Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter November 2, 2017

Reference intervals for stone risk factors in 24-h urine among healthy adults of the Han population in China

  • Zanlin Mai , Xiaoxia Li , Zelin Cui , Wenqi Wu , Yongda Liu , Lili Ou , Yueping Liang , Zhijian Zhao , Yang Liu , Xing Mai , Wei Zhu , Tao Zhang , Chao Cai , Houmeng Yang and Guohua Zeng EMAIL logo

Abstract

Background:

The aim of the study was to establish reference intervals for 24-h urinary stone risk factors in the healthy Chinese Han population.

Methods:

From May 2013 to July 2014, we collected and analyzed 24-h urine samples from healthy adult Han population during a cross-sectional study across China. The protocol for analysis of 24-h urine included volume, pH, oxalate, citrate, sodium, potassium, chloride, calcium, phosphorous, creatinine, urate, magnesium, the ion activity products of calcium oxalate (AP(CaOx) indexs) and calcium phosphate (AP(CaP) indexs). We calculated the reference intervals according to the Clinical and Laboratory Standards Institute (CLSI) 2008 guidelines and compared them with those recorded in other studies.

Results:

A total of 132 male and 123 female healthy subjects with a mean (SD, range) age of 52.4 (15.2, 19–89) years were eligible in the final analysis. Men had higher 24-h excretion of creatinine, calcium, urate and phosphorus and lower levels of citrate, magnesium, chloride, sodium and potassium than women. AP(CaOx) indexs and AP(CaP) indexs were significantly higher among men than women. When urinary findings were compared with the reference intervals, most of our data showed a high abnormality rate, especially for creatinine, calcium, citrate, magnesium, chloride, sodium and potassium.

Conclusions:

The present study revealed the normal metabolic status for stone risk factors of the Chinese Han population. It is therefore necessary for each country or region to define their own reference intervals for comparison of stone risk factors between patients and healthy subjects.


Corresponding author: Guohua Zeng, MD, PhD, Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, 1# Kangda Road, Haizhu District, Guangzhou, Guangdong 510230, P.R. China, Phone: +(86)02-34296202
aZanlin Mai, Xiaoxia Li, Zelin Cui, Wenqi Wu and Yongda Liu contributed equally to this work.

Acknowledgments

We are grateful to Hans-Göran Tiselius, for his help in revising the manuscript.

  1. Author contributions: Zanlin Mai, Xiaoxia Li, Zelin Cui, Wenqi Wu and Yongda Liu have made identical contributions to this study as the co-first authors. Guohua Zeng conceived, designed and organized this study, interpreted the results and revised the manuscript. All authors contributed to collect the data. Zanlin Mai and Xiaoxia Li analyzed the data. Zanlin Mai wrote the first draft of the manuscript. Guohua Zeng and Wenqi Wu obtained funding. Guohua Zeng is the corresponding author. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: This work was financed by grants from National Natural Science Foundation of China (no. 81370804, no. 81570633 and no. 81670643), the Science and Technology Project in Guangdong, China (no. 2014A020209085) and Guangzhou Science Technology and Innovation Commission (no. 201604020001 and no. 201704020193).

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organizations played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Hesse A, Brändle E, Wilbert D, Köhrmann KU, Alken P. Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs.2000. Eur Urol 2003;44:709–13.10.1016/S0302-2838(03)00415-9Search in Google Scholar

2. Scales Jr CD, Smith AC, Hanley JM, Saigal CS. Prevalence of kidney stones in the United States. Eur Urol 2012;62:160–5.10.1016/j.eururo.2012.03.052Search in Google Scholar PubMed PubMed Central

3. Pearle MS, Calhoun EA, Curhan GC. Urologic diseases in America project: urolithiasis. J Urol 2005;173:848–57.10.1097/01.ju.0000152082.14384.d7Search in Google Scholar PubMed

4. Turney BW, Reynard JM, Noble JG, Keoghane SR. Trends in urological stone disease. BJU Int 2012;109:1082–87.10.1111/j.1464-410X.2011.10495.xSearch in Google Scholar PubMed

5. Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 2010;12:e86–96.Search in Google Scholar

6. Zeng G, Mai Z, Xia S, Wang Z, Zhang K, Wang L, et al. Prevalence of kidney stones in China: an ultrasonography based cross-sectional study. BJU Int 2017;120:109–16.10.1111/bju.13828Search in Google Scholar PubMed

7. Uribarri J, Man S, Carroll JH. The first kidney stone. Ann Intern Med 1989;111:1006–9.10.7326/0003-4819-111-12-1006Search in Google Scholar PubMed

8. Coe FL, Parks JH, Asplin JR. The pathogenesis and treatment of kidney stones. N Engl J Med 1992;327:1141–52.10.1056/NEJM199210153271607Search in Google Scholar PubMed

9. Tiselius HG, Larsson L. Biochemical evaluation of patients with urolithiasis. Eur Urol 1981;7:31–4.10.1159/000473168Search in Google Scholar PubMed

10. CLSI. Defining, establishing, and verifying reference intervals in the clinical laboratory; Approved Guideline—Third Edition. CLSI document C28-A3. Wayne, PA: Clinical and Laboratory Standards Institute, 2008.Search in Google Scholar

11. Taylor EN, Stampfer MJ, Curhan GC. Diabetes mellitus and the risk of nephrolithiasis. Kidney Int 2005;68:1230–35.10.1111/j.1523-1755.2005.00516.xSearch in Google Scholar PubMed

12. Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, et al. Guidelines on urolithiasis of EAU. 2015;38–9. Available at: www.uroweb.org.Search in Google Scholar

13. Curcio R, Stettler H, Suter PM, Aksozen JB, Saleh L, Spanaus K, et al. Reference intervals for 24 laboratory parameters determined in 24-hour urine collections. Clin Chem Lab Med 2016;54:105–16.10.1515/cclm-2014-1041Search in Google Scholar PubMed

14. Coe FL, Favus MJ, Crockett T, Strauss AL, Parks JH, Porat A, et al. Effects of low-calcium diet on urine calcium excretion, parathyroid function and serum1,25(OH)2D3 levels in patients with idiopathic hypercalciuria and in normal subjects. Am J Med 1982;72:25–32.10.1016/0002-9343(82)90567-8Search in Google Scholar

15. Ichihara K, Itoh Y, Min WK, Yap SF, Lam CW, Kong XT, et al. Diagnostic and epidemiological implications of regional differences in serum concentrations of proteins observed in six Asian cities. Clin Chem Lab Med 2004;42:800–9.10.1515/CCLM.2004.133Search in Google Scholar

16. Mente A, Honey RJ, Mclaughlin JR, Bull SB, Logan AG. Ethnic differences in relative risk of idiopathic calcium nephrolithiasis in North America. J Urol 2007;178:1992–7.10.1016/j.juro.2007.07.024Search in Google Scholar

17. Zhu W, Mai Z, Qin J, Duan XL, Liu Y, Zhao ZJ, et al. Difference in 24-hour urine composition between diabetic and non-diabetic adults without nephrolithiasis. PLoS One 2016;11:e0150006.10.1371/journal.pone.0150006Search in Google Scholar

18. Tiselius HG. Medical evaluation of nephrolithiasis. Endocrinol Metab Clin North Am 2002;31:1031–50.10.1016/S0889-8529(02)00027-0Search in Google Scholar

19. Dixon W. Processing data for outliers. Biometrics 1953;9:74–89.10.2307/3001634Search in Google Scholar

20. Reed AH, Henry RJ, Mason WB. Influence of statistical method used on the resulting estimate of normal range. Clin Chem 1971;17:275–84.10.1093/clinchem/17.4.275Search in Google Scholar

21. Lin PH, Ginty F, Appel LJ, Aickin M, Bohannon A, Garnero P, et al. The DASH diet and sodium reduction improve markers of bone turnover and calcium metabolism in adults. J Nutr 2003;133:3130–610.1093/jn/133.10.3130Search in Google Scholar PubMed

22. James TP, Rigby N, Leach R. The obesity epidemic, metabolic syndrome and future prevention strategies. Eur J Cardiovasc Prev Rehabil 2004;11:3–8.10.1097/01.hjr.0000114707.27531.48Search in Google Scholar PubMed

23. Wu AH, editor. Tietz clinical guide to laboratory tests, 4th ed. St. Louis, MO: Saunders Elsevier, 2006.Search in Google Scholar

24. Zuckerman JM, Assimos DG. Hypocitraturia: pathophysiology and medical management. Rev Urol 2009;11:134–44.Search in Google Scholar

25. Odvina CV. Comparative value of orange juice versus lemonade in reducing stone-forming risk. Clin J Am Soc Nephrol 2006;1:1269–74.10.2215/CJN.00800306Search in Google Scholar PubMed

26. Meschi T, Maggiore U, Fiaccadori E, Schianchi T, Bosi S, Adorni G, et al. The effect of fruits and vegetables on urinary stone risk factors. Kidney Int 2004;66:2402–10.10.1111/j.1523-1755.2004.66029.xSearch in Google Scholar

27. Sebastian A, Frassetto LA, Morris RC Jr. The acid-base effects of the contemporary Western diet: an evolutionary perspective. In: Alpern RJ, Hebert SC, editors. Seldin and Giebisch’s The Kidney: physiology & pathophysiology, 4th ed. Amsterdam: Elsevier Inc., 2008:1621–44.10.1016/B978-012088488-9.50060-7Search in Google Scholar

28. Mandel EI, Taylor EN, Curhan GC. Dietary and lifestyle factors and medical conditions associated with urinary citrate excretion. Clin J Am Soc Nephrol 2013;8:901–8.10.2215/CJN.07190712Search in Google Scholar

29. Zhai F, Wang H, Du S, He Y, Wang Z, Ge K, et al. Lifespan nutrition and changing socio-economic conditions in China. Asia Pac J Clin Nutr 2007;16 Suppl:S374–82.Search in Google Scholar

30. Jahnen DJ, Ketteler M. Magnesium basics. Clin Kidney J 2012;5:3–i14.10.1093/ndtplus/sfr163Search in Google Scholar

31. Rude RK. Magnesium. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, editors. Modern nutrition in health and disease, 11th ed. Baltimore, MA: Lippincott Williams & ilkins, 2012:159–75.Search in Google Scholar

32. Classen HG, Nowitzki S. The clinical importance of magnesium. 2. The indications for supplementation and therapy. Fortschr Med 1990;10:198–200.Search in Google Scholar

33. Moshfegh A, Goldman J, Ahuja J, Rhodes D, LaComb R. What we eat in America, NHANES 2005–2006: usual nutrient intakes from food and water compared to 1997 Dietary Reference Intakes for Vitamin D, Calcium, Phosphorus, and Magnesium; U.S. Department of Agriculture, Agricultural Research Service: Washington, DC, USA, 2009. Nutrients 2015;7:8218.Search in Google Scholar

34. Shah NC, Shah JG, Li Z, Jiang XC, Altura BT, Altura BM. Short-term magnesium deficiency downregulates telomerase, upregulates neutral sphingomyelinase and induces oxidative DNA damage in cardiovascular tissues: relevance to atherogenesis, cardiovascular diseases and aging. Int J Clin Exp Med 2014;7:497–514.Search in Google Scholar

35. Massey LK, Whiting SJ. Dietary salt, urinary calcium, and kidney stone risk. Nutr Rev 1995;53:131–9.10.1111/j.1753-4887.1995.tb01536.xSearch in Google Scholar

36. Massey LK, Whiting SJ. Dietary salt, urinary calcium, and bone loss. J Bone Miner Res 1996;11:731–6.10.1002/jbmr.5650110603Search in Google Scholar

37. Burtis WJ, Gay L, Insogna KL, Ellison A, Broadus AE. Dietary hypercalciuria in patients with calcium oxalate kidney stones. Am J Clin Nutr 1994;60:424–9.10.1093/ajcn/60.3.424Search in Google Scholar

38. Audran M, Legrand E. Hypercalciuria. Joint Bone Spine 2000;67:509–15.10.1016/S1297-319X(00)00207-4Search in Google Scholar

39. Tiselius HG. A simplified estimate of the ion-activity product of calcium phosphate in urine. Eur Urol 1984;10:191–5.10.1159/000463786Search in Google Scholar PubMed

40. Tiselius HG. Estimated levels of supersaturation with calcium phosphate and calcium oxalate in the distal tubule. Urol Res 1997;25:153–9.10.1007/BF01037933Search in Google Scholar PubMed


Supplemental Material:

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2017-0401).


Received: 2017-5-9
Accepted: 2017-9-27
Published Online: 2017-11-2
Published in Print: 2018-3-28

©2018 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 6.2.2023 from https://www.degruyter.com/document/doi/10.1515/cclm-2017-0401/html
Scroll Up Arrow