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Previous issue date: 2010-10-08 === Lithiasis is considered a public health issue due to its high
prevalence and rates of recurrence.
Objective: To identify risk factors for lithiasis in kidney stone patients from
Fortaleza, Brazil.
In the first stage of the study, the medical records of
197 patients with urinary lithiasis covering the period 1996 2006 were analyzed
with regard to clinical and metabolic data. In the second stage, 340 kidney
stones were submitted to morphological examination under 10x magnification.
According to the external morphology and the cut surface, the stones were
classified as pure or mixed, and major and minor components were identified.
In addition, the stone fragments of 25 patients treated with
lithotripsy were submitted to morphological analysis. In the third stage, a
subsample of 50 stones was used in a double-blind comparison of
morphological and chemical findings. Results were expressed as concordant,
partly concordant (discordant for minor components) or discordant (discordant
for major components).
The average age of first symptoms was 35.8?13.3 years, with no
significant difference between the genders. The male/female ratio was 1:1.7.
Recurrence was reported in 53.3% of cases. The main metabolic changes
observed were hypernatriuria (80.7%), hypercalciuria (48.7%), low urine volume
(43.7%), hyperoxaluria (30.5%) and hyperuricosuria (17.3%). Pure stones
represented 34.7% of the total sample of 340 stones. The most common route
of elimination was spontaneous for pure stones (49.1%) and surgical for mixed
stones (50.5%). Pure stones consisted most frequently of calcium oxalate
(OxCa) (59.3%) and uric acid (UA) (23.7%), the former prevalent in women, the
latter prevalent in men. The most frequently observed component in mixed
stones was OxCa (67.1%), followed by carbapatite (11.2%) and struvite (7.9%).
The main components were OxCa and UA for men, and carbapatite and struvite
for women. Nearly half (48%) the 25 analyzed fragments were pure, consisting
of calcium oxalate dihydrate (COD) (56%), calcium oxalate monohydrate (COM)
(48%), phosphate (32%) and UA (20%). Four patients (16%) had infectious
stones. In the chemical analysis of the subsample of 50 stones, the most
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frequently observed major components were calcium (70%), oxalate (66%),
ammonium (56%), urate (28%) and carbonate (24%). In the morphological
analysis, the main components were calcium and magnesium phosphate (32%),
COM (24%), UA (20%), COD (18%) and cystine (6%). Morphological and
chemical findings were totally concordant for 38% of the stones, partly
concordant in 52% and discordant in 10%.
Conclusion: The risk factors for lithiasis in kidney stone patients from Fortaleza
(Brazil) were hyperoxaluria, hypercalciuria with or without hypernatriuria,
hyperuricosuria and low urine volume === A lit?ase urin?ria ? um problema de sa?de p?blica pela elevada
preval?ncia e recorr?ncia.
Objetivo: O objetivo do presente estudo foi determinar os fatores litog?nicos
em pacientes com lit?ase urin?ria de Fortaleza, Cear?.
O estudo foi dividido em tr?s fases: na primeira, realizouse
estudo documental de prontu?rios de 197 pacientes com lit?ase urin?ria
atendidos entre 1996 e 2006, para a an?lise de dados cl?nicos e avalia??o
metab?lica. Na segunda fase foi realizada uma avalia??o morfol?gica de 340
c?lculos urin?rios, classificando-os como puro ou misto e os componentes em
majorit?rios ou minorit?rios. Foi tamb?m avaliado fragmentos de c?lculos de 25
pacientes tratados com litotripsia. Na terceira fase utilizou-se uma amostra de
50 c?lculos para um estudo duplo-cego comparando a an?lise morfol?gica e a
an?lise qu?mica. Os resultados foram considerados como concordantes,
parcialmente concordantes (componentes minorit?rios discordantes) ou
discordantes (componentes majorit?rios discordantes).
A m?dia de idade dos 197 pacientes no primeiro sintoma foi 35,8
? 13,3 anos, n?o houve diferen?a entre os g?neros. A rela??o homem:mulher
foi de 1:1,7, 53,3% eram recorrentes. As principais altera??es metab?licas
foram hipernatri?ria (80,7%), hipercalci?ria (48,7%), volume urin?rio baixo
(43,7%), hiperoxal?ria (30,5%) e hiperuricos?ria (17,3%). Entre os 340 c?lculos
analisados, 34,7% foram puros. A via de elimina??o mais comum dos c?lculos
puros foi a espont?nea (49,1%) e a dos mistos foi a cir?rgica (50,5%). Os
c?lculos mais freq?entes foram o oxalato de c?lcio (OxCa=59,3%) e ?cido ?rico
(AU=23,7%), sendo o primeiro mais comum nas mulheres e o segundo nos
homens. Entre os c?lculos mistos, o OxCa foi o principal componente (67,1%),
seguido da carbapatita (11,2%) e estruvita (7,9%). Os principais componentes
nos homens foram o OxCa e AU, enquanto que nas mulheres foram a
carbapatita e estruvita. Entre os 25 fragmentos de c?lculos analisados, 48%
foram puros. Os componentes encontrados foram: OxCa dihidratado-COD
(56%), OxCa monohidratado-COM (48%), fosfato (32%), AU (20%). Quatro
pacientes (16%) apresentaram c?lculo de infec??o. Na an?lise qu?mica dos 50
c?lculos urin?rios os principais componentes majorit?rios foram c?lcio (70%),
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oxalato (66%), am?nio (56%), urato (28%) e carbonato (24%), enquanto que na
morfol?gica foram fosfato de c?lcio e magnesiano (32%), COM (24%), AU
(20%), COD (18%) e cistina (6%). Concord?ncia total foi observada em 38%,
parcial em 52% e discord?ncia em 10%.
Conclus?o: Os fatores de risco litog?nicos na regi?o de Fortaleza foram
hiperoxal?ria, hipercalci?ria com ou sem hipernatri?ria, hiperuricos?ria e
volume urin?rio reduzido
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