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24 Hour urine metabolic differences between solitary and multiple stone formers: Results of the Collaboration on
Theodore R Saitz1, Solange Mongoue-Tchokote2, Cynthia Sharadin3
1Oregon Health and Science University, Department of Urology, Portland, OR, USA.
Insights
Pediatric recurrent kidney stones are linked to higher calcium oxalate supersaturation. Early metabolic evaluation may help identify children at risk for multiple stone episodes.
Area of Science:
- Pediatric Nephrology
- Urology
- Metabolic Medicine
Background:
- Factors influencing pediatric urinary stone disease, particularly recurrent cases, require further clarification.
- Understanding risk factors for multiple stone episodes in children is crucial for effective management.
Purpose of the Study:
- To compare 24-hour urine collection results between children with solitary versus multiple stone episodes.
- To identify potential differences associated with recurrent stone formation in pediatric patients.
Main Methods:
- A multi-institutional retrospective analysis of 278 children (aged 2-18) with urolithiasis.
- Assessment of 24-hour urinary metabolic profiles, including urine volume and solute supersaturations.
- Statistical analysis using chi-square tests and general linear models to compare groups.
Main Results:
- Multiple stone patients were older and more likely to be female compared to solitary stone patients.
- Higher calcium oxalate supersaturation was significantly associated with multiple stone disease.
- Lower urine volumes were observed in multiple stone formers, though not statistically significant.
Conclusions:
- Pediatric multiple stone disease is associated with elevated calcium oxalate supersaturation.
- Urinary volume may play a role, warranting further investigation.
- Early metabolic evaluation is recommended for risk stratification in children prone to recurrent urolithiasis.
Introduction:
Specific factors associated with the risk of developing pediatric urinary stone disease remain unclear, especially those that may be associated with recurrent stone disease.
Objective:
We compared the results of 24-h urine collections in children with a solitary stone episode to those with multiple stone episodes to determine if there is a difference that may be associated with multiple stone formation in children.
Study Design:
A multi-institutional retrospective analysis was completed to assess 24-h urinary metabolic profiles in children with urolithiasis aged 2-18 years old. Differences in mean urine collections between the two groups were assessed using chi-square tests to test the associations among gender, stone type, and multiple stone status, as well as multivariate analyses using general linear models.
Results:
We analyzed 142 solitary stone patients and 136 multiple stone patients from four centers were included. Multiple stone patients were older than solitary stone patients (mean 13.4 ± 3.6 years vs. 12 ± 3.9 years, p = 0.002). Females were more likely to have multiple stones (58% vs. 39%, p = 0.002). BMI was not associated with multiple stones (p = 0.8467). Multiple stone formers had lower urine volumes, although this did not reach statistical significance when compared with solitary stone formation (20.4 mL/kg/day ± 11.5 vs. 22.9 ± 13.0, p = 0.0880). Higher values for super-saturation of calcium oxalate were associated with multiple stone disease in univariate (p = 0.0485) and multivariate analysis (p = 0.0469) (Figure). Centers located in the Southeast of the United States saw a higher proportion of children with multiple stones (Tennessee 62.7%, Virginia 44.4%, Oregon 31.6%, Michigan 27.3%, p < 0.0001).
Discussion:
In a large multi-institutional retrospective analysis we found that multiple stone disease was associated with higher super-saturations of calcium oxalate. Many urinary parameters changed with patient age, highlighting that the values should be interpreted with respect to patient age. The inability to comment on follow-up because of the nature of our dataset is a limitation of this study.
Conclusion:
Multiple stone disease in children is associated with higher super-saturation calcium oxalate, while lower urinary volume may also be associated with multiple stones; however, further study is required. Early metabolic evaluation may help risk stratify children likely to form multiple stones.
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