Biochemical Determinants of Severe Lithogenic Activity in Patients With Idiopathic Calcium Nephrolithiasis

ObjectiveTo analyze the biochemical alterations in plasma and the urine determinants of severe lithogenic activity in patients with idiopathic calcium nephrolithiasis.MethodsWe performed a cross-sectional study of 120 patients divided into 2 groups: group 1, 60 patients without nephrolithiasis; and group 2, 60 patients with severe and/or recurrent calcium nephrolithiasis. In all patients, a study of renal function, calcium metabolism, and bone remodeling markers, and a study of the lithogenic factors were performed in urine after fasting and in 24-hour urine samples.ResultsWe observed greater values for phosphorus in group 1 than in group 2 (P = .03). Also, we found greater values for intact parathyroid hormone (P = .01), osteocalcin (P = .000), and β-crosslaps (P = .000) in group 2 than in group 1. In the 24-hour urine samples, significant differences were found between groups 1 and 2 in calciuria (11.7 vs 17.4 mg/dL; P = .000), citraturia (50.6 vs 33.5 mg/dL; P = .002), calcium/creatinine quotient (0.14 vs 0.20; P = .001), calcium/citrate quotient (0.05 vs 0.13; P = .04), and calcium/creatinine quotient after fasting (0.09 vs 0.16; P = .000).ConclusionWe consider the determinants of severe and/or recurrent calcium lithiasis to be hypercalciuria and hypocitraturia and a calcium/citrate quotient >0.06. As risk markers we can consider phosphatemia <2.9 mg/dL, phosphate/chlorine quotient >35, alkaline phosphatase >80 U/L, intact parathyroid hormone >60 pg/mL, osteocalcin >16 ng/mL, β-crosslaps >0.400 ng/mL, and β-crosslaps/osteocalcin quotient >0.028.