Published: 2020-01-27

The various metabolic factors involved in stone recurrence: a prospective study

Jitendra Kumar Singh, Sanjay Singh, A. Maha Devan, Anish Kola


Background: Nephrolithiasis is the most common chronic kidney condition, is globally increasing in both sexes. Five main types of renal stones viz., calcium oxalate stones, calcium phosphate stones, uric acid stones, struvite stones and cystine stones. Purpose of the study is to evaluate various metabolic factors contributing to recurrent renal stone and determining appropriate medical treatment and diet modification to prevent recurrent renal stone disease.

Methods: This study was carried out in P.G. Department of Surgery, S.R.N. Hospital associated with M.L.N. Medical College, Allahabad. A total of 120 cases of recurrent renal calculi in and outpatient between August 2017 and July 2019 were included in the study. All patients were stone free at the time of metabolic urine evaluation.

Results: Most of the patients in the study were in the age 21 to 50 years. 80% were males and 20% were females. In 24-hour urine analysis most common metabolic abnormality seems to be hyperoxaluria (92.5%) followed by hypercalciuria (82.5%), high pH (67.5%), and least common seems to be hypocitraturia (15%), followed by hyperphosphaturia (20%), hypernatreturia (25%), and low level of potassium (25%).

Conclusions: All patient of recurrent stone formation are advised increase fluid intake. In patient with hypercalciuria and hypocitraturia, dietary restriction of protein, oxalate and sodium, treatment includes thiazides supplemented with potassium citrate. In patient with hyperoxaluria dietary restriction of oxalate rich food and in hyperuricosuria dietary restriction of animal protein is advised.



Dietary modifications, Medication, Metabolic, Nephrolithiasis, Recurrent stones

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Soldati L, Bertoli S, Terranegra A, Brasacchio C, Mingione A, Dogliotti E, et al. Relevance of Mediterranean diet and glucose metabolism for nephrolithiasis in obese subjects. J Trans Med. 2014;12(1):34.

Kramer HM, Curhan G. The association between gout and nephrolithiasis: the National Health and Nutrition Examination Survey III, 1988-1994. Am J Kidney Dis. 2002;40(1):37-42.

Kramer HJ, Choi HK, Atkinson K, Stampfer M, Curhan GC. The association between gout and nephrolithiasis in men: The Health Professionals' Follow-Up Study. Kidney Int. 2003;64(3):1022-6.

Taylor EN, Stampfer MJ, Curhan GC. Diabetes mellitus and the risk of nephrolithiasis. Kidney Int. 2005;68(3):1230-5.

Curhan GC, Willett WC, Knight EL, Stampfer MJ. Dietary factors and the risk of incident kidney stones in younger women: Nurses’ Health Study II. Arch Intern Med. 2004;164(8):885-91.

Traxer O, Huet B, Poindexter J, Pak CY, Pearle MS. Effect of ascorbic acid consumption on urinary stone risk factors. J Urol. 2003;170(2):397-401.

Bullock N, Sibley G, Whitaker R. Essential Urology. IInd Edition. Churchill Livingstone. Inc; 1994: 161.

Lifshitz DA, Shalhav AL, Lingeman JE, Evan AP. Metabolic evaluation of stone disease patients: a practical approach. J Endourol. 1999;13(9):669-78.

Goldfarb DS, Coe FL. Prevention of recurrent nephrolithiasis. Am Family Phys. 1999;60(8):2269-76.

Amaro CR, Goldberg J, Amaro JL, Padovani CR. Metabolic assessment in patients with urinary lithiasis. Int Braz J Urol. 2005;31(1):29-33.

Kıraç M, Küpeli B, Karaoğlan U, Bozkırlı I. Metabolic evaluation in patients with recurrent calcium oxalate stones. Turk J Urol. 2011;37(3):246-51.

Ana Suely de Andrade, Luíza Maria de C. Jalles, Mônica Ferreira Lopes, Cleide da C. A. de Oliveira, Tereza Neuma de S. Brito, Lucia de Fátima C. Pedrosa. Protein, Calcium and Sodium in the Basic Diet of Children and Adolescents with Nephrolithiasis in the State of Rio Grande do Norte. J Bras Nefrol. 2004;26(2):76-83.

Kochakarn W, Domrongkitchaiporn S. Urinary risk factors for recurrent calcium stone formation in Thai stone formers. J Med Assoc Thai. 2007;90(4):688-98.

Muhammad Rafique Anjum, Riaz Ahmad, Abdul Ghaffar, Ali Imran Zaidi.. Twenty four hours urinary citrate levels in recurrent renal stone formers and healthy controls. Nishtar Medi J. 2009;1(1):19-22.

Alemzadeh AM, Valavi E, Ahmadzadeh A. Predisposing factors for infantile urinary calculus in south-west of Iran. Iran J Kidney Dis. 2014;8(1):537.

Ha YS, Tchey DU, Kang HW, Kim YJ, Yun SJ, Lee SC, et al. Phosphaturia as a promising predictor of recurrent stone formation in patients with urolithiasis. Korean J Urol. 2010;51(1):54-9.

Deshmukh SR, Khan ZH. Evaluation of urinary abnormalities in nephrolithiasis patients from Marathwada region. Ind J Clini Biochem. 2006;21(1):177-80.

Strohmaier WL, Seilnacht J, Schubert G. Urinary stone formers with hypocitraturia and ‘normal’urinary pH are at high risk for recurrence. Urologia Int. 2012;88(3):294-7.

Freitas Junior CH. Metabolic assessment of elderly men with urolithiasis. Clinics. 2012;67(5):457-61.