Twenty-four-hour urine osmolality as a representative index of adequate hydration and a predictor of recurrence in patients with urolithiasis

  • Ho Won Kang
  • Sung Pil Seo
  • Yun-Sok Ha
  • Won Tae Kim
  • Yong-June Kim
  • Seok-Joong Yun
  • Wun-Jae Kim
  • Sang-Cheol LeeEmail author
Urology - Original Paper



To determine the value of 24-h urine osmolality (UOsm) as a representative index of adequate hydration and predictor of stone recurrence in patients with urolithiasis.


Medical records of consecutive patients presenting with renal or ureteric stones between 1994 and 2017 were retrospectively reviewed. Patients were grouped according to the results of 24-h UOsm (low ≤ 564 mOsm/kg H2O, high > 564 mOsm/kg H2O). Metabolic parameters and risk of stone recurrence were compared between the two groups.


The low urine concentration group were more likely to be older, to be female, and to have a lower body mass index and higher glomerular filtration rate than the high concentration group (each P < 0.005). A positive correlation was seen between 24-h UOsm and urinary calcium, sodium, uric acid, and magnesium excretion and 24-h specific gravity; a negative correlation was seen with 24-h urine volume. Stone-forming constituents, such as calcium and uric acid, were significantly higher in the high urine concentration group. Kaplan–Meier estimates showed that the low urine concentration group had a significantly longer stone recurrence-free period than the high urine concentration group (log-rank test, P < 0.001). In multivariate Cox regression analyses, 24-h UOsm was seen to be an independent risk factor for stone recurrence.


UOsm is a promising approach to assessing hydration and predicting stone recurrence in patients with urolithiasis. Maintaining UOsm < 564 mOsm/kg H2O may reduce the risk of stone recurrence.


Urinary calculi Osmolar concentration Recurrence 



The research was supported by the International Science and Business Belt Program through the Ministry of Science, ICT and Future Planning (2015-DD-RD-0070).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The requirement for informed consent was waived due to the retrospective nature of the study.

Supplementary material

11255_2019_2108_MOESM1_ESM.tif (6 mb)
Supplementary Figure Receiver operating characteristic curve of 24 h urine osmolality for the prediction of stone recurrence (Area under the receiver operating characteristic curve = 0.595; 95% confidence interval, 0.56–0.63; P = 0.002) (TIF 6174 KB)


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Urology, College of Medicine and Institute for Tumor ResearchChungbuk National UniversityCheonjuKorea
  2. 2.Department of UrologyChungbuk National University HospitalCheongjuKorea
  3. 3.Department of Urology, School of MedicineKyungpook National UniversityDaeguKorea

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