Incomplete dRTA in kidney stone formers: diagnostic performance of furosemide/fludrocortisone testing and non-provocative clinical parameters

Dhayat, Nasser; Pathare, Ganesh Tukaram; Anderegg, Manuel; Vogt, Bruno; Fuster, Daniel Guido (2017). Incomplete dRTA in kidney stone formers: diagnostic performance of furosemide/fludrocortisone testing and non-provocative clinical parameters. Clinical journal of the American Society of Nephrology, 12(9), pp. 1507-1517. American Society of Nephrology 10.2215/CJN.01320217

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Background and objectives: Incomplete distal renal tubular acidosis is a well-known cause of calcareous nephrolithiasis but the prevalence is unknown, mostly due to lack of accepted diagnostic tests and criteria. The ammonium chloride test is considered as gold standard for the diagnosis of incomplete distal renal tubular acidosis, but the furosemide/fludrocortisone test was recently proposed as an alternative. Due to the lack of rigorous comparative studies, the validity of the furosemide/fludrocortisone test in stone formers remains unknown. In addition, the performance of conventional, non-provocative parameters in predicting incomplete distal renal tubular acidosis has not been studied. Design, setting, participants, and measurements: We conducted a prospective study in an unselected cohort of 170 stone formers that underwent sequential ammonium chloride and furosemide/fludrocortisone testing. Results: Using the ammonium chloride test as gold standard, the prevalence of incomplete distal renal tubular acidosis was 7.78 %. Sensitivity and specificity of the furosemide/fludrocortisone test FF test were 77 % and 85 %, respectively, yielding a positive predictive value of 30 % and a negative predictive value of 98 %. Testing of several non-provocative clinical parameters in the prediction of incomplete distal renal tubular acidosis revealed fasting morning urinary pH and plasma potassium as the most discriminative parameters. The combination of a fasting morning urinary threshold pH <5.3 with a plasma potassium threshold >3.8 mmolmEq/l yielded a negative predictive value of 98 % with a sensitivity of 85 % and a specificity of 77 % for the diagnosis of incomplete distal renal tubular acidosis. Conclusions: The furosemide/fludrocortisone test can be used for incomplete distal renal tubular acidosis screening in stone formers, but an abnormal furosemide/fludrocortisone test result needs confirmation by ammonium chloride testing. Our data furthermore indicate that incomplete distal renal tubular acidosis can reliably be excluded in stone formers by use of non-provocative clinical parameters.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Nephrology and Hypertension
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Unit Childrens Hospital > Forschungsgruppe Nephrologie / Hypertonie
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Biochemistry and Molecular Medicine

UniBE Contributor:

Dhayat, Nasser; Pathare, Ganesh Tukaram; Anderegg, Manuel; Vogt, Bruno and Fuster, Daniel Guido

Subjects:

600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology

ISSN:

1555-9041

Publisher:

American Society of Nephrology

Language:

English

Submitter:

Nasser Dhayat

Date Deposited:

06 Sep 2017 15:35

Last Modified:

04 Aug 2018 02:30

Publisher DOI:

10.2215/CJN.01320217

PubMed ID:

28775126

Additional Information:

2nd Revision version

Uncontrolled Keywords:

clinical nephrology mineral metabolism renal tubular acidosis kidney stones

BORIS DOI:

10.7892/boris.100078

URI:

https://boris.unibe.ch/id/eprint/100078

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