Ahn, Justin

Bayne, David

Chi, Tom

Ho, Sunita

Hsu, Raymond

Srirangapatanam*, Sudarshan

Stoller, Marshall

Wiener, Scott

eScholarship - University of California

UCSFUC San Francisco Previously Published WorksTitleMP03-06 ASSOCIATION OF URINARY STONE DISEASE WITH KIDNEY FUNCTION DECLINEPermalinkhttps://escholarship.org/uc/item/59p1h8vdAuthorsSrirangapatanam*, SudarshanBayne, DavidAhn, Justinet al.Publication Date2020-04-01DOI10.1097/ju.0000000000000817.06 Peer reviewedeScholarship.org Powered by the California Digital LibraryUniversity of California<15.0 µU/mL; 2) “Moderate IR” group: HOMA-IR 2.5 and insulin<15.0 µU/mL; and 3) “Severe IR” group: HOMA-IR 2.5 and insulin15.0 µU/mL. None of the participants had low HOMA-IR and highinsulin level. Demographic variables and physical activities includingwalk and sedentary times were compared among the three groups.Logistic regression analysis was used to estimate the odds ratio (OR)and 95% confidence interval (CI) for incident kidney stones at 5 yearsafter baseline.RESULTS: A total of 97 men (4.7%) and 45 women (2.3%)developed kidney stones at 5 years after baseline. At baseline, 1,878men and 1,812 women were classified into the Control group, 158 menand 91 women into the Moderate IR group, and 48 men and 20 womeninto the Severe IR group. Body mass index, abdominal circumference,blood pressure, and triglycerides were significantly higher and high-density lipoprotein cholesterol was significantly lower, in the order cor-responding to the Control, Moderate IR, and Severe IR groups. Afteradjustment for multiple variables, the Severe IR group was associatedwith kidney stone formation (OR, 2.91; 95% CI, 1.02e8.25) in men.Meanwhile, there was no difference between IR and kidney stone for-mation in women. Sedentary lifestyle was associated with IR.CONCLUSIONS: In Japanese men, severe insulin resistancewas associated with kidney stone formation under normoglycemicconditions. Avoiding sedentary lifestyles could prevent kidney stoneformation through improving insulin resistance.Source of Funding: noneMP03-05URINARY CITRATE WASTING AMONG NEPHROLITHIASISPATIENTS ASSOCIATES WITH OBESITY AND DIABETES MELLITUSWilson Sui*, Joshua K. Calvert, Nicholas L. Kavoussi, Nashville, TN;John Asplin, Chicago, IL; Nicole L. Miller, Cosmin A. Bejan, Ryan S. Hsi,Nashville, TNINTRODUCTION AND OBJECTIVE: Urinary citrate is thought todecrease calcium stone formation through direct inhibition of crystallizationand by complexing with calcium. A subset of nephrolithiasis patientsexcrete very high amounts of citrate with unclear clinical implications. Herewe sought to profile nephrolithiasis patients with urinary citrate wasting.METHODS: We identified 2,257 consecutive patients who un-derwent 24-hour urine studies performed at our institution from 2001 to2017. We identified patients with 1st time urine testing with citratewasting, defined as >1500 mg/day. Patients were excluded if on anyalkali therapy. After applying these selection criteria, a total of 55 citratewasters were identified and randomly matched 1:3 by age and sex toother stone formers for a final comparative cohort of n [ 165. Univar-iate analyses with chi-square and t-tests were used to assess differ-ences in demographic, clinical, stone and 24-hour urine characteristics.RESULTS: Citrate wasters had significantly higher mean  SDBMI (35.0  7.3 vs 29.9  7.9 kg/m2, p < 0.001) and a higher preva-lence of diabetics (61.8 vs 20.6%, p < 0.001). Calcium oxalate mono-hydrate (COM) and uric acid stones were the two most common stonesthe citrate wasting group (70% and 15% respectively), while COM andhydroxyapatite stones were most common in the control group (58%and 20% respectively). Uric acid stones were more commonly observedamong citrate wasters (15% vs 7%, p [ 0.096). On 24-hour urineanalysis, the citrate wasting group showed higher urine values of cal-cium, oxalate, uric acid, and sodium (all p<0.001; see Figure). Notably,urine pH showed no difference between groups. These results werelargely unchanged when examining differences by sex.CONCLUSIONS: Nephrolithiasis patients who excrete >1500mg of urinary citrate per day are more likely to be obese anddiabetic, with generally worse urinary analytes overall relating to stonerecurrence risk. Further investigation is needed on the etiologic andclinical implications of these findings.Source of Funding: NoneMP03-06ASSOCIATION OF URINARY STONE DISEASE WITH KIDNEYFUNCTION DECLINESudarshan Srirangapatanam*, David Bayne, Justin Ahn, San Francisco,CA; Scott Wiener, Syracuse, NY; Tom Chi, Sunita Ho, Raymond Hsu,Marshall Stoller, San Francisco, CAINTRODUCTION AND OBJECTIVE: Prior studies have shownsignificant differences in glomerular filtration rate (GFR) betweenstone formers and non-stone formers. There is evidence thatnephrolithiasis is a risk factor for chronic kidney disease (CKD). Therole of kidney function in kidney stone formation however largelyremains unexplored. The objective of this study is to investigatedifferences in kidney function decline between stone formers andnon-stone formers over time.METHODS: A retrospective study was undertaken using de-identified patient data at our tertiary care center. Serum creatininevalues of adults (age  18) were used to calculate GFR using the CKD-EPI creatinine equation. The primary outcome was change in GFR peryear using an adjusted linear model. An adjusted cox-model was usedto calculate the average risk of stone formation associated with GFRdecline in stone formers based on date of initial nephrolithiasis diag-nosis. Our secondary outcome was GFR change post stone formationstratified by surgical versus non-surgical intervention.RESULTS: Complete data for analysis was obtained from3,450 stone formers and 112,072 non-stone formers after review ofmedical record data between 2010 and 2019. Stone formers had anoverall GFR decline of 2.8 cc/min per year (p-value < 0.001)compared to a decline of 0.04 cc/min per year (p-value [ 0.38) innon-stone forming patients. A fully adjusted cox-model indicated, onaverage, each 1 cc/min decline in GFR was associated with anincreased risk of stone development in the following 2 years by3.7%. Stone formers who underwent surgical intervention (PNL,URS, or SWL) had stable GFR post-operatively at 1 year. Patientswho did not undergo surgical intervention had GFR decline of 0.82cc/min CI [-1.56, -0.08] at 1 year (p-value [ 0.03).Vol. 203, No. 4S, Supplement, Friday, May 15, 2020 THE JOURNAL OF UROLOGY e23Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.CONCLUSIONS: A decline in GFR is associated with risk ofkidney stone presentation up to 2 years prior to a stone event. Thissuggests that upstream changes in the renal papilla which affect GFRalso may be contributing to mineralization. Kidney function declinecould be used as a possible predictive tool for risk of stone formation.Additionally, surgical intervention is associated with preservation ofGFR within one year after stone event. Clinically, unexplained GFRdecline should increase suspicion for nephrolithiasis and appropriateevaluation and treatment should be considered.Source of Funding: noneMP03-07URINARY STONE COMPOSITION IN THE UNITED STATES: DATAOF 98,043 URINARY STONE ANALYSESMadhumita Parmar*, Anika Jain, Nachiketh Soodana, Jonathan Katz,Miami, FL; Glenn Austin, Orlando, FL; Hemendra Shah, Miami, FLINTRODUCTION AND OBJECTIVE: There is a paucity oflarge-scale data on urinary stone composition in the United States.Here, we present characteristics of urinary stone composition, age andgeographic region in the United States.METHODS: We obtained compositional analyses for all urinarystones submitted to a reference laboratory from July 15, 2016 to Sept.29, 2019. Stone composition was determined by integrative crystal-lography. Stones containing >90 percent of particular chemicals wereclassified as purely made of that composition. Data was analyzed usingStata 16 (College Station, Texas) software.RESULTS: Total of 99,908 records of stones were analyzed.Of this 98,043 were categorized as urinary stones and remainingwere non-crystalline physiological particulate matter or artifacts.Common stone types were calcium oxalate (79.33%), uric acid(10.63%), calcium phosphate (5.73%) and triple phosphate (2.22%).Rare variety of stones included predominantly protein (0.93%),cystine (0.26 %) and drug induced (0.22%). Incidence of calciumoxalate and uric acid stones increased with age and that of calciumphosphate decreased with age. Amongst patient with calcium oxalatestone, incidence of calcium oxalate monohydrate increased with ageand that of mixed calcium oxalate stones and calcium oxalate dihy-drate decreases with age (p<0.01) (figure 1 and 2). Although theincidence of common stone types was similar, overall associationbetween stone composition and geographical distribution was foundto be statistically significant (figure 3).CONCLUSIONS: This series is the largest analysis to date ofurinary stone composition in the United States. Age and geographicalregion were significantly associated with variations in stonecomposition.Source of Funding: NILMP03-08ASSOCIATION OF PRIOR PREGNANCY WITH 24-HOUR URINECOMPOSITION AND STONE RISKVivian Paredes Bhushan*, Marie-Therese I. Valovska, Hanover, NH;Vernon M. Pais, Jr., Lebanon, NHINTRODUCTION AND OBJECTIVE: Pregnancy is associatedwith an increased lifetime prevalence of nephrolithiasis. During preg-nancy, purported changes in urinary milieu include hypercalciuria andalkaline urine pH, which may predispose to calcium phosphate(CaPhos) urolithiasis. Postpartum, it is unknown whether the cumulativenumber of pregnancies is associated with persistent risk of these find-ings and CaPhos stone formation. We studied the effect of prior preg-nancies on the urinary milieu and stone composition in a cohort offemale stone formers.e24 THE JOURNAL OF UROLOGY Vol. 203, No. 4S, Supplement, Friday, May 15, 2020Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.

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MP03-06 ASSOCIATION OF URINARY STONE DISEASE WITH KIDNEY FUNCTION DECLINE

https://escholarship.org/uc/item/59p1h8vd

MP03-06 ASSOCIATION OF URINARY STONE DISEASE WITH KIDNEY FUNCTION DECLINE

MP03-06 ASSOCIATION OF URINARY STONE DISEASE WITH KIDNEY FUNCTION DECLINE

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