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PubMed1990

[The interrelationship between calcium and magnesium homeostasis and its significance for the relapse-prevention treatment of calcium nephrolithiasis].

The correlation between the renal excretion of calcium and magnesium after an overload with 1000 mg of calcium is studied. The significant interrelations between the calcium and magnesium urine excretion point that there are close interrelations between their active tubular transport in the kidneys. The significantly higher magnesuria and the tendency toward a low serum magnesium level in patients with renal hypercalciuria require to take into account the hypermagnesuria. The oral treatment with magnesium which was prescribed in the past indiscriminantly to all patients with relapsing calcium nephrolithiasis is necessary only for patient with renal hypercalciuria.

Adolescent↗
PubMedDate not supplied

[The treatment of coralliform nephrolithiasis].

A total of 184 patients with dendritic nephrolithiasis (74.5% females and 25.5% males) were under study. It was established that in more than half of them the disease developed from the infectious inflammation of the urinary tract. Based on the findings, the authors supposed that in these patients the initial instability of cellular membranes was associated with a decrease in nonspecific resistance which was unfavourably complicated by infection of the urinary tracts and the formation of calcium phosphate calculus. As the presence of friable (low-contrast) calculi in the state of growth is accompanied by a severe inflammation, a continuous nonoperative treatment is mandatory. When the growth of the calculus is stopped and confirmed by its high-contrast dense X-ray shadow and the signs of inflammation ceased the authors insisted on the conduction of the 3-4-week inpatient preoperative management. The latter should include the administration of wide-range antibiotics, drugs for potentiation of nonspecific resistance and the complex of vitamins. Subcortical pyelolithotomy with partial nephrotomy is a method of choice in case of a "dry kidney". An average postoperative bedtime comprised 22.3 days.

Adult↗
PubMed1989

Triamterene nephrolithiasis.

A 59-year-old white male presented with a triamterene renal stone and pyelonephritis, requiring percutaneous lithotomy. A combination of hydrochlorothiazide and triamterene had been previously prescribed despite no history of hypokalemia. The indications for potassium replacement therapy and risks of triamterene nephrolithiasis are reviewed.

Drug Therapy, Combination↗
PubMed1989

Nephrolithiasis resulting in intermittent ureteral obstruction in a cow.

Bilateral nephrolithiasis with intermittent ureterolithiasis was diagnosed in a 7-year old Holstein cow. Two episodes of ureterolithiasis resulted in severe azotemia which resolved after spontaneous movement of the stone. A third episode of obstruction one year after the initial episode resulted in rupture of one kidney, necessitating euthanasia. The histopathological examination of the kidney was diagnostic for chronic pyelonephritis. Corynebacterium sp. was cultured from a nephrolith. In this case it is believed that the chronic pyelonephritis predisposed to the calculi formation.

Animals↗
PubMedDate not supplied

[Determination of the composition of the concretions in patients with nephrolithiasis by metabolic indices].

The authors considered an important problem of in vivo verification of urolith composition as specifying the choice of drug treatment and prevention of urolithiasis. 84 nephrolithiasis patients were allocated to 4 groups according to their concrement compositions (after spontaneous or surgical removal): 23 patients with urate calculus, 19 with oxalate, 20 with phosphate and 22 with oxalate-phosphate concrements. Polarizing microscopy, x-ray structural analysis and infrared spectrophotometry were employed for verification of calculi composition. Biochemical assay was used for the assessment of serum and circadian excretion of calcium, phosphates, sodium, potassium, uric acid, oxalates and uroacidimetric values. The findings were subjected to discriminant computed analysis which resulted in 6 linear computable functions defining 4 selective groups with regard to biochemical blood and urine data. The aforementioned functions were used in diagnostic routine for the in vivo assessment of calculous composition in 26 controls. In 61.5 per cent of the patients the diagnosis was confirmed, in 34.6 per cent it was verified, and only in 3.9 per cent the diagnosis turned to be erroneous.

Diagnosis, Computer-Assisted↗
PubMed1989

[The effect of oral calcium loading on the serum magnesium concentration and its urinary excretion in patients with recurrent calcium nephrolithiasis and hypercalciuria--differential diagnostic potentials].

The study deals with 13 healthy controls with normal basic indices for calcium-phosphorus metabolism and 25 patients with recurrent calcium nephrolithiasis and hypercalciuria, 13 of them with renal hypercalciuria and 12 patients with absorptive hypercalciuria. The oral calcium-tolerance test was carried out in all persons. The changes in the serum and urine calcium and magnesium concentrations following the calcium loading are recorder. A statistically significant increase of magnesium urine excretion was found in all persons examined, the highest being in the patients with renal hypercalciuria, considerably higher than in the healthy controls. The conclusion is reached that the magnesium urine excretion gives valuable information for the diagnosis of patients with renal hypercalciuria.

Administration, Oral↗
PubMed1989

Effect of citrate on the urinary excretion of calcium and oxalate: relevance to calcium oxalate nephrolithiasis.

Studies in 24 recurrent oxalate stone-formers have shown that values for urinary calcium excretion for this group on at-home diets vary significantly (P less than 0.001) more than values for creatinine excretions. By placing stone-formers on controlled in-hospital diets and measuring their calcium excretions, we were able to predict probable outpatient hypercalciuria (greater than 7.5 mmol/day) with a sensitivity of 95% and a specificity of 95%. In this study, the renal loss of calcium during low-calcium diets was proportional to the absorptive hypercalciuria during high-calcium diets. Calcium loading experiments in fasted stone-formers and normal subjects indicated that citrate, at citrate:calcium molar ratios ranging from 0.12 to 1, stimulated urinary calcium excretion more than did calcium carbonate loading alone. In addition, citrate also significantly (P less than 0.05) increased the excretion of urinary oxalate by two normal subjects for a given load of calcium oxalate. Malabsorption of citrate and possibly other hydroxycarboxylic acids may thus predispose to oxalate nephrolithiasis by promoting calcium and oxalate absorption.

Absorption↗
PubMedDate not supplied

Captopril therapy of recurrent nephrolithiasis in a child with cystinuria.

Traditional and current therapies for cystinuria have been difficult for patients, only partially effective, or associated with substantial risk of serious side effects. We present a case of cystinuria that has been managed for 1 year on captopril, with elimination of recurrent nephrolithiasis and with no observable morbidity.

Adolescent↗
PubMed1988

Nephrolithiasis.

The management of the patient presenting to the Emergency Department with nephrolithiasis or renal colic should include evaluation of the patient for concurrent diseases, risk factors for stone formation, and possible etiologies for stones. Suspicion of ureterolithiasis is based on a cogent history and physical examination and reinforced by a finding of hematuria. Diagnosis should be based upon a promptly performed intravenous pyelogram, unless the patient is truly allergic to contrast media or has substantial risk of a contrast-induced renal failure. A solitary flat plate of the abdomen adds no useful information and is an unnecessary expense to the patient. Essential laboratory data include a urinalysis, CBC, and electrolyte, BUN, creatinine, and serum calcium levels. A urine culture should be obtained in all patients because urinalysis alone may not be sufficient to exlude a urinary tract infection. Initial treatment of the patient with an uncomplicated renal colic should include hydration, relief of pain, and reassurance. Evaluation by a consultant may be done as an outpatient on a nonemergent basis. If the colic has not resolved after 72 hours, hospitalization generally is recommended. If the patient has vomiting, dehydration, a complete obstruction, or a solitary kidney, hospitalization in indicated and urgent consultation recommended. If the patient has fever or other signs of infection, emergent consultation and immediate hospitalization are essential. Retained obstructing stones are generally managed by urologic consultants. It is in the care of the patient with the retained stone that greatest advances have been made in the past 10 years. Patients should be counseled that the retained stone no longer calls for extended hospitalization and convalescence.

Colic↗
PubMedDate not supplied

[Dietary and drug treatments of calcium nephrolithiasis (author's transl)].

Dietary and drug treatments of calcium nephrolithiasis depend mainly on the mineral composition of renal stones: calcium oxalate, phosphate or mixed stones. The association with an hypercalciuria is an important factor which must be taken into account because oxalates and phosphates precipitate as calcium crystals in case of urinnary oversaturation. Despite many therapies have been proposed, their efficiency seems to be rather small when they are used alone. Usually, it is necessary to act on several factors with a combination of therapeutic methods. Absorptive hypercalciuria are improved with both low calcium diets and inhibitors of calcium absorption. In renal hypercalciuria, the treatment is based on the administration of thiazide diuretics which enhance calcium renal tubular reabsorption. The other therapeutic methods depend on the nature of renal stones: urinary acidification for calcium phosphate; administration of succinimide, oral phosphate or organic phosphonates for calcium oxalate stones; association with purine biosynthesis inhibitors in case of the presence of urates in renal calculi.

Benzothiadiazines↗
PubMed1987

[Resorption of oxalic acid in calcium oxalate nephrolithiasis].

In 43 healthy reference persons and 54 patients with relapsing calcium oxalate nephrolithiasis the absorption of oxalic acid was measured by means of 14C-oxalic acid. In patients with oxalate calculi the absorption of oxalic acid is totally increased and also in such ones with Whewellite-calculi. It is decreased in carriers of Weddelite calculi. The increase of the absorption of oxalic acid in patients with mixed calculi is not significant.

Adult↗
PubMed1987

The effect of parathyroidectomy on the recurrence of nephrolithiasis.

Little information is available on the long-term influence of parathyroidectomy on the rate of renal stone formation in patients with primary hyperparathyroidism (pHPT) and nephrolithiasis. The reported occurrence of renal stone disease in untreated patients with pHPT is 15% to 30%. A registry of 258 pHPT patients who underwent parathyroidectomies at the Milwaukee Regional Medical Center has allowed continued follow-up of the 71 (28%) pHPT patients with associated renal stone disease. Patients have been followed up for an average of 5 years (range, 1 to 15 years) since surgery. The rate of renal stone formation before and after parathyroidectomy was compared. Identification of a "new" renal stone was defined as passage and collection, extraction, or radiographic visualization of stones. All 71 pHPT patients with stone disease had hypercalcemia and inappropriately elevated parathyroid hormone concentrations, and after parathyroidectomy these values returned to normal in 69 of 71 patients. Since undergoing parathyroidectomy, only 4 patients have passed renal stones. The rate of stone formation per patient per year was 0.36 before and 0.02 after surgery (p less than 0.001). Surgical correction of pHPT significantly reduced the rate of stone formation.

Adult↗
PubMed1986

Subtotal nephrectomy in the rabbit: a model of chronic hypercalcemia, nephrolithiasis, and obstructive nephropathy.

The association of a critical reduction in renal mass with the subsequent destruction of remaining nephrons has been observed in several species. We studied this process in experimental rabbits after 1 2/3 nephrectomy to define the course and its pathogenesis in this species. Control rabbits underwent sham operative procedures. After renal ablation, rabbits became increasingly cachectic and developed polyuria and hypertension. Despite food intake similar to that of controls (grams per kilogram per day), experimental rabbits developed severe hypercalcemia by 5 to 8 weeks after renal ablation, a change that persisted until death. During the study 17 experimental animals died of uremia 9 to 27 weeks after surgery, and the remaining seven experimental and 25 sham-operated rabbits were sacrificed at 5 to 7 months. At death, 19/24 experimental rabbits had severe obstruction of their collecting systems by concretions of gravel (n = 3) or large calcium carbonate stones (n = 16). Renal biopsy at 4 weeks revealed focal interstitial round cell infiltration progressing by 12 weeks to diffuse tubulointerstitial inflammation and fibrosis. Histologic evidence of obstruction was also evident at this time and became extensive on all subsequent examinations. By contrast, the glomeruli remained well preserved without evidence of sclerosis. We speculate that chronic hypercalcemia and, perhaps more significantly, urinary obstruction may have altered intrarenal hemodynamics and prevented the development of progressive sclerosis observed in the rat remnant kidney model. The present study describes an experimental model of chronic hypercalcemia and spontaneous calcium carbonate nephrolithiasis.

Animals↗
PubMed1986

[Optimal dosage of chlorthalidone in the prevention of the recurrence of nephrolithiasis is 25 mg per day].

Thiazides are considered to be effective in preventing recurrence of various types of nephrolithiasis, but the optimum dosage has not been established. To address this issue, 5 idiopathic stone formers with hypercalciuria on low Ca diet received chlorthalidone (CT) in 3 different oral doses and were randomly assigned either to the sequence 25-50-100 mg/day or the reverse (2 months per dose, monthly blood and urine measurements). The anticalciuric effect of CT was significant only at 50 and 100 mg/day, at the expense of a dose-dependent decrease in U-citrate excretion. We also observed a dose-dependent decrease in blood levels of K, increases in those of HCO3 and urate, as well as in U-pH, a tendency for blood levels of Mg and U-oxalate excretion to fall, and no change in U-urate excretion. Therefore, to derive the optimal CT dose the Tiselius' risk index was applied, which is based on the values of urinary [Ca], [oxalate], [Mg], [citrate] and volume. CT produced a decrement in risk index which was similar at each of the doses tested. Thus, raising CT doses beyond 25 mg/day does not hold out the prospect of improved prophylaxis. This agrees with Ettinger's preliminary data (Urol. Res., 1984) showing a similar protective effect of CT at 25 and 50 mg/day despite the absence of a significant anticalciuric effect at 25 mg/day.

Calcium↗
PubMed1986

Successful treatment of hyperuricosuric calcium oxalate nephrolithiasis with potassium citrate.

Calcium stone (renal) formation in patients with hyperuricosuria has been ascribed to the urate-induced crystallization of calcium oxalate. Citrate (0.5mM), added to synthetic medium metastably supersaturated with respect to calcium oxalate, was shown to inhibit heterogeneous nucleation of calcium oxalate by monosodium urate (2 mg/mL). Long-term trial with potassium citrate (60 to 80 mEq/day) was therefore undertaken to determine whether induced hypercitraturia would prevent calcium oxalate stone formation in 19 patients with hyperuricosuria. The treatment produced a sustained rise in urinary pH by 0.55 to 0.85 to the high normal range (6.5 to 7.0). Urinary citrate levels rose by 249 to 402 mg/day to approximate the normal mean value of 643 mg/day. Commensurate with these changes, urinary saturation of calcium oxalate (relative saturation ratio) and the amount of undissociated uric acid declined significantly. However, the urinary uric acid and saturation of monosodium urate remained elevated. Stone formation declined from 1.55 +/- 2.70 per patient-year to 0.38 +/- 1.22 per patient-year during mean treatment period of 2.35 +/- 0.88 years. Stones ceased to form in 16 of 19 patients during treatment. The results provide physicochemical and clinical evidence for the utility of potassium citrate in the management of hyperuricosuric calcium oxalate nephrolithiasis.

Adult↗
PubMed1979

Idiopathic calcium nephrolithiasis. 2. Differences between hypercalciuric and normocalciuric persons with recurrent kidney stone formation and persons without such a history.

Normocalciuric and hypercalciuric patients with idiopathic recurrent calcium nephrolithiasis were compared with healthy individuals without such a history to examine the factors that predispose normocalciuric patients to stone formation. The urine calcium excretion rate was higher in the normocalciuric patients than in the control subjects (227 v. 183 mg/24 h; P less than 0.01), but the urine calcium concentration was not significantly different. The urine magnesium and citrate excretion rates and concentrations were lower in the normocalciuric patients than in the control subjects (P less than 0.001), while the urine uric acid and oxalate excretion rates and concentrations and the urine saturation with brushite (CaHPO4-2H2O) were not significantly different. These results suggest the importance of slight increases in the urine calcium excretion rate together with decreased urine magnesium and citrate excretion rates in normocalciuric persons with recurrent calcium stone formation. The urine of the hypercalciuric patients was more highly saturated with brushite than the urine of the normocalciuric patients and the control subjects, and the excretion rates of uric acid and oxalate were increased in the hypercalciuric patients. The hypercalciuric patients had a higher urine creatinine excretion rate than the normocalciuric patients and a higher daily urine volume than the control subjects, which suggests that differences in lean body mass or fluid and food intake, or both, may be important determinants of these differences in crystalloid excretion. As in the normocalciuric patients, the urine citrate excretion rate and concentration were decreased in the hypercalciuric patients compared with the control subjects.

Adult↗