 (95% CI,
1.61-2.25; P<.001 for trend) and 2.09 (95% CI,
1.77-2.48; P<.001 for trend). Waist circumference
was also positively associated with risk in men (P = .002
for trend) and in older and younger women (P<.001
for trend for both).ConclusionsObesity and weight gain increase the risk of kidney stone formation.
The magnitude of the increased risk may be greater in women than in men.
977 citations
"Influence of Overweight on 24-hour ..." refers background in this paper
...[11] reported a significantly increased risk between increasing body mass and subsequent kidney stones in three large prospective cohorts....
[...]
TL;DR: The incidence of urolithiasis in the pediatric population increased nearly 5-fold at this institution during the last decade, and it is recommended that the primary diagnostic test be a 24-hour urine collection.
Abstract: Purpose: The incidence of kidney stones in adults has increased in the last 30 years. This retrospective, single site review was done to test the hypotheses that the incidence of urolithiasis in pediatric patients increased from 1994 to 2005, and that metabolic abnormalities were more common in patients with renal stones in the final 3 years of the study period.Materials and Methods: Charts from 2 time periods were reviewed, 1994 to 1996 (period 1) and 2003 to 2005 (period 2). Clinical and laboratory data, including demographics, presenting complaints, laboratory assessment, treatment and outcome, were tabulated in patients with confirmed urolithiasis.Results: The number of patients with urolithiasis increased from 7 in period 1 to 61 in period 2. When expressed as cases per 100 new patients the incidence increased 4.6 times (p = 0.014). Focusing on period 2, 28% of patients were younger than 10 years. While blood tests were generally normal, 76% of patients had at least 1 abnormality in the 24-hour urine...
309 citations
"Influence of Overweight on 24-hour ..." refers background in this paper
...Recent studies have shown that the annual incidence is increasing in different populations [2]....
[...]
...[2] also observed that hypocitraturia is the most commonly identified metabolic abnormality, which was present in 52% of the children studied between 2003 and 2005....
[...]
01 Mar 1993
TL;DR: Overall, 166 of 221 children examined at the Mayo Clinic between 1965 and 1987 were found to have factors that predisposed to urolithiasis, and 166 of 166 children (75.1%) were foundTo determine the clinical characteristics, types of stone problems, and outcomes of pediatric patients with urolithsiasis encountered in a referral center, retrospectively assessed 221 patients.
Abstract: Urolithiasis in pediatric patients has been perceived as uncommon, and the appropriate evaluation and management have been controversial. To determine the clinical characteristics, types of stone problems, and outcomes of pediatric patients with urolithiasis encountered in a referral center, we retrospectively assessed 221 patients (113 girls and 108 boys) with urolithiasis examined at the Mayo Clinic between 1965 and 1987. The median age at onset of symptoms was 11 6 / 12 years among the female patients and 10 6 / 12 years among the male patients. Analysis of stone constituents in 122 patients showed the proportion of calcium oxalate (44.7%), calcium phosphate (23.6%), and cystine (8.1%) stones to be similar in all age-groups. Overall, struvite stones were found in 17.1% and uric acid stones in 1.6% of patients. Conditions that predisposed to metabolic urolithiasis were identified in 115 patients (52%). Hypercalciuria was confirmed in 49 of 145 patients (33.8%) and hyperoxaluria in 25 of 124 (20.2%). Eight of 96 patients had hyperuricosuria, and 5 of 54 had hypocitraturia. Forty-one patients (18.6%) had infection-related stones. Of 66 patients with structural anomalies of the genitourinary tract, 24 (36%) had metabolic abnormalities and 26 (39%) had chronic infection. Among patients with chronic infection, 29% had metabolic abnormalities. Of the 221 patients, 148 (67%) had two or more stones during a mean follow-up of 59 months. Among 140 patients with 12 months or more of follow-up, metabolic activity was present in 31 (22.1%) at the time of most recent examination. Overall, 166 of 221 children (75.1%) were found to have factors that predisposed to urolithiasis. Infected, obstructed, or structurally anomalous urinary tracts seem to be factors permissive for formation of stones and do not obviate the need for careful metabolic assessment in all young patients who form renal stones.
288 citations
"Influence of Overweight on 24-hour ..." refers background in this paper
...Most children with urinary UL have underlying metabolic abnormalities, and hypercalciuria is the most prevalent [3]....
[...]
TL;DR: Positive associations between BMI and urinary calcium excretion likely are due to differences in animal protein and sodium intake and may be due to an increase in uric acid nephrolithiasis.
Abstract: Background: Greater body mass index (BMI) is a risk factor for kidney stones. However, the relation between BMI and the urinary excretion of many lithogenic factors remains unclear. Methods: We studied urine pH, urine volume, and 24-hour urinary excretion of calcium, oxalate, citrate, uric acid, sodium, magnesium, potassium, phosphate, and creatinine in stone-forming and non–stone-forming participants in the Health Professionals Follow-Up Study (599 stone-forming and 404 non–stone-forming men), Nurses' Health Study (888 stone-forming and 398 non–stone-forming older women), and Nurses' Health Study II (689 stone-forming and 295 non–stone-forming younger women). Each cohort was divided into quintiles of BMI. Tests of linear trend were conducted by 1-way analysis of variance. Linear regression models were adjusted for age, history of stone disease, dietary intake, and urinary factors. Results: Participants with greater BMIs excreted more urinary oxalate ( P for trend ≤ 0.04), uric acid ( P P P P ≤ 0.02). Positive associations between BMI and urinary calcium excretion in men and stone-forming younger women ( P ≤ 0.02) did not persist after adjustment for urinary sodium and phosphate excretion. Because of differences in urinary volume and excretion of inhibitors such as citrate, we observed no relation between BMI and urinary supersaturation of calcium oxalate. Urinary supersaturation of uric acid increased with BMI ( P ≤ 0.01). Conclusion: Positive associations between BMI and urinary calcium excretion likely are due to differences in animal protein and sodium intake. The greater incidence of kidney stones in the obese may be due to an increase in uric acid nephrolithiasis.
281 citations
"Influence of Overweight on 24-hour ..." refers background in this paper
...Increasing BMI is a risk factor for abnormal 24-hour urine chemistry studies in adult stone formers and healthy controls without a history of UL [8]....
[...]
TL;DR: Overweight and obese men are more prone to stone formation than overweight women, and the risk of stone formation increased significantly with increasing BMI among both men and women with urolithiasis.
Abstract: Objective: The aim of the study was to assess the influence of overweight and obesity on the risk of calcium oxalate stone formation.
Research Methods and Procedures: BMI, 24-hour urine, and serum parameters were evaluated in idiopathic calcium oxalate stone formers (363 men and 164 women) without medical or dietetic pretreatment.
Results: Overweight and obesity were present in 59.2% of the men and in 43.9% of the women in the study population. Multiple linear regression analysis revealed a significant positive relationship between BMI and urinary uric acid, sodium, ammonium, and phosphate excretion and an inverse correlation between BMI and urinary pH in both men and women, whereas BMI was associated with urinary oxalate excretion only among women and with urinary calcium excretion only among men. Serum uric acid and creatinine concentrations were correlated with BMI in both genders. Because no association was established between BMI and urinary volume, magnesium, and citrate excretion, inhibitors of calcium oxalate stone formation, the risk of stone formation increased significantly with increasing BMI among both men and women with urolithiasis (p = 0.015). The risk of calcium oxalate stone formation, median number of stone episodes, and frequency of diet-related diseases were highest in overweight and obese men.
Discussion: Overweight and obesity are strongly associated with an elevated risk of stone formation in both genders due to an increased urinary excretion of promoters but not inhibitors of calcium oxalate stone formation. Overweight and obese men are more prone to stone formation than overweight women.
255 citations
"Influence of Overweight on 24-hour ..." refers background in this paper
...[13] demonstrated a strong association between obesity and an increased risk for stone formation owing to increased urinary excretion of stone-forming risk factors....
[...]
...[13] noted that increased BMI affects urinary homeostasis by increasing factors that promote stone formation, such as decreased urinary pH, increased urinary calcium, and increased urinary uric acid excretion....
[...]