Active metabolic lithiasis: A condition that requires proper evaluation and monitoring

Kidney stone evolution is different among patients, with some exhibiting kidney stones once in a lifetime and others experiencing multiple recurrences, with some even presenting with them at short intervals of time. The present study analyzed the risk of recurrence in order to organize a personalized prophylaxis and follow-up for the patients at risk. Prior to the analysis, the patients completed the liquids, antecedents, medication, associated pathologies and aliments questionnaire. A total of 350 patients with kidney stones were consecutively enrolled between April 2019 and April 2022. The spectroscopic analysis of stone samples was performed with the Bruker Alpha II spectrometer, while the stone morphology was assessed using the Olympus SZ61TR stereomicroscope. Intact stones were sectioned and their cores were analyzed separately. Patients with metabolically active lithiasis had stones made of cystine (CYS), uric acid (UA), brushite or calcium oxalate dihydrate. Among patients aged 18-30 years, two morphological factors defining the metabolically active lithiasis were identified: Randall's plaques [odds ratio (OR), 8.8] and poor stone organization (OR, 12.0). In patients aged 31-40 years, one criterion for the diagnosis of metabolically active lithiasis was the identification of pale stone color (OR, 12.0). Among the 149 patients aged >50 years, 24.8% (n=37) had UA lithiasis. Furthermore, the association of the defining elements of the metabolic syndrome significantly increased the likelihood of the lithiasis recurrence (P=0.03; OR, 4.3). The presence of kidney stones in the family history was significantly associated with the type of stone (P=0.004). Among the 7 patients with CYS stones, 71.4% of them had family history of lithiasis. The study findings suggest that the identification of Randall plaques, a light stone color or a low degree of stone organization is associated with increased odds of lithiasis recurrence.