Hypocitraturia and urolithiasis risk: Insights from a 24-h urinary metabolic evaluation in South-Asian stone formers

Abstract Background Urolithiasis is a chronic, systemic condition, with a high prevalencet and rising incidence. It leads to a lower quality-of-life for patients affected by it—even though asymptomatic. Lithogenesis is a metabolic process where urinary chemical abnormalities promote stone formation in the urinary tract. As a consequence, there needs to be an assessment of urinary chemicals that may prevent stone formation. The purpose of this study was to observe changes in a 24-h urine collection for metabolites to suggest an intervention to reduce the risk of recurrence in stone formers (SFs). Methods An observational study performed at a tertiary care hospital, with a cohort of 40 stone formers—after 4 weeks of any intervention and when found to be stone-free, were included in this prospective study. All patients underwent a basic metabolic work-up followed by a single 24-h urine collection which was evaluated for metabolites. Patients were categorized based on the risk for stone formation and critically analyzed. Results The mean age was 35 years (range: 9–65). Risk stratification identified 17 (42.5%) as first-time stone formers and 23 (57.5%) as recurrent stone formers. Overall, 27 (67.5%) patients were categorized as high risk for stone formation. 17 (42.5%) had at least one abnormality, the most common (26/40, 65%) being hypocitraturia, with only isolated hypocitraturia in 18 (45%) stone formers. Low urine volume ( r = 0.317, p = 0.046) was significantly co-related with low magnesium and citrate levels ( r = 0.534, p = 0.001). A solitary patient was identified to have gouty diathesis with no abnormality identified in 12 (30%). The mean body mass index (BMI) was 24.3 ± 3.12 kg/m 2 and a higher BMI was significantly associated with high-risk status ( χ 2 (2) = 17.43, p < 0.001) for stone formation. Conclusions Clinicians should consider dietary modifications as the primary intervention for South-Asian patients with urolithiasis based on findings of hypocitraturia in 24-h urine collections. Future studies should validate dietary interventions to reduce stone recurrence and compare outcomes between South-Asian and Western populations.