Analysis of urine composition from split 24-h samples: use of 12-h overnight samples to evaluate risk factors for calcium stones in healthy and stone-forming children.

INTRODUCTION: The analysis of 24-h urine is the gold standard to diagnose metabolic abnormalities in the stone-forming patient. However, urinary composition changes throughout the day and analyzing the whole 24-h urine may mask peaks of increased risk of crystallization. OBJECTIVE: To examine variations of stone-promoting and stone-inhibiting factors in urine using split 24-h samples from healthy and stone-forming children. STUDY DESIGN: Urine was collected from 87 healthy and 26 stone-forming children using a split collection procedure (12-h daytime urine and 12-h overnight urine). Urine volume, pH, calcium (Ca), magnesium (Mg), phosphate (P), citrate (Cit), uric acid (Ur), and oxalate (Ox) were determined, and the Ca/Cit ratio was calculated. RESULTS: The overnight urine samples in both groups had higher levels of P and Mg, lower volume, lower pH, and less citrate and uric acid. As can be seen in the table, higher percentages of healthy and stone-forming children had altered 12-h night urine than 24-h urine with regards to Ca/Cr, Cit/Cr and Ca/Cit ratios. All healthy subjects and all stone-forming children (except one) with altered Cit/Cr ratios or Ca/Cit ratios in the 24-h sample also had altered ratios in the 12-h overnight sample. DISCUSSION: This study indicates that urine composition changes throughout the day, and that there is daily variability in most of the parameters related to kidney stone formation. Furthermore, 12-h overnight samples seem to be more sensitive than 24-h samples in detecting the most common urinary abnormalities. The main limitation of this study is the relative low sample size of stone-forming children, owing to the low prevalence of nephrolithiasis in childhood. CONCLUSIONS: We observed a higher excretion of stone-promoting substances and a lower citrate in urine at night. However, the study results do not provide enough evidence to conclude that the use of a 12-h overnight sample collection can replace 24 h urine analysis in the metabolic evaluation of children with lithiasis.

Effect of sample time on urinary lithogenic risk indexes in healthy and stone-forming adults and children.

BACKGROUND: The diagnosis and follow-up of stone forming patients is usually performed by analysis of 24-h urine samples. However, crystallization risk varies throughout the day, being higher at night. The main objective of this study is to evaluate the urinary crystallization risk in adults and children by calculating risk indexes based on different collection periods. METHODS: The study included 149 adults (82 healthy and 67 stone-formers) and 108 children (87 healthy and 21 stone-formers). 24-h urine was collected, divided into 12-h daytime sample (8 am to 8 pm), and 12-h overnight sample (8 pm to 8 am next morning). Solute concentrations, the calcium to citrate ratio (Ca/Cit), and the ion activity product of calcium oxalate (AP[CaOx]) and calcium phosphate (AP[CaP]) were calculated in each 12-h sample and in overall 24-h urine. Assessments were also related to stone type. RESULTS: Ca/Cit and AP(CaOx) were significantly higher in stone forming patients than in healthy subjects. The 12-h overnight samples had the highest values for both risk indexes, confirming a greater risk for crystallization at night. The AP(CaP) index was significantly higher in patients with pure hydroxyapatite stones than healthy controls, but was not significantly different between stone-formers overall and healthy controls. CONCLUSIONS: The calculation of risk indexes is a simple method that clinicians can use to estimate crystallization risk. For this purpose, the use of 12-h overnight urine may be a reliable alternative to 24-h collections.

HPLC method for urinary theobromine determination: Effect of consumption of cocoa products on theobromine urinary excretion in children.

OBJECTIVE: To validate a simple method of urinary theobromine determination, to assess urinary theobromine levels in 80 healthy children and to relate these levels to consumption of cocoa products. DESIGN AND METHODS: Urine samples were diluted, directly injected into an HPLC system, separated by gradient elution on a C18 column, and detected by UV spectrometry. The method was validated for linearity, limits of detection and quantification, imprecision, accuracy, recovery and interferences. The proposed method was used to assess 12-h day and 12-h night urinary theobromine excretion by 80 healthy children, divided into four groups based on consumption of cocoa products. In addition, urinary excretion of magnesium and oxalate, also present in cocoa, was measured in these four groups. RESULTS: The method was linear to a theobromine concentration of 278µmol/L (50mg/L). LOD and LOQ for urine samples, diluted 1:5 (vol/vol) with water, were 1.1 and 3.6µmol/L respectively. Within-run and between-run imprecisions (CV) were each <2%. Average recovery was 99%, and analysis of a certified reference sample showed an error <2.5%. Theobromine excretion levels were significantly higher in healthy children with higher consumption of cocoa products (p<0.001), but oxalate (p=0.098) and magnesium (p=0.068) excretion levels did not differ significantly. CONCLUSION: This validated method resulted in urinary theobromine determination with 100% recovery, without sample pretreatment. Urinary theobromine levels in healthy children were directly related to their consumption of cocoa products.

Factors Associated With the Lower Prevalence of Nephrolithiasis in Children Compared With Adults.

OBJECTIVE: To determine the reasons behind the lower prevalence of kidney stones in children by assessing urinary lithogenic parameters in healthy children, healthy adults, and 3 groups of stone-former patients. METHODS: The study subjects included 75 healthy adults, 105 healthy children, 62 patients with previous calcium oxalate monohydrate papillary stones, 120 patients with previous calcium oxalate monohydrate unattached stones, and 248 patients with previous calcium oxalate dihydrate stones. Twenty-four-hour urine samples were collected, and the urinary lithogenic parameters were measured. RESULTS: Calcium, magnesium, and phosphorous concentration differed significantly between healthy children and adults. Except citrate, all solute/creatinine ratios differed between healthy children and adults. However, these differences were much more important in the cases of calcium and magnesium. The calcium/creatinine ratio was 2-fold lower, whereas the magnesium/creatinine ratio was 2-fold higher, in healthy children than that in healthy adults (P <.001 each). The calcium/creatinine ratio was higher and the citrate/creatinine ratio lower in calcium oxalate dihydrate stone formers than that in healthy adults. CONCLUSION: Ratios of calcium and magnesium to creatinine, as well as morphoanatomic factors and lifestyle habits, may explain the lower prevalence of nephrolithiasis in children than those in adults.

Urinary phytate (Myo-inositol hexaphosphate) in healthy school children and risk of nephrolithiasis.

OBJECTIVE: Although the incidence of urolithiasis is lower in children than in adults, the number of children with urolithiasis is increasing. Phytate, a naturally occurring compound present in legumes, nuts, and whole meals, has antilithiasic activity. The aim of this study was to assess, for the first time, the urinary levels of phytate in children and to correlate these levels with other urinary parameters related to crystallization risk and to general dietary habits. DESIGN AND METHODS: This was a cohort study conducted from April 2012 to March 2013 in the Laboratory of Investigation in Renal Lithiasis and at Son Espases Universitary Hospital in Palma de Majorca, Spain. SUBJECTS: Subjects included 165 healthy schoolchildren aged 5 to 12 years. INTERVENTION: All subjects followed their habitual diet. Information on the main dietary habits of the study subjects was obtained by asking each child's parents to fill out a dietary questionnaire. MAIN OUTCOME MEASURE: Phytate and citrate concentration and excretion were measured in 2 urine samples (a spot sample and a 12-hour overnight sample) for each child. Furthermore, common urinary biochemical indicators of stone risk were measured in each sample. RESULTS: The urinary phytate concentrations were low in this child population because of low consumption of dietary phytate. The urinary concentrations of phytate and citrate were low in 27.5% of these children. CONCLUSION: Because both substances are important inhibitors of crystallization, these finding suggests that these children are at risk of crystallization. Moreover, their diets consisted of foods rich in animal protein, with insufficient consumption of vegetables, legumes, and fruits.

Urinary excretion of calcium, magnesium, phosphate, citrate, oxalate, and uric acid by healthy schoolchildren using a 12-h collection protocol.

BACKGROUND: Improving knowledge about normal urine composition in children is important for early prevention of lithiasis. We describe urinary excretion values of calcium (Ca), magnesium (Mg), phosphate (P), citrate (Cit), uric acid (Ur), and oxalate (Ox) in healthy children with and without a family history of lithiasis, using a 12-h urine collection protocol. METHODS: Urine samples were obtained from 184 children (5-12 years): a spot sample collected in the afternoon, and a 12-h overnight sample. Solute/creatinine (Cr) and 12-h solute excretion was calculated. RESULTS: Urinary excretion values of the studied solutes are presented as percentile values, separately for each type of sample. Due to age-related differences in the solute/creatinine ratios, except for Ca and Cit, results are described according to the child's age. The presence of excretion values related to an increased risk of lithiasis was more common in children with a family history. CONCLUSIONS: We report data from urine samples collected by using a simplified collection protocol. The observed differences between children with and without a family history of lithiasis could justify that in population studies aimed at setting reference values, the former are excluded.

Risk factors for urinary stones in healthy schoolchildren with and without a family history of nephrolithiasis.

BACKGROUND: The prevalence of lithiasis is increasing at all ages. This study aimed to assess the crystallization risk in urine from healthy school children and to determine urinary parameters that are most associated with it. METHODS: Urine samples were obtained from 184 children aged 5-12 years: a spot sample collected in the afternoon, and a 12-h overnight sample. Information was obtained regarding family histories of lithiasis. Urine volume, pH, and biochemical parameters of stone risk were measured. Crystallization risk was defined by the presence of specific urine conditions that had previously been associated with stone formation in vitro. RESULTS: Crystallization risk was observed in 15 % of spot urine samples and 54 % of 12-h samples. Metabolic abnormalities and a low urinary volume were more frequently detected in children with crystallization risk. Calcium excretion and calcium/citrate ratio were higher in children with a family history of lithiasis. CONCLUSIONS: We observed a high prevalence of crystallization risk in urine, especially in children with a family history of the disease. Low urinary volume was the factor most associated with increased risk. Adequate fluid intake at an early age may be a simple and effective measure to reduce the incidence of nephrolithiasis.

Sinus graft with safescraper: 5-year results.

PURPOSE: In the procedure of sinus floor elevation, autogenous bone, allogenic grafts, and several other bone substitutes are used. However, autogenous bone is still considered the gold standard. Donor sites for autogenous bone are generally the iliac crest, oral cavity, calvarium bone, and tibia. In this work the experience with the use of a Safescraper device for harvesting of autogenous bone is reported and a decision-making algorithm for grafting in sinus floor elevation procedures is proposed. MATERIALS AND METHODS: Forty sinus augmentation procedures were performed in 34 patients. All sinuses were filled with a mixture of autogenous bone and bovine hydroxyapatite. A Safescraper device was used to harvest autologous bone from the maxillary area. Platelet-rich plasma was used to sustain bone placement. Sixty-five dental implants were placed at 4 months with a flapless procedure. A clinical and radiological 5-year retrospective case series of a cohort is reported. RESULTS: In all cases new bone formation was confirmed radiologically and implant placement was performed successfully. Analysis of samples obtained by biopsy with histology and microcomputed tomography showed the presence of mature bone. Healing problems were observed in only 1 case. CONCLUSIONS: Sinus augmentation with bone grafts obtained from oral cavity with a bone scraper device has the advantage of providing autogenous bone without the need for an extra surgical approach. This procedure yields satisfactory results in bone formation, implant survival, and patient satisfaction. When combined with a flapless approach for implant placement, a decrease in the morbidity of the entire process is achieved.

Primers lliuraments del Banc de Llet de les illes / The first deliveries of the Milk Bank of the islands

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