Comparison of comprehensive and limited metabolic evaluations in the treatment of patients with recurrent calcium urolithiasis

Purpose: We compared diagnostic information from limited and comprehensive metabolic evaluations of recurrent calcium stone formers. Materials and Methods: A total of 74 men and 45 women with recurrent calciu m stones underwent comprehensive metabolic evaluation. The number of specif ic and total metabolic abnormalities diagnosed on 1 or 2 random 24-hour uri nalyses were compared to those obtained on a comprehensive metabolic evalua tion. We also examined the ability of the comprehensive evaluation to detec t dietary calcium sensitive oxaluria. Results: The comprehensive metabolic evaluation yielded a specific metaboli c diagnosis in 90% of the patients compared to 68% for 1 and 75% for 2 urin alyses. Average total number of specific metabolic abnormalities for each p atient was approximately 50% higher on a comprehensive metabolic evaluation compared to 1 urinalysis (1.59 +/- 0.08 versus 0.94 +/- 0.07, p <0.05). Hy percalciuria, hyperoxaluria and hypocitruria were diagnosed significantly m ore often by the comprehensive than by the limited evaluation. Type II abso rptive hypercalciuria was the most common pattern of hypercalciuria, and di etary calcium sensitive oxaluria was present in 22% of the patients. Conclusions: Comprehensive metabolic evaluation yields significantly more u seful diagnostic information and allows implementation of a more specific t herapeutic plan than limited metabolic evaluation for the recurrent calcium stone former.