Clinical implications of abundant calcium phosphate in routinely analyzed kidney stones.
BACKGROUND
To better portray the clinical phenotype of kidney stone patients with high calcium phosphate (CaP) stone abundance, we present here clinical and laboratory findings of large numbers of stone formers (SF) with stone CaP ranging from 0% to 100%. Our purpose was to inform clinicians and highlight areas that seem to deserve further research.


METHODS
We calculated average percent CaP (CaP%) in all stones of 1201 patients, and classified them into CaOx (N= 1011) or CaP (N= 190). Sex differences, stone formation rates, urine stone risk factors, extracorporeal shock wave lithotripsy (ESWL) treatments, and relapse during treatment were quantified in relation to stone CaP content.


RESULTS
CaP% has risen for three decades, especially among women. ESWL rates adjusted for numbers of stones and duration of stone disease were higher in CaP SF (0.6 vs. 1.86 and 0.73 vs. 1.82, CaOx vs. CaP, men and women, respectively, P < 0.001), and especially when stones contained brushite (2.90 vs. 1.02 and 3.11 vs. 1.35, brushite vs. not, males and females, respectively, P < 0.001). Urine pH and CaP supersaturation rose in proportion to CaP% in a dose response manner. Relapse rates of CaP and CaOx SF did not differ, and both did well with medical prevention.


CONCLUSIONS
Stone CaP% has risen for three decades. CaP SF, particularly with brushite stones, receive more ESWL treatments than CaOx SF, not explained by stone number or duration of stone disease. Urine supersaturations explain the high CaP%. High CaP% does not hamper medical stone prevention.
Parks
Joan H
JH
Nephrology Section, Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
Worcester
Elaine M
EM
Coe
Fredric L
FL
Evan
Andrew P
AP
Lingeman
James E
JE
D017677:Age Distribution; D002130:Calcium Phosphates / Q000378:metabolism / Q000652:urine*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007669:Kidney Calculi / Q000453:epidemiology / Q000378:metabolism* / Q000628:therapy; D008096:Lithotripsy; D008297:Male; D012307:Risk Factors; D017678:Sex Distribution
D002130:Calcium Phosphates; C020243:calcium phosphate; C494366:calcium phosphate, dibasic, dihydrate