Clinical study
Risk factors for nephrolithiasis in patients with familial idiopathic hypercalciuria

https://doi.org/10.1016/S0002-9343(02)01152-XGet rights and content

Abstract

Purpose

About 40% of patients with nephrolithiasis have idiopathic hypercalciuria, sometimes associated with a family history of kidney stones. In these families, little is known about the frequency of, and risk factors for, stone formation among hypercalciuric patients. We therefore conducted a prospective study of 216 subjects from 33 families with idiopathic hypercalciuria.

Materials and methods

We recorded the age, weight, and history of calcium stones in all subjects, and measured 24-hour urine volume and excretion of calcium, uric acid, sodium, magnesium, urea, citrate, phosphate, and sulfate on a nonrestricted diet. We performed a more complete metabolic evaluation in many of the hypercalciuric subjects (calciuria/weight >0.1 mmol/kg/d). Multivariate logistic regression analysis was performed to identify independent risk factors for stone formation.

Results

The prevalence of self-reported nephrolithiasis was 46% (61/132) in hypercalciuric subjects and 11% (7/63) in normocalciuric subjects (P <0.0001). In multivariate analysis, age (odds ratio [OR] per 10 years of age = 1.3; 95% confidence interval [CI]: 1.1 to 1.6), urine calcium excretion (OR = 1.3 per mmol/d increase; 95% CI: 1.2 to 1.5), and uric acid excretion (OR = 3.3 per mmol/d increase; 95% CI: 1.4 to 7.5) were independent risk factors for nephrolithiasis. The risk of nephrolithiasis increased progressively with greater levels of hypercalciuria.

Conclusion

We found a significant dose-effect association between calciuria and stone disease in patients with familial hypercalciuria. Other factors associated with stone formation included higher uric acid excretion, probably reflecting higher food intake, and age, probably reflecting the length of exposure to hypercalciuria and hyperuricosuria.

Section snippets

Materials and methods

We offered a family evaluation to all patients who were referred to the Department of Nephrology of Tenon Hospital, or the Department of Physiology of Broussais-Georges Pompidou Hospital, Paris, France, for hypercalciuria and stone disease from January 1996 to December 1999. Subsequently, all families with evidence of hypercalciuria among siblings were offered the opportunity to participate in a prospective study. Thirty-three families were recruited, and informed consent was obtained in

Results

Two hundred and sixteen subjects (120 [56%] women; 96 [44%] men) in 33 families were included in the study. All except one family were of Caucasian origin. Seventy-one subjects (32%) reported a history of kidney stones. We measured 24-hour urine calcium in 195 subjects, 132 (68%) of whom had hypercalciuria on a nonrestricted diet. The prevalence of nephrolithiasis among hypercalciuric subjects was 46% (61/132) versus 11% (7/63) among normocalciuric subjects (P <0.0001).

Subjects with kidney

Discussion

Nearly half (46%) of the subjects with hypercalciuria reported a history of kidney stones, consistent with previous data from family studies 4, 6, 7, 16, 17. The prevalence of nephrolithiasis (11%) in nonhypercalciuric subjects in our study is within the range observed in a population-based sample (18). Thus, hypercalciuria seems to explain the high prevalence of stones in patients with familial idiopathic hypercalciuria.

The frequency of nephrolithiasis was significantly associated with 24-hour

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