Abstract
Objective
To determine the variation in kidney stone composition and its association with risk
factors and recurrence among first-time stone formers in the general population.
Patients and Methods
Medical records were manually reviewed and validated for symptomatic kidney stone
episodes among Olmsted County, Minnesota, residents from January 1, 1984, through
December 31, 2012. Clinical and laboratory characteristics and the risk of symptomatic
recurrence were compared between stone compositions.
Results
There were 2961 validated first-time symptomatic kidney stone formers. Stone composition
analysis was obtained in 1508 (51%) at the first episode. Stone formers were divided
into the following mutually exclusive groups: any brushite (0.9%), any struvite (0.9%),
any uric acid (4.8%), and majority calcium oxalate (76%) or majority hydroxyapatite
(18%). Stone composition varied with clinical characteristics. A multivariable model
had a 69% probability of correctly estimating stone composition but assuming calcium
oxalate monohydrate stone was correct 65% of the time. Symptomatic recurrence at 10
years was approximately 50% for brushite, struvite, and uric acid but approximately
30% for calcium oxalate and hydroxyapatite stones (P<.001). Recurrence was similar across different proportions of calcium oxalate and
hydroxyapatite (P for trend=.10). However, among calcium oxalate stones, 10-year recurrence rate ranged
from 38% for 100% calcium oxalate dihydrate to 26% for 100% calcium oxalate monohydrate
(P for trend=.007).
Conclusion
Calcium stones are more common (93.5% of stone formers) than has been previously reported.
Although clinical and laboratory factors associate with the stone composition, they
are of limited utility for estimating stone composition. Rarer stone compositions
are more likely to recur.
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Article Info
Publication History
Published online: September 06, 2015
Footnotes
Grant Support: This project was supported by grants DK100227 and DK83007 from the National Institute of Diabetes and Digestive and Kidney Diseases (Mayo Clinic O'Brien Urology Research Center) and made possible by the Rochester Epidemiology Project (grant number R01-AG034676; Principal Investigator: Walter A. Rocca, MD, MPH, and Barbara P. Yawn, MD, MSc). The funding source had no role in the study design, conduct, or reporting.
Identification
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© 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
