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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (6): 1134-1140. doi: 10.19723/j.issn.1671-167X.2022.06.013

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Diagnostic values of urinary citrate for kidney stones in patients with primary gout

Yu WANG1,Hui-min ZHANG2,Xue-rong DENG1,Wei-wei LIU3,Lu CHEN4,Ning ZHAO5,Xiao-hui ZHANG1,Zhi-bo SONG1,Yan GENG1,Lan-lan JI1,Yu WANG2,Zhuo-li ZHANG1,*()   

  1. 1. Department of Rheumatology and Immunology, Peking University First Hospital, Beijing 100034, China
    2. Department of Nephrology, Peking University First Hospital, Beijing 100034, China
    3. Department of Internal General Medicine, Zhongjie Hospital, Cangzhou 061108, Hebei, China
    4. Department of Traditional Chinese Medicine, Aviation General Hospital of China Medical University, Beijing 100012, China
    5. Department of Acupuncture, Huguosi Traditional Chinese Medicine Hospital affiliated to Beijing University of Chinese Medicine, Beijing 100035, China
  • Received:2022-08-10 Online:2022-12-18 Published:2022-12-19
  • Contact: Zhuo-li ZHANG E-mail:zhuoli.zhang@126.com
  • Supported by:
    National Natural Science Foundation of China(81501400);National High Level Hospital Clinical Research Funding(Interdepartmental Clinical Research Project of Peking University First Hospital)(2022CR10)

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Abstract:

Objective: To evaluate the relationship between 24 h urinary ion content and kidney stones, and to explore the diagnostic values of kidney stone in primary gout patients. Methods: Patients diagnosed with primary gout had ultrasound scanning of both feet and kidneys in Peking University First Hospital from Jan. 2020 to May 2021. Their clinical characteristics were compared between the positive and negative kidney stone groups, and the relationship between kidney stone and urinary ion composition were analyzed. Risk factors of kidney stone were analyzed. The explored diagnostic values were evaluated for urinary oxalate and citrate according with uric acid kidney stones by dual-energy computed tomography (DECT). Results: Among the 100 gouty patients, 80 patients had uric acid crystal deposition in lower joints of extremity by ultrasonography, 61 patients had kidney stone, and 34 had kidney uric acid stones by DECT. All the multiple kidney stones were proved as uric acid kidney stones by DECT. Compared with patients without kidney stone group proved by ultrasonography, patients with kidney stone had longer gouty duration [(48.7±26.6) months vs. (84.0±30.6) months, P=0.01], higher 24 h urinary oxalate [(20.1±9.6) mg vs. (28.6±20.7) mg, P=0.001] and lower 24 h urinary citrate [(506.3±315.4) mg vs. (355.7±219.6) mg, P=0.001]. Compared with the patients without kidney stone by DECT, the patients with uric acid kidney stone also had longer disease duration [(49.1±28.4) months vs. (108.3±72.2) months, P=0.001], higher 24 h urinary oxalate [(23.6±16.9) mg vs. (28.5±18.8) mg, P < 0.05], lower 24 h urinary citrate [(556.0±316.3) mg vs. (391.7±261.2) mg, P < 0.05], higher serum uric acid [(466.2±134.5) μmol/L vs. (517.2±18.1) μmol/L, P < 0.05] and higher 24 h urinary uric acid [(1 518.1±893.4) mg vs. (1 684.2±812.1) mg, P < 0.05]. Logistic regression analysis showed long gout disease duration (OR=1.229, 95%CI: 1.062-1.522, P < 0.05), high serum uric acid level (OR=1.137, 95%CI: 1.001-1.213, P=0.01), low 24 h urinary citrate (OR=0.821, 95%CI: 0.659-0.952, P=0.01) were all risk factors of kidney stones by ultrasonography. Also, long gout disease duration (OR=1.201, 95%CI: 1.101-1.437, P=0.005), high serum creatine uric level (OR=1.145, 95%CI: 1.001-1.182, P=0.04), low 24 h urinary citrate (OR=0.837, 95%CI: 0.739-0.931, P=0.02) were all risk factors of kidney uric acid stones by DECT. Conclusion: Long disease duration and low 24 h urinary citrate were risk factors for kidney stones.

Key words: Gout, Kidney stone, Citrate, Ultrasonography, Dual-energy computed tomography

CLC Number: 

  • R589.7

Table 1

Clinical characteristics of gout patients with and without kidney stone by ultrasonography"

Items Positive kidney stone by US (n=61) Negative kidney stone by US (n=39) P
Age/years 43.5±9.0 42.8±11.0 0.992
Disease duration/months 84.0±30.6 48.7±26.6 0.01
Gout flare frequency/years 4 (1, 10) 1 (1, 2) 0.05
BMI/(kg/m2) 27.8±3.4 27.2±3.3 0.396
Serum uric acid/(μmol/L) 513.1±128.0 480.4±103.4 0.001
Serum creatinine/(μmol/L) 93.7±14.8 83.4±17.7 0.004
eGFR/(mL/min) 87.4±15.1 97.9±16.6 0.002
hsCRP/(mg/L) 13.8±4.2 12.8±3.2 0.601
Glucose/(mmol/L) 2.4±3.0 3.3±2.6 0.301
TG/(mmol/L) 2.1±1.1 3.2±2.5 0.036
TCHO/(mmol/L) 4.5±1.4 4.6±0.9 0.838
LDL-C/(mmol/L) 2.6±0.9 2.5±0.8 0.549
Urinary oxalic acid/(mg/L) 15.0±8.0 8.3±3.6 0.001
Urinary oxalic acid/(mg/24 h) 28.6±20.7 20.1±9.6 0.006
Urinary citrate/(mg/L) 148.0±86.4 279.2±180.9 0.001
Urinary citrate/(mg/24 h) 355.7±219.6 506.3±315.4 0.006
Urinary calcium/(mmol/L) 2.0±1.3 1.4±1.1 0.037
Urinary uric acid/(mmol/24 h) 1 793.4±863.4 1 235.0±765.0 0.001
Urinary P/(mmol/L) 14.8±6.7 10.4±6.9 0.003
Urinary Mg/(mmol/L) 1.9±0.8 1.6±1.1 0.202
Urinary creatine/(mmol/L) 8.6±3.0 6.4±3.9 0.002

Table 2

Clinical characteristics of gout patients with uric acid kidney stone and without kidney stone by dual-energy CT"

Items Positive uric acid kidney stone by DECT (n=34) Negative kidney stone by DECT (n=30) P
Age/years 44.9±7.4 42.4±10.7 0.475
Disease duration/months 108.3±72.2 49.1±28.4 0.001
Gout flare frequency/years 4 (1, 10) 1 (1, 2) 0.05
BMI/(kg/m2) 27.5±3.6 27.6±3.2 0.933
Serum uric acid/(μmol/L) 517.2±108.1 466.2±134.5 0.001
Serum creatinine/(μmol/L) 93.2±14.7 87.9±17.4 0.132
eGFR/(mL/min) 87.0±14.4 93.8±17.0 0.05
hsCRP/(mg/L) 13.4±2.8 10.1±2.5 0.891
Glucose/(mmol/L) 3.4±2.1 2.2±1.7 0.123
TG/(mmol/L) 1.9±0.8 2.6±2.4 0.089
TCHO/(mmol/L) 4.8±0.6 4.4±1.5 0.204
LDL-C/(mmol/L) 2.7±0.6 2.5±0.9 0.535
Urinary oxalic acid/(mg/L) 15.4±7.2 10.9±7.0 0.003
Urinary oxalic acid/(mg/24 h) 28.5±18.8 23.6±16.9 0.02
Urinary citrate/(mg/L) 183.3±126.2 314.9±193.3 0.001
Urinary citrate/(mg/24 h) 391.7±261.2 556.0±316.3 0.007
Urinary calcium/(mmol/L) 1.9±1.4 1.7±1.3 0.502
Urinary uric acid/(mmol/24 h) 1 684.2±812.1 1 518.1±893.4 0.371
Urinary P/(mmol/L) 13.6±6.2 12.8±7.5 0.583
Urinary Mg/(mmol/L) 1.5±0.5 1.9±1.1 0.083
Urinary creatine/(mmol/L) 8.6±3.1 7.3±3.7 0.077

Figure 1

Receiver operating characteristic curve of 24 h urinary oxalate and urinary citrate for diagnosis of uric acid kidney stone in gout patients"

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