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Metabolismo calcio fosforo/nefrolitiasi

Differences in 24-h urine profiles and stone composition among stone formers with and without coronary heart disease

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Razionale

Kidney stone disease seems to be associated with increased risk of incident cardiovascular outcomes. The reasons for this association are still unknown. We analyzed differences in 24-h excretory profiles and stone composition among stone formers with and without coronary heart disease (CHD).

Casistica e Metodi

We used data from the UCL Centre for Nephrology’s metabolic stone clinic dataset, including clinical and biochemical information from stone formers attending the clinic from 1995 to 2012. Patients were included if they had available information on the covariates of interest. We divided the sample into two groups according to the presence or absence of a history of CHD (myocardial infarction, angina, coronary revascularization, or surgery for calcified heart valves) and analyzed 24-h urines and stone composition measurements for differences between groups with univariate and multivariate regression models; variables were log-transformed as appropriate.

Risultati

1826 patients had available data for 24-h urine analysis. Among these, 108 (5.9%) had a history of CHD. Those with CHD were older (59±13 vs 46±13 years, p<0.001), whereas the prevalence of males was similar (73 vs 70%, p=0.52). Univariate analyses showed that patients with CHD had significantly lower urinary excretions for citrate (2.4±1.5 vs 2.6±1.4 mmol, p=0.04) and magnesium (3.9±1.3 vs 4.2±1.3 mmol, p=0.03); adjustment for age and sex did not change these findings.

A subgroup of 677 patients had available data for stone composition analysis. The proportion of calcium oxalate, calcium phosphate, and uric acid in analyzed stones was similar for those with and without CHD.

Conclusioni

Stone formers with CHD have lower urinary excretions for citrate and magnesium. Since both citrate and magnesium have been implicated in the pathogenesis of arterial plaque formation, as well protective factors in nephrolithiasis, this may indicate a common mechanism underlying the processes of kidney stone formation and of arterial calcification and plaque formation.

Ferraro PM(1), Moochaala S(2), Robertson WG(2), Gambaro G(1), Unwin RJ(2)
([1]Nephrology, Catholic University of the Sacred Heart, [2]Nephrology, University College London)
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