{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:46:13Z","timestamp":1785732373692,"version":"3.56.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with kidney disease have a high incidence of kidney stones, yet the specific mechanisms remain elusive. The purpose of this study was to explore the connection between urinary lithogenic factors and renal function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 150 patients with kidney disease -associated nephrolithiasis and 84 stone-forming patients with common nephrolithiasis. The renal disease group comprised 69 renal transplant recipients, 36 patients with CKD stages 1\u20132, and 45 patients with CKD stages 3\u20134. Urinary lithogenic factors and renal function indicators were compared and correlated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients with kidney disease showed significantly higher calcium\/creatinine and magnesium\/creatinine ratios, and lower citrate\/creatinine ratios and urinary uric acid levels, compared to those with common nephrolithiasis (all\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05). No significant differences were observed in oxalate\/creatinine or phosphate\/creatinine ratios. Multivariate analysis identified Scr, BUN, PCR, eGFR, calcium\/creatinine, citrate\/creatinine, magnesium\/creatinine, and urinary uric acid as independent factors associated with renal disease-associated nephrolithiasis (all\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05). The distribution of core lithogenic factors differed across renal disease subtypes: citrate\/creatinine was the core factor in renal transplant recipients, whereas calcium\/creatinine was the core factor in patients with CKD stages 1\u20132, with urinary uric acid as a secondary factor. The prevalence of hypocitraturia, defined as a urinary citrate-to-creatinine ratio &amp;lt; 0.22 mmol\/mmol, was markedly elevated across all renal disease subgroups (93.5% in transplant recipients, 100% in CKD stages 3\u20134, and 88.9% in CKD stages 1\u20132) compared with 66.7% in the general nephrolithiasis group. Correlation analysis revealed that declining renal function was positively associated with calcium\/creatinine and magnesium\/creatinine ratios, and negatively associated with citrate\/creatinine ratio (all\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with kidney disease had increased urinary calcium and magnesium excretion and decreased citrate levels compared to people with common nephrolithiasis. Kidney disease is associated with distinct alterations in urinary lithogenic factors, particularly hypocitraturia, with subtype-specific patterns that may guide targeted prevention strategies. These findings were based on a cross-sectional assessment using a single first-morning urine sample adjusted for urinary creatinine and should be validated with 24-h urine metabolic evaluation in future studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1826969","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:27:50Z","timestamp":1785731270000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Urinary lithogenic factors in urolithiasis patients with kidney disease and correlation with renal function"],"prefix":"10.3389","volume":"13","author":[{"given":"Qian","family":"Dong","sequence":"first","affiliation":[{"name":"Department of Nephrology, The Affiliated Lihuili Hospital of Ningbo University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Affiliated Lihuili Hospital of Ningbo University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengjie","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Affiliated Lihuili Hospital of Ningbo University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Affiliated Lihuili Hospital of Ningbo University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3075","DOI":"10.3390\/ijms25053075","article-title":"Pathophysiology and main molecular mechanisms of urinary stone formation and recurrence","volume":"25","author":"Tamborino","year":"2024","journal-title":"Int J Mol Sci"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1917","DOI":"10.3390\/nu13061917","article-title":"Nutrition and kidney stone disease","volume":"13","author":"Siener","year":"2021","journal-title":"Nutrients"},{"key":"B3","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1159\/000540990","article-title":"Association between urinary flora and urinary stones","volume":"109","author":"Qiao","year":"2025","journal-title":"Urol Int."},{"key":"B4","first-page":"333","article-title":"Urolithiasis: history, epidemiology, aetiologic factors and management","volume":"45","author":"Kachkoul","year":"2023","journal-title":"Malays J Pathol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1038\/s41581-021-00513-4","article-title":"The genetics of kidney stone disease and nephrocalcinosis","volume":"18","author":"Singh","year":"2022","journal-title":"Nat Rev Nephrol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"58","DOI":"10.22037\/uj.v22i.8456","article-title":"Laparoscopic management of the urinary stones","volume":"22","author":"Pakmanesh","year":"2025","journal-title":"Urol J."},{"key":"B7","first-page":"277","article-title":"Understanding the link between kidney stones and cancers of the upper urinary tract and bladder","volume":"10","author":"Mihalopoulos","year":"2022","journal-title":"Am J Clin Exp Urol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1016\/j.advnut.2023.03.002","article-title":"Kidney stone prevention","volume":"14","author":"Peerapen","year":"2023","journal-title":"Adv Nutr."},{"key":"B9","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1053\/j.ajkd.2023.03.017","article-title":"Kidney stone pathophysiology, evaluation and management: core curriculum 2023","volume":"82","author":"Shastri","year":"2023","journal-title":"Am J Kidney Dis."},{"key":"B10","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1053\/j.akdh.2023.10.002","article-title":"Popular diets and kidney stones","volume":"30","author":"Zayed","year":"2023","journal-title":"Adv Kidney Dis Health."},{"key":"B11","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1016\/j.pop.2020.08.005","article-title":"Nephrolithiasis","volume":"47","author":"Bishop","year":"2020","journal-title":"Prim Care."},{"key":"B12","doi-asserted-by":"publisher","first-page":"299","DOI":"10.23736\/S2724-6051.20.04042-4","article-title":"Fluoroless versus conventional ureteroscopy for urinary stones: a systematic review and meta-analysis","volume":"73","author":"Peng","year":"2021","journal-title":"Minerva Urol Nephrol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"4320","DOI":"10.1097\/JS9.0000000000001345","article-title":"Recent advances in the treatment of renal stones using flexible ureteroscopys","volume":"110","author":"He","year":"2024","journal-title":"Int J Surg."},{"key":"B14","doi-asserted-by":"publisher","first-page":"12703","DOI":"10.4081\/aiua.2024.12703","article-title":"Management of urinary stones: state of the art and future perspectives by experts in stone disease","volume":"96","author":"Papatsoris","year":"2024","journal-title":"Arch Ital Urol Androl."},{"key":"B15","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1038\/s41585-022-00647-5","article-title":"Mechanisms of the intestinal and urinary microbiome in kidney stone disease","volume":"19","author":"Miller","year":"2022","journal-title":"Nat Rev Urol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1093\/eurheartj\/ehz486","article-title":"2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD","volume":"41","author":"Cosentino","year":"2020","journal-title":"Eur Heart J."},{"key":"B17","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.tcm.2019.05.003","article-title":"Blood pressure and the new ACC\/AHA hypertension guidelines","volume":"30","author":"Flack","year":"2020","journal-title":"Trends Cardiovasc Med."},{"key":"B18","first-page":"16","article-title":"Etiopathogenic factors of urolithiasis","volume":"74","author":"Wagner","year":"2021","journal-title":"Arch Esp Urol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/j.eururo.2024.05.029","article-title":"Metabolic evaluation and recurrence prevention for urinary stone patients: an EAU guidelines update","volume":"86","author":"Skolarikos","year":"2024","journal-title":"Eur Urol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"4982","DOI":"10.3892\/ijmm.2021.4982","article-title":"Recent advances on the mechanisms of kidney stone formation (Review)","volume":"48","author":"Wang","year":"2021","journal-title":"Int J Mol Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1142207","DOI":"10.3389\/fimmu.2023.1142207","article-title":"Metabolic changes in kidney stone disease","volume":"14","author":"Xu","year":"2023","journal-title":"Front Immunol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1291","DOI":"10.3904\/kjim.2020.410","article-title":"Renal effects of uric acid: hyperuricemia and hypouricemia","volume":"35","author":"Park","year":"2020","journal-title":"Korean J Intern Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"856","DOI":"10.25122\/jml-2023-0234","article-title":"The effectiveness of citrates and pyridoxine in the treatment of kidney stones","volume":"16","author":"Ene","year":"2023","journal-title":"J Med Life."},{"key":"B24","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1080\/21681805.2020.1840430","article-title":"Metabolic diagnoses of recurrent stone formers: temporal, geographic and gender differences","volume":"54","author":"Huynh","year":"2020","journal-title":"Scand J Urol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1097\/MNH.0000000000000903","article-title":"Metabolomic profiles and pathogenesis of nephrolithiasis","volume":"32","author":"Kowalczyk","year":"2023","journal-title":"Curr Opin Nephrol Hypertens."},{"key":"B26","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1016\/j.ajur.2023.02.001","article-title":"Contemporary minimal invasive surgical management of stones in children","volume":"10","author":"Guzel","year":"2023","journal-title":"Asian J Urol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1957","DOI":"10.1007\/s00394-023-03143-7","article-title":"Protein intake and risk of urolithiasis and kidney diseases: an umbrella review of systematic reviews for the evidence-based guideline of the German Nutrition Society","volume":"62","author":"Remer","year":"2023","journal-title":"Eur J Nutr."},{"key":"B28","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1038\/s41585-020-0332-x","article-title":"Genetics of kidney stone disease","volume":"17","author":"Howles","year":"2020","journal-title":"Nat Rev Urol."},{"key":"B29","first-page":"4634","article-title":"Influence of vitamin D and calcium-sensing receptor gene variants on calcium metabolism in end-stage renal disease: insights from machine learning analysis","volume":"28","author":"Sridharan","year":"2024","journal-title":"Euro Rev Med Pharmacol Sci."},{"key":"B30","doi-asserted-by":"publisher","first-page":"108981","DOI":"10.1016\/j.diabres.2021.108981","article-title":"Association of urinary calcium and phosphorus excretion with renal disease progression in type 2 diabetes","volume":"178","author":"Duan","year":"2021","journal-title":"Diabetes Res Clin Pract."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1826969\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:27:52Z","timestamp":1785731272000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1826969\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":30,"alternative-id":["10.3389\/fmed.2026.1826969"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1826969","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]},"article-number":"1826969"}}