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Importance of citrate and the calcium : citrate ratio in patients with calcium renal lithiasis and severe lithogenesis.
MedLine Citation:
PMID:  22757744     Owner:  NLM     Status:  Publisher    
Study Type - Prognosis (cohort) Level of Evidence 2a What's known on the subject? and What does the study add? Different studies have shown the importance of citrate in the formation of calcium stones. It has further been shown that the states of metabolic acidosis result in an increase in bone resorption and lower urinary citrate levels. Increasing the intake of citrate in these patients can reduce the lithogenic risk and improve bone mineral density (BMD), contributing to control of both diseases. The study shows the importance of citrate in patients with calcium stones and BMD loss. The deficit in citrate excretion is associated with a decrease in bone mineralization and increased β-crosslaps. A calcium : citrate ratio >0.25 in patients with calcium stones and loss of mineral density may predict severe lithogenic activity. OBJECTIVE: •  To analyse the importance of urinary citrate and the urinary calcium : citrate ratio in patients with calcium renal lithiasis and severe lithogenesis compared with a control group of patients without lithiasis. MATERIAL AND METHODS: •  A cross-sectional study of 115 patients in eastern Andalusia, Spain was conducted. •  The patients were divided into two groups: Group A: 56 patients aged 25-60 years without calcium renal lithiasis; Group B: 59 patients aged 25-60 years, presenting with calcium renal lithiasis and severe lithogenesis. •  The citrate levels and the calcium : citrate ratio in the patients' urine and the relationship of these two factors to lithiasic activity were analysed and compared. RESULTS: •  In Group B, 32.2% of the patients presented with hypocitraturia, compared with 14.3% of the patients in Group A (P= 0.02). •  The urinary citrate levels were lower in Group B than in Group A (P= 0.001) and the calcium : citrate ratio was higher in Group B than in Group A (P= 0.005). •  The results suggest that a patient urinary calcium : citrate ratio > 0.25 indicates severe lithogenesis (with a sensitivity of 89% and a specificity of 57%). •  After linear regression analysis, we found that the urinary citrate level is an independent factor associated with the changes in bone densitometry T-score values of patients. CONCLUSIONS: •  The patients with severe lithogenesis presented with hypocitraturia, which was associated with lower bone mineral density. •  The calcium : citrate ratio, which is linearly related to the bone resorption marker β-crosslaps, could be useful in evaluating the risk of severe lithogenesis when this ratio is >0.25.
Miguel Angel Arrabal-Polo; Miguel Arrabal-Martin; Salvador Arias-Santiago; Juan Garrido-Gomez; Antonio Poyatos-Andujar; Armando Zuluaga-Gomez
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-3
Journal Detail:
Title:  BJU international     Volume:  -     ISSN:  1464-410X     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100886721     Medline TA:  BJU Int     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Department of Urology, San Cecilio University Hospital Department of Medicine, Baza Hospital Department of Medicine, University of Granada Departments of Traumatology Biochemistry, San Cecilio University Hospital, Granada, Spain.
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