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Urinary saturation: casual or causal risk factor in urolithiasis?
1Department of Chemistry, University of Cape Town, Cape Town, South Africa.
BJU International
|October 15, 2013
Summary
Urinary supersaturation (SS) does not reliably distinguish stone formers from healthy individuals. High SS values lack diagnostic worth for identifying stone formers, suggesting it is a casual, not causal, factor in stone formation.
Area of Science:
- Nephrology
- Urology
- Biochemistry
Background:
- Urinary supersaturation (SS) is a key concept in nephrolithiasis research.
- Previous studies suggest a link between elevated SS and kidney stone formation.
- The diagnostic utility of absolute SS values remains debated.
Purpose of the Study:
- To evaluate the discriminatory power of urinary SS between stone formers and healthy individuals.
- To determine the diagnostic worth of absolute SS values.
- To investigate if high SS is a fundamental cause of kidney stone formation.
Main Methods:
- Systematic literature search on Google Scholar for urinary compositional data.
- Recalculation of SS values where necessary.
- Construction of SS distribution plots for calcium oxalate, brushite, and uric acid.
- Statistical analysis using unpaired t-test and Mann-Whitney test.
Main Results:
- 47 studies provided 123 SS values for healthy individuals and 122 for stone formers.
- Mean and median SS values were significantly higher in stone formers, but with wide variations.
- Urinary SS values did not effectively separate stone formers from healthy individuals.
Conclusions:
- Absolute urinary SS lacks diagnostic value for differentiating stone formers.
- Quantifying a 'high' SS value is not feasible for diagnostic purposes.
- SS is more likely a casual factor than a direct cause of kidney stones, though useful for monitoring treatment efficacy.
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