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The DANSTEN database

This study evaluates and classifies upper urinary tract stone patients in Denmark from 2002 to 2004 following Scandinavian guidelines. It aims to increase awareness and proper evaluation of stone formers. Metabolic, infectious, anatomical, and functional causes are identified, and recommendations for medical management are provided. Classification includes simple and complicated stone diseases, with detailed criteria for each. The Scandinavian Cooperative Group for Urinary Stones' guidelines are emphasized throughout the study.

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The DANSTEN database

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  1. NUF congress 2005 The DANSTEN database Patients with upper urinary tract stones in Denmark 2002 – 2004 evaluated and classified as recommended by theScandinavian Cooperative Group for Urinary Stones. Kim AndreassenFrederiksberg Hospital, University of Copenhagen, Denmark.

  2. The DANSTEN 2002 project Project group: Palle J. OstherAsger Lind PoulsenPalle Rosenkilde OlsenJohn AabechKim Andreassen Thanks to the local project leaders from the participating departments

  3. Background

  4. Patients with upper urinary tract stones in Denmark 1995 -2002 (Danish population appr. 5.4 million) Andreassen KH. 2004

  5. Treatment of kidney stones in Denmark 1996 -2001 Andreassen KH. 2004

  6. Treatment of ureteric stones in Denmark 1996 -2001 Andreassen KH. 2004

  7. Purpose • To describe the prevalence of various causes to stone disease, using a classification system adapted from the guidelines published by the Scandinavian Cooperative Group for Urinary Stones • To propagate these guidelines and increase the awareness of proper evaluation of stone formers.

  8. Guidelines Metabolic evaluation and medical management of upper urinary tract stone disease. Guidelines from the Scandinavian Cooperative Group for Urinary Stones.Osther PJ, Grenabo L, Haraldsson G, Holmberg G, Lindell O, Mogensen P, Schultz A, Ulvik NM. Scand J Urol Nephrol. 1999; 33: 372-81. • simple • based on documented risk factors in the Nordic area • based on clinical controlled trials

  9. Classification

  10. MIAF urolithiasis: Conditions with a definitive Metabolic Infectious Anatomical Functional cause of stone formation Metabolic evaluation and medical management of upper urinary tract stone disease. Guidelines from the Scandinavian Cooperative Group for Urinary Stones. Osther PJ, Grenabo L, Haraldsson G, Holmberg G, Lindell O, Mogensen P, Schultz A, Ulvik NM. Scand J Urol Nephrol. 1999; 33: 372-81.

  11. Metabolic Infectious Anatomical/Functional

  12. Metabolic causes (classification) Uric acid related disorders Uric acid stone with hyperuricaemia Uric acid stone without hyperuricaemia 2.8 dihydroxyadenuria XanthinuriaHyperoxaluric states Primary hyperoxaluria Enteric hyperoxaluria Hypercalcaemic states Primary hyperparathyroidism Other hypercalcaemic conditionsRenal tubular acidosis Chronic diarrhoeal states Cystinuria Other rare causes not mentioned above (ex. Indinavir)

  13. Metabolic Uric acid stone with hyperuricaemia Uric acid stone without hyperuricaemia 2.8 dihydroxyadenuria Xanthinuria Primary hyperoxaluria Enteric hyperoxaluria Primary hyperparathyroidisme Other hypercalcaemic conditions Renal tubular acidosis Chronical diarrhoel states Cystinuria Other rare (ex. Indinavir) Infectious Anatomical/Functional

  14. Metabolic Uric acid stone with hyperuricaemia Uric acid stone without hyperuricaemia 2.8 dihydroxyadenuria Xanthinuria Primary hyperoxaluria Enteric hyperoxaluria Primary hyperparathyroidisme Other hypercalcaemic conditions Renal tubular acidosis Chronical diarrhoel states Cystinuria Other rare (ex. Indinavir) Infectious Anatomical/Functional Simple Complicated

  15. Definition of simple and complicated stone disease: Simple stone disease: Single stone former with spontaneous passage of stone.Unilateral typical radiopaque stone that is easily fragmented and cleared from the renal tract following ESWL and/or endoscopical surgery.Insignificant recurrence of typical radiopaque stone. Complicated stone disease: Suspicion of MIAF urolithiasis.Significant recurrence.High stone burden.Early stone debut (<20 years). Metabolic evaluation and medical management of upper urinary tract stone disease. Guidelines from the Scandinavian Cooperative Group for Urinary Stones. Osther PJ, Grenabo L, Haraldsson G, Holmberg G, Lindell O, Mogensen P, Schultz A, Ulvik NM. Scand J Urol Nephrol. 1999; 33: 372-81.

  16. Classification af patients with complicated idiopathic calcium urolithiasis (risk factors) Hypercalciuria Hypocitraturia Both hypercalciuria and hypocitraturia Neither hypercalciuria nor hypocitraturia Unknown U-calcium and U-citrate Hypercalciuria: U-calcium > 0.10 mmol/kg/24 h. Hypocitraturia: U-citrate < 2 mmol/24 h.

  17. Metabolic Uric acid stone with hyperuricaemia Uric acid stone without hyperuricaemia 2.8 dihydroxyadenuria Xanthinuria Primary hyperoxaluria Enteric hyperoxaluria Primary hyperparathyroidisme Other hypercalcaemic conditions Renal tubular acidosis Chronical diarrhoel states Cystinuria Other rare (ex. Indinavir) Infectious Anatomical/Functional Simple Complicated Hypercalciuria Hypocitraturia Both Neither Unknown

  18. Evaluation

  19. No suspicion of MIAF urolithiasis Suspicion of MIAF urolithiasis MIAF UROLITHIASIS IDIOPATHIC CALCIUM-NEPHROLITHIASIS SIMPLE COMPLICATED Selective evaluation ex. Urine cystine, S-PTH, Urine oxalate, S-electrolytes, blood gas,etc. No further Evaluation 24 hour urine analysis: volume calcium citrate creatinine Selective treatmentaccording tounderlying disorder Increase fluid intake Hypercalciuria:consider thiazide Hypocitraturia:consider potassiumcitrate Medical history & Imaging Urine culture and pH S-creatinine, S-ionized calcium, S-uric acid Stone analysis (if available)

  20. Methods and material All urological departments in Denmark were invited to join a central registration of all patients (> 15 years) with upper urinary tract stones during a 2-year period. (1/4 2002 – 31/3 2004).Both hospitalized and out-patients were included.Patients could only be registered once. Patients were evaluated and classified according to the guidelines. Participating departments entered data in a local database, and updated datafiles were sent by e-mail to a central database on a regular basis.

  21. Ålborg Viborg Randers Holstebro Skejby Herlev Gentofte Fredericia Vestsjæl. Fredbg. RH Odense Haderslev Næstved Svendborg Sønderborg Nyk. Falster Participating departments (and counties represented) 17 departments participated,representing 11 of 14 counties. Counties not represented:Ribe CountyRoskilde CountyFrederiksborg County The counties represented constitutes approximately 85 % of the Danish population. Dansten-2002

  22. Number of patients registered per department Number of patients/department: median 81 (range: 19 - 429). Dansten-2002

  23. Results • 2294 patients were registered. • 57.4 % were new stone formers. • Median age: 53 years (range 16 – 96 years). • The female:male ratio was 1:2.

  24. Relative distribution Not classified 8 % MIAF urolithiasis 17 % 75 % Idiopathic calcium urolithiasis Fig. 2. Distribution of MIAF and idiopathic calcium urolithiasis.

  25. Relative distribution Not classified 8 % Anatomical/Functionel 5 % Infectious 3 % Metabolic 9 % Simple idiopathiccalcium urolithiasis 52 % Complicated idiopathiccalcium urolithiasis 23 % Fig. 3. Distribution of MIAF and idiopathic calcium urolithiasis.

  26. Metabolic causes (N=214) Fig. 5. Number of patients with metabolic causes (N=214).

  27. Hypercalciuria and/or hypocitraturia in patients with complicated idiopathic calcium urolithiasis (N=534) Hypercalciuria (n=48) 9% 24 h urine analysisnot available (n=195) 36 % 29 % Hypocitraturia (n=155) 4 % 22 % Both (n=19) Neither (n=117) Fig. 4. Presence of hypercalciuria (> 0.1 mmol/kg/24 h) and/or hypocitraturia (< 2 mmol/24 h) in patients with complicated idiopathic calcium urolithiasis (N=534).

  28. Conclusion 9 % had a metabolic cause 3 % had a infectious cause 5 % had an anatomical/functional cause 52 % had simple idiopathic calcium nephrolithiasis 23 % had complicated idiopathic calcium nephrolithiasis 8 % were not classified Since the distribution pattern of the different stone diseases was fairly identical from department to department, the results are supposed to be representative for the whole nation of Denmark.

  29. Conclusion • 17 % of stone formers are candidates for selective management (MIAF). • 23 % of stone formers should undergo extended evaluation with 24-h urine sample analysed for calcium and citrate (complicated idiopathic calcium urolithiasis). • 42 % of stone formers with complicated idiopathic calcium urolithisis should be offered medical profylaxis (with thiazide or potassiumcitrate). (approximately 10 % of all stoneformers).

  30. Conclusion The classification system was found to be applicable and of clinical value.

  31. Diagnostic codes for upper urinary tract stones These can be specified with one of the following letters: Diagnosekodning sten. 2004 KA

  32. Complete classification of upper urinary tract stones: Diagnosekodning sten. 2004 KA

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