Comparison of comprehensive and limited metabolic evaluations in the treatment of patients with recurrent calcium urolithiasis.

ABSTRACT

PURPOSE: We compared diagnostic information from limited and comprehensive metabolic evaluations of recurrent calcium stone formers. MATERIALS AND METHODS: A total of 74 men and 45 women with recurrent calcium stones underwent comprehensive metabolic evaluation. The number of specific and total metabolic abnormalities diagnosed on 1 or 2 random 24-hour urinalyses were compared to those obtained on a comprehensive metabolic evaluation. We also examined the ability of the comprehensive evaluation to detect dietary calcium sensitive oxaluria. RESULTS: The comprehensive metabolic evaluation yielded a specific metabolic diagnosis in 90% of the patients compared to 68% for 1 and 75% for 2 urinalyses. Average total number of specific metabolic abnormalities for each patient was approximately 50% higher on a comprehensive metabolic evaluation compared to 1 urinalysis (1.59 +/- 0.08 versus 0.94 +/- 0.07, p <0.05). Hypercalciuria, hyperoxaluria and hypocitruria were diagnosed significantly more often by the comprehensive than by the limited evaluation. Type II absorptive hypercalciuria was the most common pattern of hypercalciuria, and dietary calcium sensitive oxaluria was present in 22% of the patients. CONCLUSIONS: Comprehensive metabolic evaluation yields significantly more useful diagnostic information and allows implementation of a more specific therapeutic plan than limited metabolic evaluation for the recurrent calcium stone former.