（尿渗透压预测） Upper metastable limit osmolality of urine as a predictor of kidney stone formation in children..pdfVIP

Urolithiasis(2019)47:155–163

/10.1007/s00240-018-1041-2

ORIGINALPAPER

Uppermetastablelimitosmolalityof

urineas

a

predictorof

kidney

stoneformationin

children

123114

Tadeusz

Porowski

·Jan

K.

Kirejczyk

·Piotr

Mrozek

·Piotr

Protas

·Agata

Kozerska

·Łukasz

Łabieniec

·

41

Krzysztof

Szymański

·Anna

Wasilewska

Received:2June2017/Accepted:10January2018/Publishedonline:22January2018

©TheAuthor(s)2018.Thisarticleisanopenaccesspublication

Abstract

Highluidintakehasbeenuniversallyrecommendedforkidneystoneprophylaxis.Weevaluated24-hurineosmolality

regardedasthebestbiomarkerofoptimalhydrationanduppermetastablelimitosmolalityafterwaterevaporationfromurine

sampletotheonsetofspontaneouscrystallizationanditsusefulnessasanewriskindexthatwoulddescribeanindividual

lithogenicpotential.Wecollected24-hurinefrom257pediatricpatientswithkidneystonesand270controls.Aftervolume

andosmolalityassessment,theurinesamplesweresubjectedtovolumereductioninvacuumrotavaporcontinuedtothe

onsetofaninducedurinarycrystallization.Theuppermetastablelimitosmolalityofurinesamplewascalculatedbasedon

itsinitialosmolalityvalueandtheamountofwaterreduction.Pediatricstoneformerspresentedwithhigherurinevolume

andlowerurineosmolalitythanhealthycontrols.Despitethat,theirurinesamplesrequiredmuchlowervolumereductionto

inducethespontaneouscrystallizationthanthoseofcontrols.TheROCanalysisrevealedanAUCfortheuppermetastable

limitosmolalityof0.9300(95%CI0.9104–0.9496)fordistinguishingbetweenstoneformersandhealthysubjects.Atthe

cutofof2696

mOsm/kg,thetestprovidedsensitivityandspeciicityof0.8638and0.8189,