Do Urinary Cystine Parameters Predict Clinical Stone Activity?

Justin I. Friedlander, Jodi A. Antonelli, Noah Canvasser, Monica S.C. Morgan, Daniel Mollengarden, Sara Best, Margaret S. Pearle

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose An accurate urinary predictor of stone recurrence would be clinically advantageous for patients with cystinuria. A proprietary assay (Litholink, Chicago, Illinois) measures cystine capacity as a potentially more reliable estimate of stone forming propensity. The recommended capacity level to prevent stone formation, which is greater than 150 mg/l, has not been directly correlated with clinical stone activity. We investigated the relationship between urinary cystine parameters and clinical stone activity. Materials and Methods We prospectively followed 48 patients with cystinuria using 24-hour urine collections and serial imaging, and recorded stone activity. We compared cystine urinary parameters at times of stone activity with those obtained during periods of stone quiescence. We then performed correlation and ROC analysis to evaluate the performance of cystine parameters to predict stone activity. Results During a median followup of 70.6 months (range 2.2 to 274.6) 85 stone events occurred which could be linked to a recent urine collection. Cystine capacity was significantly greater for quiescent urine than for stone event urine (mean ± SD 48 ± 107 vs –38 ± 163 mg/l, p <0.001). Cystine capacity significantly correlated inversely with stone activity (r = –0.29, p <0.001). Capacity also correlated highly negatively with supersaturation (r = –0.88, p <0.001) and concentration (r = –0.87, p <0.001). Using the suggested cutoff of greater than 150 mg/l had only 8.0% sensitivity to predict stone quiescence. Decreasing the cutoff to 90 mg/l or greater improved sensitivity to 25.2% while maintaining specificity at 90.9%. Conclusions Our results suggest that the target for capacity should be lower than previously advised.

Original languageEnglish (US)
Pages (from-to)495-499
Number of pages5
JournalJournal of Urology
Volume199
Issue number2
DOIs
StatePublished - Feb 1 2018
Externally publishedYes

Fingerprint

Cystine
Cystinuria
Urine Specimen Collection
Urine
Urinary Calculi
ROC Curve
Recurrence

Keywords

  • analysis
  • cystinuria
  • kidney calculi
  • recurrence
  • urine

ASJC Scopus subject areas

  • Urology

Cite this

Friedlander, J. I., Antonelli, J. A., Canvasser, N., Morgan, M. S. C., Mollengarden, D., Best, S., & Pearle, M. S. (2018). Do Urinary Cystine Parameters Predict Clinical Stone Activity? Journal of Urology, 199(2), 495-499. https://doi.org/10.1016/j.juro.2017.09.034

Do Urinary Cystine Parameters Predict Clinical Stone Activity? / Friedlander, Justin I.; Antonelli, Jodi A.; Canvasser, Noah; Morgan, Monica S.C.; Mollengarden, Daniel; Best, Sara; Pearle, Margaret S.

In: Journal of Urology, Vol. 199, No. 2, 01.02.2018, p. 495-499.

Research output: Contribution to journalArticle

Friedlander, JI, Antonelli, JA, Canvasser, N, Morgan, MSC, Mollengarden, D, Best, S & Pearle, MS 2018, 'Do Urinary Cystine Parameters Predict Clinical Stone Activity?', Journal of Urology, vol. 199, no. 2, pp. 495-499. https://doi.org/10.1016/j.juro.2017.09.034
Friedlander JI, Antonelli JA, Canvasser N, Morgan MSC, Mollengarden D, Best S et al. Do Urinary Cystine Parameters Predict Clinical Stone Activity? Journal of Urology. 2018 Feb 1;199(2):495-499. https://doi.org/10.1016/j.juro.2017.09.034
Friedlander, Justin I. ; Antonelli, Jodi A. ; Canvasser, Noah ; Morgan, Monica S.C. ; Mollengarden, Daniel ; Best, Sara ; Pearle, Margaret S. / Do Urinary Cystine Parameters Predict Clinical Stone Activity?. In: Journal of Urology. 2018 ; Vol. 199, No. 2. pp. 495-499.
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abstract = "Purpose An accurate urinary predictor of stone recurrence would be clinically advantageous for patients with cystinuria. A proprietary assay (Litholink, Chicago, Illinois) measures cystine capacity as a potentially more reliable estimate of stone forming propensity. The recommended capacity level to prevent stone formation, which is greater than 150 mg/l, has not been directly correlated with clinical stone activity. We investigated the relationship between urinary cystine parameters and clinical stone activity. Materials and Methods We prospectively followed 48 patients with cystinuria using 24-hour urine collections and serial imaging, and recorded stone activity. We compared cystine urinary parameters at times of stone activity with those obtained during periods of stone quiescence. We then performed correlation and ROC analysis to evaluate the performance of cystine parameters to predict stone activity. Results During a median followup of 70.6 months (range 2.2 to 274.6) 85 stone events occurred which could be linked to a recent urine collection. Cystine capacity was significantly greater for quiescent urine than for stone event urine (mean ± SD 48 ± 107 vs –38 ± 163 mg/l, p <0.001). Cystine capacity significantly correlated inversely with stone activity (r = –0.29, p <0.001). Capacity also correlated highly negatively with supersaturation (r = –0.88, p <0.001) and concentration (r = –0.87, p <0.001). Using the suggested cutoff of greater than 150 mg/l had only 8.0{\%} sensitivity to predict stone quiescence. Decreasing the cutoff to 90 mg/l or greater improved sensitivity to 25.2{\%} while maintaining specificity at 90.9{\%}. Conclusions Our results suggest that the target for capacity should be lower than previously advised.",
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N2 - Purpose An accurate urinary predictor of stone recurrence would be clinically advantageous for patients with cystinuria. A proprietary assay (Litholink, Chicago, Illinois) measures cystine capacity as a potentially more reliable estimate of stone forming propensity. The recommended capacity level to prevent stone formation, which is greater than 150 mg/l, has not been directly correlated with clinical stone activity. We investigated the relationship between urinary cystine parameters and clinical stone activity. Materials and Methods We prospectively followed 48 patients with cystinuria using 24-hour urine collections and serial imaging, and recorded stone activity. We compared cystine urinary parameters at times of stone activity with those obtained during periods of stone quiescence. We then performed correlation and ROC analysis to evaluate the performance of cystine parameters to predict stone activity. Results During a median followup of 70.6 months (range 2.2 to 274.6) 85 stone events occurred which could be linked to a recent urine collection. Cystine capacity was significantly greater for quiescent urine than for stone event urine (mean ± SD 48 ± 107 vs –38 ± 163 mg/l, p <0.001). Cystine capacity significantly correlated inversely with stone activity (r = –0.29, p <0.001). Capacity also correlated highly negatively with supersaturation (r = –0.88, p <0.001) and concentration (r = –0.87, p <0.001). Using the suggested cutoff of greater than 150 mg/l had only 8.0% sensitivity to predict stone quiescence. Decreasing the cutoff to 90 mg/l or greater improved sensitivity to 25.2% while maintaining specificity at 90.9%. Conclusions Our results suggest that the target for capacity should be lower than previously advised.

AB - Purpose An accurate urinary predictor of stone recurrence would be clinically advantageous for patients with cystinuria. A proprietary assay (Litholink, Chicago, Illinois) measures cystine capacity as a potentially more reliable estimate of stone forming propensity. The recommended capacity level to prevent stone formation, which is greater than 150 mg/l, has not been directly correlated with clinical stone activity. We investigated the relationship between urinary cystine parameters and clinical stone activity. Materials and Methods We prospectively followed 48 patients with cystinuria using 24-hour urine collections and serial imaging, and recorded stone activity. We compared cystine urinary parameters at times of stone activity with those obtained during periods of stone quiescence. We then performed correlation and ROC analysis to evaluate the performance of cystine parameters to predict stone activity. Results During a median followup of 70.6 months (range 2.2 to 274.6) 85 stone events occurred which could be linked to a recent urine collection. Cystine capacity was significantly greater for quiescent urine than for stone event urine (mean ± SD 48 ± 107 vs –38 ± 163 mg/l, p <0.001). Cystine capacity significantly correlated inversely with stone activity (r = –0.29, p <0.001). Capacity also correlated highly negatively with supersaturation (r = –0.88, p <0.001) and concentration (r = –0.87, p <0.001). Using the suggested cutoff of greater than 150 mg/l had only 8.0% sensitivity to predict stone quiescence. Decreasing the cutoff to 90 mg/l or greater improved sensitivity to 25.2% while maintaining specificity at 90.9%. Conclusions Our results suggest that the target for capacity should be lower than previously advised.

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