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Urolitiasis.

Dr. Eduardo Quintana Pia

Eritrocituria

Leucocituria

Clulas tubulares

Sedimento activo

Clulas epiteliales

Clulas transicionales

Cilindro hialino

Cilindro granuloso

Cilindro creo y granuloso

Cilindro eritrocitario

Cilindro mixto tubular

Cilindro lipdico con luz polarizada

Cilindro lipdico en refringencia.

Cuerpo lipdico con luz polarizada

Cuerpo lipdico en birefringencia

Cristales de cistina

Cristales de triple fosfato

Cristales de oxalato

Cristales de urato

Cristales de sulfas

Inicidencia de las urolitiasis.

7 a 12 casos por 10 000 habitantes (EUA),


Los hombres tienen mayor riesgo 3:1
Edad ms frecuente es entre los 30 a 60 aos
Existen zonas endmicas con mayor riesgo (enfermedad
de los Balcanes)
El 40% de los pacientes van a desarrollar un nuevo
cuadro de litiasis en menos de 5 aos
Si el paciente presente un evento nuevo de litiasis en
menos de 1 ao, habr que realizar estudio metablicos
completos a la brevedad.

Sistema urinario

Diferentes tipos de clculos renales.


%(USRDS)
35.7

% (Canad)
44.7

4.4

6.1

16.2

14.9

Fosfato de amonio y magnesio (Estruvita)

18.2

17.2

Ac rico

10.4

9.9

Urato monosdico

5.7

3.0

Urato cido de amonio

4.8

0.2

Cistina

1.2

0.9

Xantina

0.5

0.6

2,8 dihidroxiadenina

0.4

0.3

Fosfato de magnesio

2.5

2.2

Oxalato de calcio (Webelita)


Fosfato de calcio (Brusita)
Fosfato de calcio bsico (apatina)

74.5

82.9

Etiologa de los clculos renales.

Hipercalciuria
Hiperoxaluria
Hipocitraturia
Hiperuricemia/hiperuricosuria
Acidosis tubular renal
Medicamentos
Alteraciones anatmicas del trayecto urinario
Infeccin de vas urinarias
Deshidratacion

Evaluacin del paciente con litiasis renal.


Historia clnica
Antecedentes familiares, antecedente personal de litiasis previa, estilo de
vida, actividad fsica, consumo de sal y tipo de dieta, trabajo y tipo de
actividades en el mismo, deporte, antecedente de IVU, edad, datos de Sx
prosttico

Exploracin fsica
Estudios de laboratorio
Estudios de Gabinete

Sintomatologa.
Dolor sbito en fosa renal (Dolor tipo clico renal)
Dolor irradiado hacia el trayecto urinario hasta loa regin del
perin
Hematuria
Disuria
Sndrome febril
Polaquiria
Nauseas
Vmito
leo
Observacin del calculo en PSA (80%)
Nefrocalcinosis (HPT 1 o ATR)
Uropata obstructiva (TAC o US renal)

Estudios de laboratorio en el paciente con


urolitiasis.
Sricos:
Na, K, Ca, P, Ac. rico, Creatinina, Hormona paratiroidea

Urinarios:
Creatinina, Na, Ca, Ac rico, Examen de de orina, urocultivo, Oxalatos y
citratos.

Estudio con reto de dieta baja en calcio


400 mgs de calcio y 100 meq de sodio al da

Estudio con reto de dieta alta en calcio


Estudio de 4 hrs: Administracin de 1 gr de calcio elemental
Estudio de 5 das: Administracin de 2 grs de calcio elemental al da

Criterios diagnsticos para las diferentes


formas de hipercalciuria.
HA TI

HA TII

FRC

Calcio

Fsforo

HPT

1,24(OH)D3

Sricos

Calcio urinario
Ayuno
Restriccin de calcio
Carga de calcio

HPTP

1,25(OH)D3

Valores ideales en el paciente con


urolitiasis.
Volumen urinario/da
1.5 lts/m2 (2 a 2.5 lts)

Calcio urinario
<2 mg/kg/peso ideal (menos de 140 mg/da)

Oxalatos
<40 mgs/da

Citratos
> 350 mgs/da

uricosuria
< de 450 mg/da en mujeres, < de 600 mg/da en hombres

Sodio urinario
< de 100 mg/da

Fsforo
< de 1 grs/da

pH urinario
Entre 5.5 y 7.5

Causas de hiperoxaluria
Alteraciones en la sntesis de oxalatos y/o alteraciones enzimticos
Hiperoxalemia tipo I y tipo II
Deficiencia de piridoxina

Incremento en el consumo de sustratos generadores de oxalatos


Aumento en el consumo de vitamina C
Farmacos (etinil-glicol)
Aumento en la dieta de oxalatos

Incremento en la absorcin intestinal


Hiperoxaluria entrica
Desequilibrio entre las concentraciones de Ca y oxalato intraintestinal
Incremento en la dieta con oxalato

Diagnstico diferencial de las hiperoxalurias.


Primaria

Entrica

Absortiva

Gnero

Semejante

Femenino

Masculino

Oxalosis

Comn

Frecuente

Rara

Funcin renal
Potasio

A nivel urinario:
Calcio

Magnesio

N
N

Oxalato

Citrato

pH

Composicin del
lito

Ox de Ca

Ox de Ca y Ac.
Urico

Ox de Ca y
HP0Ca

Causas de hipocitraturia
Acidosis tubular distal
Completa o incompleta

Sx diarreico crnico
Mala absorcin intestinal de citrato

Uso de tiazidas
Elevado consumo de protenas
Elevado consumo de sal
Infeccin de vas urinaria
Idioptico

Urolitiasis por hipercalciuria


Causas que generen hipercalcemia

Hiperparatiroidismo
Enfermedades granulomatosas
Tirotoxicosis
Inmovilizacin
Tumores malignos
Medicamentos

Alteraciones especificas del metabolismo del calcio


Fuga renal de calcio
Hipercalciuria absortiva tipo I y tipo II

Hipercalciuria idioptica

Urolitiasis.
Estruvita
Infecciones de vas urinaria
pH urianario alto

Cistina
Bajo volumen urinario
Incremento en la ingesta de aminocidos esenciales
(cistina, ornitina, lisina, glargina)
Alteraciones genticas del metabolismo

Grmenes productores de ureasa.


Gram positivos

Staphylococo aureus
Micrococo varians
Corynebacterium
Peptoestreptococo
Bacilus sp

Gram negativos

Proteus
Flavobacterium
Brucela sp
Yersenia
Bordetella pertusis

Grmenes productores de ureasa.


Mycoplasma
Ureaplasma urealyticum

Hongos

Criptococo
Rhadotorilla
Esporobolmices
Cndida humicola
Tricosporum cutaneum

Litiasis por cido rico


Hiperuricosuria
Dieta alta en purinas y xantinas
Hiperuricemia

Gota
-sndrome de lisis tumoral
Anemia hemoltica
Medicamentos
Errores congnitos del metabolismo
Sx de Lesch-Nyham, deficiencia de 6 frutuosa

Hipovolemia
Diarrea, baja ingesta de lquidos, prdida de lquidos por
otras vas

pH urinario bajo

Urolitiasis relacionada a frmacos.


Promueven la formacin de litos por calcio

Diurticos de asa
Anticidos
Acetazolamida
Teofilina
Glucocorticoides
Vitaminas D y C

Promueven la formacin por litos de c. rico y xantinas


Tiazidas, salicilatos, probenecid, alopurinol

Otros
Triamtireno, antivirales

Tratamiento:
Fase aguda
Recordar que el 90% de los clculos menores de 1 cm, se van a
expulsar mediante las siguientes medidas:
Analgsicos potentes con poder anti inflamatorio
Indometacina

Relajantes del msculo liso


Bultil hiocina, papaverina, floroglucinol,

Uso de antibiticos profilcticos


Sobre hidratacin
Evaluar la causa
Bsqueda de complicaciones
Pelo nefritis, hidronefrosis

Abra que recordar que ante la presencia de embarazo, todas las


pacientes se deben de internar para su manejo conjunto (urologa,
obstetricia, infectologa, neonatologa, terapia intensiva, )

Tratamiento:
Fase aguda
Si hay complicaciones realizar las siguientes medidas:
Internar al paciente para:
Analgsicos potentes endovenosos y antibiticos tambin endovenosos

Sobre hidratacin
Considerar realizar procedimientos de endourologa
Litotripsia endo urologica (litotriptor neumtico, pinzas fragmentadoras)
Canasteo

Uso de litrotripsia extra corprea


Litotomia
Nefrostomia percutanea
Colocacin de catter doble J
*Recordar que la litotripsia ser efectiva, si los clculos tienen
algn componente de calcio

Tratamiento:
Fase crnica:

Identificar la causa
Vigilancia mdica estrecha
Si hay recada valorar estudios metablicos completos
Valorar riesgos de infecciones incluyendo micobacteriosis
Evaluar malformaciones de la va urinaria
Una vez establecido el diagnstico, dar el tratamiento
especfico
En un 10% de los casos, el paciente debe de ser manejado por
ms de 2 sub especialistas
Evitar complicaciones mayores que pongan en riesgo el
funcionamiento renal y la vida del paciente

Renal stone epidemiology in Rochester,


Minnesota: An update

Kidney International (2006) 69, 760764

Renal stone epidemiology in Rochester,


Minnesota: An update
Men

Year
1970
1980
1990
2000

Rate (
155.1 (
183.7 (
144.0 (
105.0 (

s.e.) a
28.5)
29.3)
22.3)
16.8)

Total 140.6 ( 11.4)

Women

Total

Cases
31
42
44
40

Rate ( s.e.) a
43.2 ( 14.0)
53.6 ( 13.8)
92.4 ( 16.3)
68.4 ( 12.3)

Cases
10
16
34
31

Rate ( s.e.) b
98.7 ( 15.7)
116.5 ( 15.8)
117.1 ( 13.6)
85.1 ( 10.2)

Cases
41
58
78
71

157

65.8 ( 7.0)

91

101.8 ( 6.6)

248

Kidney International (2006) 69, 760764

Renal stone epidemiology in Rochester,


Minnesota: An update

Kidney International (2006) 69, 760764

Renal stone epidemiology in Rochester,


Minnesota: An update

Kidney International (2006) 69, 760764

Renal stone epidemiology in Rochester,


Minnesota: An update
Year of diagnosis
1970
Total stones
Stone type known: number (% of
total)

1980

1990

2000

41

58

78

71

18

32

41

62

(44
)

(55
)

(53
)

(87
)

% Calcium Oxalate

72.2

78.1

70.7

74.2

% Calcium Phosphate

22.2

12.5

29.3

17.7

% Uric Acid

5.6

9.4

8.1

Kidney International (2006) 69, 760764

Renal stone epidemiology in Rochester,


Minnesota: An update
Men

Year
1970
1980
1990
2000

Rate (
189.0 (
229.7 (
171.6 (
125.9 (

s.e.) a
31.8)
32.8)
24.2)
18.4)

Total 170.1 ( 12.5)

Women

Total

Cases
37
52
53
48

Rate ( s.e.) a
47.8 ( 4.8)
59.4 ( 14.2)
107.2 ( 17.4)
77.7 ( 13.2)

Cases
11
19
40
35

Rate (
116.8 (
142.2 (
138.1 (
100.1 (

s.e.) b
17.1)
17.5)
14.7)
11.0)

190

75.4 ( 7.5)

105

121.0 ( 7.2)

Cases
48
71
93
83
295

Kidney International (2006) 69, 760764

NPT2a gene variation in calcium nephrolithiasis


with renal phosphate leak

Kidney International (2006) 69, 22612267

nephrolithiasis with renal phosphate


leak

Kidney International (2006) 69, 22612267

NPT2a gene variation in calcium nephrolithiasis


with renal phosphate leak

Kidney International (2006) 69, 22612267

Effect of cinacalcet on urine calcium excretion and


supersaturation in genetic hypercalciuric stone-forming rats

Kidney International (2006) 69, 15861592

Effect of cinacalcet on urine calcium excretion and


supersaturation in genetic hypercalciuric stone-forming rats

Kidney International (2006) 69, 15861592

Effect of cinacalcet on urine calcium excretion and


supersaturation in genetic hypercalciuric stone-forming rats

Kidney International (2006) 69, 15861592

Effect of cinacalcet on urine calcium excretion and


supersaturation in genetic hypercalciuric stone-forming rats

Kidney International (2006) 69, 15861592

Effect of cinacalcet on urine calcium excretion and


supersaturation in genetic hypercalciuric stone-forming rats

Kidney International (2006) 69, 15861592

Effect of cinacalcet on urine calcium excretion and


supersaturation in genetic hypercalciuric stone-forming rats

Kidney International (2006) 69, 15861592

175

173

9a

9a,b

<0

72.8 15.9 ,
25.1 4.9a,b
89.9
10.1
52.0
86.9
31.8/57.3/11.0a,b
18.9/58.9/22.2a
32.8/45.2/22.0a
14.5/57.2/28.3a
1.7 1.0a,b
5.0 2.2a,b

<0
<0
0.9
0.4
0.4
0.1
<0
0.0
<0
<0
<0
<0

170

Effect of dietary modification on urinary astone risk factorsa b

g
m2
nes% pts
s% pts
story of stones% pts
urrence% pts
% pts Low/Moderate/High
% pts Low/Moderate/High
% pts Low/Moderate/High
ke% pts Low/Moderate/High
a mol/dL GF
mol/dL GF
s, no. (%)

86.7 17.5
28.2 5.4
92.1
7.9
54.2
90.4
11.8/36.1/52.1
14.0/52.8/33.2
18.1/40.4/41.5
4.7/42.9/52.5
2.5 1.7
7.0 3.0

78.6 15
26.2 4.4a
89.5
10.5
57.6
91.5
14.2/60.8/25.0a
18.7/57.1/25.2
27.0/46.5/26.6a
7.9/55.8/36.3a
2.2 1.2a
6.0 2.2a

262 (73.6)

Kidney
a International
a,b 68, 22642273<0
153 (63.0)
0 (0)(2005)

TV mL
2081 918
1963 954
0.002
Effect
urinary
risk factors
pHof dietary modification
5.99 0.39 on5.94
0.41stone 0.01
Ca mmol/day
Ox mmol/day
Cit mmol/day

9.18 2.00
6.54 2.35
0.408 0.141 0.392 0.160
3.01 1.39
2.70 1.36

Mg mmol/day
P mmol/day
Na mmol/day
K mmol/day
UA mmol/day
SO4 mmol/day
NH4 mEq/day
Cr mmol/day
RSR CaOx
RSR Br

4.95 1.62
35.7 9.9
208 76
57.3 19.6
4.05 1.20
24.4 9.2
42.8 17.4
15.9 3.6
9.94 4.22
3.21 1.79

<0.0001
0.0635
<0.0001

4.14 1.49
<0.0001
31.5 10.4
<0.0001
125 64
<0.0001
53.6 21.8
0.0003
3.98 1.49
0.4
23.4 9.5
0.1
43.3 15.3
0.8
15.8 3.8
0.3
8.76 3.94
<0.0001
2.22 1.65
<0.0001
Kidney International (2005) 68, 22642273

TV mL
1795 852
1727 851
0.1
Effect
urinary
risk factors
pHof dietary modification
6.03 0.39 on5.97
0.44stone 0.02
Ca mmol/day
Ox mmol/day
Cit mmol/day

5.89 0.52
4.74 1.62
0.364 0.133 0.344 0.127
2.62 1.34
2.27 1.26

Mg mmol/day
P mmol/day
Na mmol/day
K mmol/day
UA mmol/day
SO4 mmol/day
NH4 mEq/day
Cr mmol/day
RSR CaOx
RSR Br

4.05 1.30
29.1 7.5
170 63
51.1 18.2
3.48 1.01
19.6 7
33.9 11.8
14.1 3.4
8.62 4.01
2.64 1.72

<0.0001
0.1
<0.0001

3.50 1.37
<0.0001
27.1 8.8
0.0003
108 50
<0.0001
45.3 18.5
<0.0001
3.32 1.20
0.02
20.3 10.1
0.2
40.8 15.8
0.0001
14.1 3.5
0.6
8.09 3.62
0.04
2.07 1.89
<0.0001
Kidney International (2005) 68, 22642273

TV mL
1581 694
1618 773
0.3
Effect
urinary
risk factors
pHof dietary modification
6.01 0.44 on5.96
0.43stone 0.04
Ca mmol/day
Ox mmol/day
Cit mmol/day

3.62 1.05
3.24 1.37
0.363 0.215 0.355 0.224
2.15 1.27
2.05 1.21

Mg mmol/day
P mmol/day
Na mmol/day
K mmol/day
UA mmol/day
SO4 mmol/day
NH4 mEq/day
Cr mmol/day
RSR CaOx
RSR Br

3.40 1.53
25.7 7.7
147 59
46.1 17.4
3.10 1.01
16.6 7.3
32.4 16.1
12.6 3.5
6.88 4.33
1.73 1.52

<0.0001
0.8
0.3

3.18 1.25
0.002
23.7 7.9
<0.0001
102 51
<0.0001
43.3 17.3
0.002
3.08 1.18
0.9
17.3 7.9
0.1
34.4 13.2
0.1
13.0 3.8
0.3
6.57 3.58
0.09
1.43 1.35
<0.0001
Kidney International (2005) 68, 22642273

Effect of dietary modification on urinary stone risk factors

Kidney International (2005) 68, 22642273

Effect of dietary modification on urinary stone risk factors

Kidney International (2005) 68, 22642273

Effect of dietary modification on urinary stone risk factors

Kidney International (2005) 68, 22642273

Characterization of glycosaminoglycans in tubular


epithelial cells: Calcium oxalate and oxalate ions effects

Kidney International (2005) 68, 16301642

Characterization of glycosaminoglycans in tubular


epithelial cells: Calcium oxalate and oxalate ions effects

Kidney International (2005) 68, 16301642

Characterization of glycosaminoglycans in tubular


epithelial cells: Calcium oxalate and oxalate ions effects

Kidney International (2005) 68, 16301642

Characterization of glycosaminoglycans in tubular


epithelial cells: Calcium oxalate and oxalate ions effects

Kidney International (2005) 68, 16301642

Characterization of glycosaminoglycans in tubular


epithelial cells: Calcium oxalate and oxalate ions effects

Kidney International (2005) 68, 16301642

Characterization of glycosaminoglycans in tubular


epithelial cells: Calcium oxalate and oxalate ions effects

Kidney International (2005) 68, 16301642

Characterization of glycosaminoglycans in tubular


epithelial cells: Calcium oxalate and oxalate ions effects

Kidney International (2005) 68, 16301642

Characterization of glycosaminoglycans in tubular


epithelial cells: Calcium oxalate and oxalate ions effects

Kidney International (2005) 68, 16301642

Characterization of glycosaminoglycans in tubular


epithelial cells: Calcium oxalate and oxalate ions effects

Kidney International (2005) 68, 16301642

Urinary macromolecular inhibition of crystal adhesion to


renal epithelial cells is impaired in male stone formers

Kidney International (2005) 68, 17841792

Urinary macromolecular inhibition of crystal adhesion to


renal epithelial cells is impaired in male stone formers

Kidney International (2005) 68, 17841792

Urinary macromolecular inhibition of crystal adhesion to


renal epithelial cells is impaired in male stone formers

Kidney International (2005) 68, 17841792

Urinary macromolecular inhibition of crystal adhesion to


renal epithelial cells is impaired in male stone formers

Kidney International (2005) 68, 17841792

Direct and indirect costs of nephrolithiasis in an employed


population: Opportunity for disease management?

Prevalence Number of persons with


Full sample
rate
nephrolithiasis
persons
Total 1.12
3600
322,556
Age
180.80
1115
138,647
44
451.25
1311
104,549
54
551.48
1174
79,360
64
Gender
Kidney International (2005) 68, 18081814

ersons
without
nephrolithiaisis
(N of
= 318,956)
Total Persons
nephrolithiais
Direct
and
indirect costs
nephrolithiasis
in anwith
employed
Total
Medical
R
population: Opportunity for disease management?
3,038
$6,532
$5,381
$1

2,809
3,278
3,123

$6,114
$7,093
$6,525

$5,086
$5,777
$5,375

$1
$1
$1

2,808
3,331

$6,302
$6,825

$5,227
$5,578

$1
$1

2,948
2,962
3,152

$6,442
$6,456
$6,647

$5,367
$5,369
$5,402

$1
$1
$1

2,978

Kidney International (2005) 68, 18081814

$6,472

$5,351

$1

ersons
without
nephrolithiaisis
(N of
= 318,956)
Total Persons
nephrolithiais
Direct
and
indirect costs
nephrolithiasis
in anwith
employed
Total
Medical
R
population: Opportunity for disease management?
3,038
$6,532
$5,381
$1

2,809
3,278
3,123

$6,114
$7,093
$6,525

$5,086
$5,777
$5,375

$1
$1
$1

2,808
3,331

$6,302
$6,825

$5,227
$5,578

$1
$1

2,948
2,962
3,152

$6,442
$6,456
$6,647

$5,367
$5,369
$5,402

$1
$1
$1

2,978

Kidney International (2005) 68, 18081814

$6,472

$5,351

$1

Direct and indirect costs of nephrolithiasis in an employed


population: Opportunity for disease management?

0 individuals with nephrolithiasis Average expenditure per procedure


6,209)
$1,947
$3,624
$2,916
3,933)
$2,295
930)
$1,425

Mean nu
1.26
1.00
1.22
1.12

Kidney International (2005) 68, 18081814

Direct and indirect costs of nephrolithiasis in an employed


population: Opportunity for disease management?

Number of personsa

upper tract 834

Average work absenc


% Missing work Inpatient
Outpatient

30.0%

4.4 (2.5-6.3) 14.6 (11.5-17.7)

Kidney International (2005) 68, 18081814

Direct and indirect costs of nephrolithiasis in an employed


population: Opportunity for disease management?

Inpatient care
Ou
r of hospitalizationsa Average work absence (hours) Number of outpatient vis

47.9 (30.9-64.9)

2,373

Kidney International (2005) 68, 18081814

Direct and indirect costs of nephrolithiasis in an employed


population: Opportunity for disease management?

Inpatient care
Ou
r of hospitalizationsa Average work absence (hours) Number of outpatient vis

47.9 (30.9-64.9)

2,373

Kidney International (2005) 68, 18081814

Diabetes mellitus and the risk of


nephrolithiasis
Diabetes +

Diabetes -

P value

NHS I
Number %
Age years b

1473 (1.9%)
48.6

74,266 (98.1%)
46.3

<0.001

BMI kg/m2 b
Current thiazide use
Kidney stone history

28.1
329 (22.3%)
64 (4.3%)

24.3
7382 (9.9%)
2029 (2.7%)

<0.001
<0.001
<0.001

NHS II
Number %
Age years b

949 (1.0%)
37.6

94,485 (99.0%)
36.1

<0.001

2b

Kidney International (2005) 68, 12301235

Diabetes mellitus and the risk of


nephrolithiasis
Age-adjusted RR Multivariate RRb
NHS I

Diabetes
Diabetes +
NHS II
Diabetes
Diabetes +
HPFS
Diabetes
Diabetes +

1.00 (reference)
1.55 (1.20, 1.99)

1.00 (reference)
1.38 (1.06, 1.79)

1.00 (reference)

1.00 (reference)

1.84 (1.41, 2.41)

1.67 (1.28, 2.20)

1.00 (reference)

1.00 (reference)

1.21 (1.03, 1.42)

1.31 (1.11, 1.54)

Kidney International (2005) 68, 12301235

Diabetes mellitus and the risk of


nephrolithiasis
Person- years Kidney stones Age-adjusted RR Multivariate RRb
NHS I

Diabetes 1,371,080
Diabetes + 65,566

1578
109

Diabetes 824,076

1491

Diabetes + 12,291

40

Diabetes 450,984

1426

Diabetes + 21,676

44

1.00 (reference)
1.45 (1.20, 1.77)
NHS II
1.00 (reference)
1.86 (1.36, 2.56)
HPFS
1.00 (reference)
0.76 (0.56, 1.03)

1.00 (reference)
1.29 (1.05, 1.58)
1.00 (reference)
1.60 (1.16, 2.21)
1.00 (reference)

0.81 (0.59, 1.09)

Kidney International (2005) 68, 12301235

Diabetes mellitus and the risk of


nephrolithiasis
Person- years Diabetes Age-adjusted RR Multivariate RRb
NHS I

Stones
Stones +
NHS II
Stones
Stones +
HPFS
Stones
Stones +

1,522,293
64,590

4005
295

1.00 (reference)
1.65 (1.47, 1.86)

1.00 (reference)
1.33 (1.18, 1.50)

988,262

712

1.00 (reference)

1.00 (reference)

44,290

73

2.26 (1.78, 2.88)

1.48 (1.14, 1.91)

399,935

1157

1.00 (reference)

1.00 (reference)

44,373

218

1.54 (1.33, 1.78)

1.49 (1.29, 1.72)

Kidney International (2005) 68, 12301235

ry sodium mmol/24h

130

5.3

146

5.7

189

7.7c

155

Urinary
calcium
a determinant
bone
mineral
density
ry NTx nmol
BCE/mmol
Cris 50
5.3 (45) 45of 3.0
(53)
46 2.2
(48) in47

3.

2.1

elderly men participating


the InCHIANTI
cular vBMD z-score
0.19 0.103 in0.00
0.095 -0.18 study
0.098d
al vBMD z-score
0.02 0.112 -0.01 0.089 -0.02 0.097
y calories kcal/24h
2254 50.1 2421 64.2 2441 61.3

0.00 0
0.00 0
2372 3

um intake mmol/24h
n g/1000 kcal
g/1000 kcal
hydrate g/1000 kcal

22.0 0.70
37.8 0.46
32.1 0.49
132.2 1.67

22.1 0.85
37.0 0.44
32.5 0.55
126.8 1.64

21.1 0.8
38.0 0.47
32.8 0.53
127.1 1.62

22.5 0
37.6 0
32.5 0
128.7

ears

98
72

98
66

97
60

293
66 0.9

kg/m2
a calcium mmol/L
a PTH pg/mL

26.5
2.36
26.4

n
1.4

0.44 26.7
0.009 2.35
1.29 22.9

1.7

1.6e

0.39
27.6 0.47
26.9 0
0.008 2.37 0.008
2.36 0
f
1.10
21.9 1.11
23.8 0
Kidney International
(2005) 67, 20062014

Urinary calcium is a determinant of bone mineral density in


Urinary
tertiles
elderly men participating
incalcium
the InCHIANTI
study

e years

MI kg/m2
sma calcium mmol/L
sma PTH pg/mL

rum 25(OH)D nmol/L


rum IL-6 pg/mL
rum IL-6R ng/mL
rum IL-1 pg/mL
rum IL-1 ra pg/mL
inary calcium mmol/24h

Tertile 1
80
76 0.9

Tertile 2
74
73 0.6b

26.6
2.31
23.5

27.3
2.34
22.5

0.22
0.009
1.28

55.5 3.55
1.56 0.072
127 6.1
50 6.3 (35)
0.22 0.120
-0.03 0.135

Tertile 3
65
71 0.6a

0.35 27.4
0.010 2.37
1.11 19.4

56.3 3.37
3.36 0.058
147 6.8
46 3.5 (37)
-0.0 0.117
0.01 0.104

0.40
0.009c
1.0d

66.9 3.71
6.13 0.257
186 10.2e
48 2.8 (33)
-0.29 0.127f
-0.12 0.130

All tertiles
219
74 0.4
27.1
2.34
22.0

0.22
0.006
0.68

59.1 2.07
3.52 0.150
151 4.7
48 2.6 (10
-0.01 0.07
-0.01 0.07

Kidney International (2005) 67, 20062014

Urinary calcium is a determinant of bone mineral density in


elderly men participating in the InCHIANTI study
Variable
Men

R 2 change R 2 change P B

Creatinine clearance
Urinary sodium
Plasma calcium
Trabecular BMD z-score
Logarithm of plasma 25(OH)D
Women
Urinary sodium
Creatinine clearance

0.111
0.043
0.029
0.025
0.013

0.001
0.001
0.002
0.003
0.035

0.017
0.006
0.984
-0.352
1.131

0.0001
0.001
0.003
0.004
0.035

0.199

0.001

0.014 0.0001

0.031

0.001

0.013 0.001

Kidney International (2005) 67, 20062014

Urinary calcium is a determinant of bone mineral density in


elderly men participating in the InCHIANTI study

Kidney International (2005) 67, 20062014

Urinary calcium is a determinant of bone mineral density in


elderly men participating in the InCHIANTI study

Kidney International (2005) 67, 20062014

s, daily intake
fruits
vegetables on
Dieturinary
without fruits
The effectDiet
of with
fruits
andand
vegetables
stoneand vege

lly skimmed milk


ary bread
m wheat pasta

100 g
200 g
80 g

meat or fish
arella or soft cheese
esan cheese
salt

100 g
100 g
10 g
10 g
20 g
50 g
0
100 g
400 g
300 g

oil
arose

e juice
mixed fruita
mixed vegetablesb

risk factors

100 g
200 g
100 g

100 g
100 g
30 g
10 g
20 g
45 g
40 g
0
0
0
Kidney International (2004) 66, 24022410

ients, daily intake Diet with fruits and vegetables Diet without fruits and veget

The effect of fruits and vegetables on urinary stone


ries kcal
2156
2156
risk factors 80
in g
80

ohydrates g

99
252

99
252

um mmol
ride mmol
sium mmol

216
250
81

218
254
30

um mmol
phorus mmol
nesium mmol
ate mmol
g
r from foods g
cid load mmol a

22.7
40.0
10.2
3.72
21
1006
47.6

23.4
38.5
7.1
0.20
10
305
Kidney
76.7International (2004) 66, 24022410

The effect of fruits and vegetables on urinary stone


risk factors
Freshly squeezed orange juice (recommended daily dose 100 g)
Fresh mixed fruit (recommended daily dose 400 g)
Choice of: oranges, pineapple, apples, pears, avocado, mango, bananas, apricots,
persimmon, plums, kiwi, melons, watermelon
Fresh mixed vegetables (recommended daily dose 300 g)
Choice of: asparagus, broccoli, cauliflower, cucumber, lettuce, onions, radishes,
turnip, artichokes, fennel, radicchio, peppers, courgettes, tomatoes, carrots

Kidney International (2004) 66, 24022410

37.6 (11.0)

16.4 (5.9)

ol/day

23.4 (5.5)
16.5 (7.5)

20.2 (6.7)
16.4 (8.5)

ol/day

4.01 (0.75)
2.83 (1.32)
203 (32)

2.95 (0.60)
2.40 (1.26)
221 (56)

ay

ay

day

ay

The effect of fruits and vegetables on urinary stone


4.87 (2.90)
7.28 (3.32)
risk factors
3.61 (2.52)
6.34 (4.41)

137 (41)
2.71 (0.64)
1.86 (0.61)
2.70 (1.05)
1.93 (1.23)
0.35 (0.07)
0.24 (0.08)

167 (47)
2.66 (0.56)
2.13 (0.93)
1.52 (0.80)
1.30 (1.07)
0.24 (0.06)
Kidney
International
0.20
(0.11) (2004) 66, 24022410

28.7 (11.2)

27.9 (10.8)

ol/day

20.2 (6.8)
18.4 (7.6)

21.8 (7.4)
11.7 (5.0)

ol/day

2.73 (0.93)
2.60 (1.43)
163 (55)

3.35 (0.89)
1.75 (0.55)
170 (59)

ay

ay

day

ay

The effect of fruits and vegetables on urinary stone


5.17 (2.71)
5.53 (2.60)
risk factors
4.83 (2.67)
2.89 (1.29)

153 (75)
2.92 (0.85)
2.75 (1.23)
1.17 (0.30)
1.10 (0.49)
0.34 (0.17)
0.31 (0.17)

89 (29)
3.22 (1.16)
1.67 (0.58)
1.97 (0.64)
1.09 (0.51)
0.33 (0.17)
Kidney International
(2004) 66, 24022410
0.17 (0.08)

The effect of fruits and vegetables on urinary stone


risk factors

Kidney International (2004) 66, 24022410

The effect of fruits and vegetables on urinary stone


risk factors

Kidney International (2004) 66, 24022410

The effect of fruits and vegetables on urinary stone


risk factors

Kidney International (2004) 66, 24022410

The effect of fruits and vegetables on urinary stone


risk factors

Kidney International (2004) 66, 24022410

The effect of fruits and vegetables on urinary stone


risk factors

Kidney International (2004) 66, 24022410

The effect of fruits and vegetables on urinary stone


risk factors

Kidney International (2004) 66, 24022410

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