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Clinical and biochemical patterns of presentation in monolateral and bilateral calcium nephrolithiasis
C Vitale1, M Marangella, D Cosseddu
1Nephrology Division, Mauriziano Hospital, Torino, Italy.
Insights
Idiopathic calcium stone disease (ICaSD) shows unique monolateral patterns, unlike primary hyperparathyroidism (PHP). These distinct ICaSD forms cannot be identified by standard clinical or biochemical tests.
Area of Science:
- Nephrology
- Urology
- Biochemistry
Background:
- Nephrolithiasis, or kidney stones, can affect one or both kidneys.
- Understanding the patterns of stone formation is crucial for diagnosis and treatment.
- Idiopathic calcium stone disease (ICaSD) and primary hyperparathyroidism (PHP) are common causes of kidney stones.
Purpose of the Study:
- To investigate and compare the patterns of monolateral (one-sided) versus bilateral (both sides) kidney stone disease in patients with ICaSD and PHP.
- To determine if ICaSD with monolateral disease has distinct pathogenic mechanisms compared to bilateral ICaSD.
- To assess if clinical and biochemical parameters can differentiate between monolateral and bilateral ICaSD.
Main Methods:
- Enrolled 196 patients with ICaSD and 36 with PHP, all with at least three stone events.
- Analyzed the prevalence of monolateral versus bilateral nephrolithiasis in both groups.
- Compared clinical, biochemical, metabolic, urine saturation, and diet-related parameters between monolateral and bilateral ICaSD groups.
Main Results:
- Monolateral disease was observed in 45 ICaSD patients and 3 PHP patients.
- The distribution of monolateral stones in PHP followed expected random patterns, but not in ICaSD, especially with over 6 stone events.
- No significant differences in metabolic derangements, urine saturation, or diet-related biochemistries were found between monolateral and bilateral ICaSD.
- Bilateral stone formers had higher recurrence rates but similar surgical interventions (stone-operations or ESWL).
- In bilateral ICaSD, the distribution of stones between kidneys did not deviate from random chance.
Conclusions:
- Nephrolithiasis associated with PHP exhibits predictable patterns.
- ICaSD includes a subset of patients with monolateral kidney stone disease.
- Monolateral ICaSD forms are not distinguishable from bilateral forms using standard clinical features or routine biochemical analyses.
Abstract:
To investigate patterns of monolateral and bilateral nephrolithiasis, we enrolled 196 patients with idiopathic calcium stone disease (ICaSD) and 36 with proven primary hyperparathyroidism (PHP). Monolateral disease occurred in 45 subjects with ICaSD and 3 with PHP. All had had three or more stone events. They were studied for a number of clinical and biochemical parameters. The expected prevalence of monolateral stone disease was calculated according to the binomial distribution of random events. Whereas the observed and expected prevalence of monolateral nephrolithiasis did not differ in PHP, the distribution did not follow a chance pattern in ICaSD, since monolateral disease was still frequent among patient with more than 6 episodes. To find out whether monolateral and bilateral ICaSD had distinct pathogenic mechanisms the two groups were compared for clinical and biochemical patterns: no differences emerged concerning metabolic derangements, urine saturation and diet-related biochemistries. Bilateral stone-formers had a higher recurrence rate, but a similar number of stone-operations or ESWL. In 81 of 151 bilateral idiopathic stone-formers in which we were able to assess the exact number of stone events in left and right kidney, the distribution of stones between kidneys did not differ from the binomial distribution. In conclusion, while PHP-associated nephrolithiasis presents predictable patterns, ICaSD comprises a subset in which the disease occurs monolaterally. These forms cannot be distinguished from bilateral forms with common clinical features or routine biochemistries.