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The alteration of urine composition due to stone material present in the urinary tract.

Abstract：

OBJECTIVES:Based on a recently introduced mathematical model approach we show that uroliths located in the urinary tract (UT) can substantially deplete the urinary concentrations of lithogenic constituents by continuous growth. METHODS:To illustrate the influence of the urinary depletion effect on urinalysis, a "typical" calcium oxalate (CaOx) stone former, presently not stone-free, was investigated. Serum and urine samples were analyzed. Several metabolic tests were performed. Crystallization risk according to the BONN-Risk-Index (BRI) and the relative supersaturation in respect to CaOx (RS(CaOx)) were determined. X-ray films taken before and after a period of six months were evaluated in order to estimate stone size and average stone growth rate taken place within that period. RESULTS:Regarding CaOx urolithiasis the urine samples show a pathologically altered pH, a low 24h-citric acid excretion, and a low 24h-urine volume. Neither calcium nor oxalate excretion data reflect values indicating these substances as risk factors. However, BRI and RS(CaOx) reflect a high crystallization risk. The patient's intestinal oxalate absorption is high. Applying the depletion model, the patient's 24h-urine composition shifts from normooxaluric to hyperoxaluric. CONCLUSION:In the patient, a hitherto undetected hyperoxaluria is diagnosed when in-vivo stone growth is taken into account. This is a clear indication that the metabolic status can only be evaluated correctly in "stone-free" patients. Any stone material present in the UT must be considered in urinalysis interpretation as the stone-related urinary depletion effect is of high clinical relevance. A helpful nomogram is presented, allowing the estimation of the extent of urinary depletion caused by CaOx uroliths.

journal_name

Eur Urol

journal_title

European urology

authors

Laube N,Pullmann M,Hergarten S,Schmidt M,Hesse A

doi

10.1016/s0302-2838(03)00365-8

keywords:

subject

Has Abstract

pub_date

2003-11-01 00:00:00

pages

595-9

issue

5

eissn

0302-2838

issn

1873-7560

pii

S0302283803003658

journal_volume

44

pub_type

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