(UroToday.com) The 2022 American Urological Association Annual Meeting included a stone disease session featuring work from Dr. Pankti Kothari highlighting changes in urine composition for patients during the COVID-19 pandemic. Due to changes in the general population’s dietary and lifestyle habits, Dr. Kothari and her team sought to investigate how such changes can impact the urinary environment of patients and especially in relation to kidney stone formation. For any typical patient exhibiting kidney stones, dietary modifications are the first step to addressing systemic causes of nephrolithiasis. This is especially true for calcium stone formation, which is the most common type of kidney stone seen in patients. Sodium and calcium intake are seen as likely causes for producing kidney stones, and the drastic shift in eating habits during the pandemic may impact the ingestion of these minerals.
As such, the team aimed to see if dietary changes made during the height of the COVID-19 pandemic from March 16, 2020 – December 31, 2020, had an impact on the 24-hour urine studies of patients. Patients were retroactively included in the study if they had a history of recurrent nephrolithiasis and were seen in the single center for an outpatient visit from April 1, 2020 – December 31, 2020. Only patients with a 24-hour collection prior to the start of the pandemic, during the pandemic, and after the pandemic were included. To investigate potential differences, Dr. Kothari and her team compared the mean values of the urine collection between each of the 3 aforementioned cohorts. With a total of 93 enrolled patients, it was found that urinary calcium levels decreased from a mean of 214 mEq/L before the pandemic to 191 mEq/L during the pandemic. Of equal importance, urinary sodium was found to be significantly reduced during COVID-19 as well with a mean level of 166 mEq/L before the pandemic to 149 mEq/L during the pandemic.
Dr. Kothari concluded that the shifting dietary practices of the studied patients in New York during the COVID-19 pandemic significantly altered their urine makeup. She attested that known risk factors for kidney stones, particularly urinary sodium and calcium levels, were reduced during the pandemic. During an interview after the presentation, Dr. Kothari expanded upon how the patients were selected and noted that only those with a history of recurrent stone formation were retrospectively added. When asked about how long she thinks these positive effects on urine composition might last given that the pandemic is now over, Dr. Kothari pointed to some of the data showing that the post-COVID cohort studied showed lasting effects in reduced calcium and sodium levels. The researcher pointed out that it is unclear whether these lasting effects are due to patients maintaining healthy lifestyle changes, or that their physiology benefited from the home-cooked meals during the pandemic and that this change lasted even after their practices reverted to eating outdoors again.
Figure 1: Bar charts displaying 24-hour urine calcium (A) and sodium (B) changes between 3 cohorts of patients (pre-pandemic, during the pandemic, and post-pandemic).
Presented by: Pankti Kothari, Resident Physician PGY-3, Stony Brook University Hospital, Stony Brook, NY
Written by: Allen Rojhani, BS; MD Candidate at the Drexel University College of Medicine and 2022-2023 LIFT Research Fellow at the University of California, Irvine Department of Urology during the 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023