Document Detail


Profile of the brushite stone former.
MedLine Citation:
PMID:  20719342     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The incidence of brushite stones has increased during the last 3 decades and we report our experience with brushite stone formers.
MATERIALS AND METHODS: From 1996 to 2008 we identified 82 patients with brushite urinary calculi. After institutional review board approval a review of our prospectively collected database was performed.
RESULTS: There were 54 (65.9%) male and 28 (34.1%) female stone formers. Mean age was 44 years (range 4 to 84). Prior stone events were reported by 69 (84.1%) patients with 54 (78.3%) having received shock wave lithotripsy. Bilateral calculi were present in 28 (34.1%) patients. Mean stone area was 29.2 mm(2) (range 2 to 130). Surgery was performed in 80 patients including 63 (76.8%) percutaneous nephrolithotomy, 8 (9.8%) ureteroscopy, 3 (3.7%) shock wave lithotripsy, and 6 (7.3%) ureteroscopy and percutaneous nephrolithotomy. After primary and secondary procedures 76 (92.7%) patients were rendered stone-free. Metabolic urine studies were available in 45 patients. All patients demonstrated 1 or more abnormalities, with hypercalciuria (greater than 250 mg daily for women and greater than 275 mg daily for men) in 38 (80.9%), urine pH greater than 6.2 in 29 (61.7%), urine volume less than 2 l in 27 (57.4%), hypocitraturia (less than 320 mg daily) in 22 (46.8%), hyperuricosuria (greater than 750 mg daily in women, greater than 800 mg daily in men) in 8 (17%) and hyperoxaluria (greater than 32 mg daily in women and greater than 43 mg daily in men) in 5 (10.6%). Recurrent stone events occurred in 31 (37.8%) patients at a mean of 33 (range 2 to 118) months from treatment.
CONCLUSIONS: Brushite stone formers are a treatment challenge. Almost a third will present with bilateral stones and the stone burden is sizeable. Nearly 80% of patients report having prior shock wave lithotripsy and recurrent stone events occurred approximately 3 years after treatment. All patients with brushite stones in this cohort had an underlying metabolic abnormality and specifically brushite stones should be heralded as a marker for hypercalciuria. Based on these data we recommend all brushite stone formers undergo 24-hour urine studies and have close long-term followup.
Authors:
Amy E Krambeck; Shelly E Handa; Andrew P Evan; James E Lingeman
Publication Detail:
Type:  Journal Article     Date:  2010-08-17
Journal Detail:
Title:  The Journal of urology     Volume:  184     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-13     Completed Date:  2010-10-04     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1367-71     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana 46202, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Calcium Phosphates* / analysis
Child
Child, Preschool
Female
Humans
Kidney Calculi* / chemistry,  diagnosis,  surgery
Male
Middle Aged
Prospective Studies
Ureteral Calculi* / chemistry,  diagnosis,  surgery
Young Adult
Grant Support
ID/Acronym/Agency:
P01 DK056788/DK/NIDDK NIH HHS; P01 DK056788-10/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Calcium Phosphates; 14567-92-1/brushite
Comments/Corrections

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