Urinary stone formers with hypocitraturia and 'normal' urinary pH are at high risk for recurrence

Urol Int. 2012;88(3):294-7. doi: 10.1159/000335441. Epub 2012 Mar 7.


Background: Citrate is one of the most important inhibitors in urolithiasis. Hypocitraturia is a common risk factor in stone formers. Citrate excretion is regulated - amongst others - by acidosis and protein intake. A considerable number of stone formers, however, show hypocitraturia in the presence of normal urine pH levels. This is potentially due to defects in the renal tubular citrate carriers (NaDC 1 and 3) which may be genetically determined.

Patients and methods: 350 consecutive stone formers were examined. Exclusion criteria were urinary tract infection, hypokalemia, and steatorrhea. The following parameters were measured: serum: creatinine, calcium, potassium, and uric acid; urine: pH profiles, citrate, calcium, uric acid, ammonia, urea, and creatinine.

Results: 83/350 patients were hypocitraturic (48 males, 35 females). 14/83 had low urine pH (≤ 6), 69/83 showed normal levels (>6). In the latter group there was a significantly higher recurrence rate (23 vs. 9%). The two groups were not different in serum parameters apart from uric acid. In urine, only pH and calcium (males) were significantly lower in the first group. Citrate did not correlate with urine pH and creatinine in the hypocitraturia-normal pH group, only with calcium in both sexes and urea and ammonia in females. In the hypocitraturia-low pH patients, there was no significant correlation between citrate and any other parameter tested.

Conclusions: Hypocitraturia with normal urine pH is an entity indicating a high risk for recurrence. Since there was no correlation between citrate and pH, urea and ammonia, respectively, citrate excretion is not regulated in these patients as usual. There may be a link to calcium excretion. Potentially, these patients have defects in the renal tubular citrate carriers which may be genetically determined. Genetic examinations should be performed to elucidate a potential genetic disorder in hypocitraturia-normal pH stone formers.

MeSH terms

  • Biomarkers / blood
  • Biomarkers / urine
  • Citric Acid / urine*
  • Down-Regulation
  • Female
  • Germany
  • Humans
  • Hydrogen-Ion Concentration
  • Kidney Tubules / metabolism*
  • Male
  • Recurrence
  • Risk Assessment
  • Risk Factors
  • Urolithiasis / blood
  • Urolithiasis / etiology*
  • Urolithiasis / urine


  • Biomarkers
  • Citric Acid