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Characterisation of risk factors for stones in hyperuricosuric men attending a stone clinic

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Abstract

Hyperuricosuria is common among stone formers, but its significance is uncertain. To progress our understanding and target treatment, we need to identify and characterise patients with uniform underlying pathology. We aimed to identify hyperuricosuric patients with a primary defect in renal urate reabsorption (renal hyperuricosuria) and to look for associated risk factors for stones. We undertook a retrospective cross-sectional database study of 666 male stone formers attending the Southampton stone clinic. We estimated filtered urate from plasma urate and 24-h creatinine clearance, and the net percentage reabsorbed. 153 men had hyperuricosuria (urine urate >4.80 mmol/24 h); 513 had normouricosuria. Hyperuricosuric men filtered more urate (median 68.1 and 52.5 mmol/24 h) but the ranges overlapped. Thirty hyperuricosuric men with filtered urate below the median for normouricosuria were selected as the renal hyperuricosuria group. Their normal plasma urate and high urate clearance substantiated this classification. In comparison with 60 normouricosuric stone formers matched for filtration, they had a higher incidence of hypercalciuria (67 versus 40 %), but similar, high, frequencies of hyperoxaluria (25 and 11 %) and phosphaturia (40 and 27 %).There were no differences in age at first stone, incidence of stone recurrence or positive family history (20 and 25 %). The findings demonstrate multiple risk factors for stones in this subgroup. In comparison, the 30 hyperuricosuric men with the highest filtration had a higher incidence of hyperoxaluria (58 %) but fewer (7 %) had a positive family history. Creatinine clearance was raised in 73 %. An excessive protein intake might be a major correctable factor underlying these abnormalities.

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Abbreviations

TmPO4/GFR:

Renal threshold of phosphate concentration

GFR:

Glomerular filtration rate

eGFR:

Estimated glomerular filtration rate

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Acknowledgments

We are grateful to Mrs. Elizabeth Stansbridge for work on the database, preliminary data evaluation and literature search, Dr. Mary Curran and Mrs. Morag Sloan for their substantial help with data input, and Dr. Emmanuel Abu for allowing us to include his patients. The study was funded by Southampton Hospital Charity (Registered Charity No. 1051543; Fund number 0182), University Hospital Southampton NHS Foundation Trust, Southampton UK. The Charity had no involvement in the conduct of the study or in preparation of the article.

Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

The study was approved by the Southampton and South West Hampshire Research Ethics Committee (REC reference 07/H0502/172) and was therefore performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Authors and Affiliations

  1. Department of Clinical Biochemistry, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    Valerie Walker & Paul Cook

  2. Department of Clinical Biochemistry, Galway University Hospital, Galway, Republic of Ireland

    Damian G. Griffin

  3. Department of Clinical Biochemistry, C Level MP 6 South Block, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK

    Valerie Walker

Authors
  1. Valerie Walker
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  2. Paul Cook
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  3. Damian G. Griffin
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Correspondence to Valerie Walker.

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Walker, V., Cook, P. & Griffin, D.G. Characterisation of risk factors for stones in hyperuricosuric men attending a stone clinic. Urolithiasis 42, 291–300 (2014). https://doi.org/10.1007/s00240-014-0667-y

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  • DOI: https://doi.org/10.1007/s00240-014-0667-y

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