Urinary Supersaturation in a Randomized Trial Among Individuals With Recurrent Nephrolithiasis Comparing Empiric vs Selective Preventive Therapy: The URINE Trial.
Ryan S Hsi, Aaron X Lee, Tatsuki Koyama et al.
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In 30 seconds
The URINE Trial was a single-center randomized trial comparing empiric prevention with testing-guided selective therapy in adults with recurrent idiopathic calcium stones. The analytic sample included 56 participants, assessed over 8 weeks. At week 8, urinary calcium oxalate supersaturation was 4.7 [2.9] with empiric therapy versus 5.0 [2.9] with selective therapy (P = .81); calcium phosphate supersaturation was also not significantly different. Other measured urine parameters likewise showed no significant between-group differences. The trial found no statistically significant short-term difference in urinary stone risk between the strategies.
Key findings
- At week 8, calcium oxalate supersaturation was 4.7 [2.9] vs 5.0 [2.9] for empiric and selective therapy, respectively (P = .81).
- Calcium phosphate supersaturation was 1.3 [0.9] vs 1.4 [1.1] (P = .58) in the empiric and selective groups.
- Urine volume, pH, and excretion of calcium, oxalate, citrate, uric acid, and sodium did not differ significantly at 8 weeks.
Why it matters
The findings address whether urine testing to tailor preventive treatment produces a greater short-term reduction in urinary stone risk than starting a standard empiric regimen. In this trial, neither strategy showed a significant advantage on the measured urinary outcomes, providing comparative evidence for prevention approaches in adults with recurrent idiopathic calcium stones.
What to keep in mind
This was a single-center trial with 56 participants and only 8 weeks of follow-up; the primary outcomes were urinary supersaturation measures rather than stone recurrence.