Table 2.
The metabolic factors involved in secondary UA and calcium stone formation and their effects on urinary risk factors and stone type.
| Metabolic factor | Urinary risk factor(s) |
Stone type | |
|---|---|---|---|
| Increase | Decrease | ||
| Gout | UA | UA | |
| Glycogen storage disease | UA | UA | |
| Lesch–Nyhan syndrome | UA | UA | |
| Neoplastic disease | UA | UA | |
| Secondary polycythaemia | UA | UA | |
| Anaemia | UA | UA | |
| Haemoglobinopathy | UA | UA | |
| Psoriasis | UA | UA | |
| Cystinuria | UA, cystine | Cystine/UA | |
| Laxative abuse | Volume | NH4 urate | |
| Metabolic syndrome | Often + oxalate, UA, citrate | pH | UA/CaOx |
| Ileostomy | Volume, pH | UA/CaOx | |
| Primary hyperparathyroidism | Calcium, pH | CaP/CaOx | |
| Distal renal tubular acidosis | pH, calcium | CaP | |
| Hereditary hyperoxaluria | Oxalate | CaOx | |
| Enteric hyperoxaluria | Oxalate | pH, citrate, magnesium | CaOx |
| Medullary sponge kidney | Calcium | CaOx/CaP | |
| Cushing’s disease | Calcium, pH | CaOx/CaP | |
| Sarcoidosis | Calcium | CaOx/CaP | |
| Vitamin D intoxication | Calcium | CaOx/CaP | |
| Milk–alkali syndrome | Calcium, pH | CaP/CaOx | |
| Immobilization | Calcium, pH (from UTI) | CaP/MAP | |
| Dent’s disease | pH | CaP | |
| Sjögren’s syndrome | pH | CaP | |
| Primary biliary cirrhosis | pH | CaP | |
| Thalassaemia major | Calcium (from excessive vitamin D) | CaOx/CaP | |
| Betel-chewing | Calcium, pH | CaP/CaOx | |
| Hypomagnesaemia | Oxalate | CaOx/CaP | |
| Pancreatitis | Oxalate | CaOx/CaP | |
| Hyperthyroidism | Calcium | CaOx/CaP | |
| Corticosteroids | Calcium | CaOx/CaP | |
| Acetazolamide | pH | CaP | |
| CaCO3 antacids | Calcium, pH | CaP/CaOx | |
| Small bowel resection | Oxalate | pH, citrate, magnesium | CaOx |
| Jejunal-ileal by-pass | Oxalate | CaOx/CaP | |
| Bariatric surgery | Oxalate | CaOx/CaP | |
| Enterocystoplasty | Calcium | pH, citrate, magnesium | CaP/CaOx |