[Renal lithiasis medicamentosa].
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Biomedical subjects
Publications and source records attributed to M L Traba.
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A precise specific method for measuring 25-hydroxycholecalciferol (25-OH CC) in 2 ml of human serum is described. It includes extraction with acetonitrile, separation with Sep-Pak C-18 cartridges, purification through HPLC and a further quantitation by means of a protein-binding assay. An exhaustive study of this protein-binding method has been performed. The sensitivity of the protein-binding assay is 20 pg/tube and the inter and intra-assay coefficients of variation are 9.6% and 8.7% respectively. The precision of the overall process has been assessed by calculating the inter and intra-assay coefficients of variation, 15.5 and 10.4% respectively. Mean serum value of 25-OH CC in normal subjects (18-50 years old, during spring) is 11.2 +/- 5.5 ng/ml.
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We describe a precise, specific method for measuring 24,25-dihydroxyvitamin D3 in human serum. A 2-mL serum sample is extracted with acetonitrile and passed through a Sep-Pak C-18 cartridge. The sample is further purified by "high-performance" liquid chromatography under isocratic conditions on a normal-phase column (Radial-Pak silica-gel cartridge), then subjected to a protein-binding assay. The mean concentration of 24,25-dihydroxyvitamin D3 in serum from 22 normal adults (measured during the spring) was 2.9 micrograms/L (SD 1.9, range 6.3-0.42 microgram/L). The intra-assay CV was 7.7%, the interassay CV 11.2%. Purification of the sample with Sep-Pak C-18 and liquid chromatography on normal plus reversed-phase columns leads to a mean value of 3.4 micrograms/L (SD 1.6 micrograms/L, n = 12), not significantly different from results with our method.
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Seventy-seven patients with nephrocalcinosis as revealed by X-ray studies over a 10-year period are reviewed. A programmed clinical and metabolic study was performed on each case; the author's criteria included the different pathogenic factors considered in the etiologic definition of the disease. There were 22 cases with primary hyperparathyroidism, 19 with spongy kidney, nine with tubulointerstitial nephropathy, five with hyperoxaluria, five with distal renal tubular acidosis, four with esential hypomagnesemia, and three cases of miscellaneous etiology (vitamin D intoxication, Fanconi's syndrome, Bartter's disease). Ten other cases were classified as idiopathic nephrocalcinosis since no definite cause could be found. The clinical characteristics (symptoms, associated diseases, diet and medication intake, family history) and the biochemical findings are analysed for each group. The physiopathologic mechanisms, comparisons between each etiologic group, treatment, clinical course, and prognosis are commented on. The conclusion drawn is that nephrocalcinosis is a clinical syndrome of various etiologies which in most cases arises from an underlying metabolic disease.
Idiopathic hypercalciuria was noted in 10% of a series of 1635 subjects with renal lithiasis. Eight-day administration of thiazide diuretics as a test for the discovery of latent hyperparathyroidism in idiopathic hypercalciuria is described. In 6 cases diagnosed in this way, surgery disclosed the presence of a parathyroid adenoma. Resection was followed by persistent hypercalciuria and, in some instances, renal lithiasis activity. The pathogenesis of associations of these frequently observed diseases is examined.
In the group of 1635 patients with nephorolithiasis the authors found 16% with idiopathic hypercalciuria. They administered thiazide diuretics for 8 days as a test for the detection of masked hyperparathyroidism in idiopathic hypercalciuria. In 6 cases which were diagnosed in this manner, the existence of a parathyroidadenoma could be demonstrated by surgical operation. The hypercalciuria persisted after exstirpation of the tumor, in some cases the nephrolithiasis also remained active. the various pathogenetic mechanisms connected with these common diseases are discussed in relation to these results.
Areas of ectopic ossification were found in thin sections from 19 of 1,624 calculi submitted to a petrographic procedure, an incidence of 1.16 per cent. Only 8 calculi of renal, pelvic or ureteral origin with osseous tissue in its structure have been described since the first report by Phemister in 1923.
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