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PubMed2007

Evidence that postprandial reduction of renal calcium reabsorption mediates hypercalciuria of patients with calcium nephrolithiasis.

Idiopathic hypercalciuria (IH) is common among calcium stone formers (IHSF). The increased urinary calcium arises from increased intestinal absorption of calcium, but it is unclear whether increased filtered load or decreased renal tubular reabsorption of calcium is the main mechanism for the increased renal excretion. To explore this question, 10 IHSF and 7 normal subjects (N) were studied for 1 day. Urine and blood samples were collected at 30- to 60-min intervals while subjects were fasting and after they ate three meals providing known amounts of calcium, phosphorus, sodium, protein, and calories. Fasting and fed, ultrafiltrable calcium levels, and filtered load of calcium did not differ between N and IHSF. Urine calcium rose with meals, and fractional reabsorption fell in all subjects, but the change was significantly higher in IHSF. The changes in calcium excretion were independent of sodium excretion. Serum parathyroid hormone levels did not differ between N and IHSF, and they could not account for the greater fall in calcium reabsorption in IHSF. Serum magnesium and phosphorus levels in IHSF were below N throughout the day, and tubule phosphate reabsorption was lower in IHSF than N after meals. The primary mechanism by which kidneys ferry absorbed calcium into the urine after meals is via reduced tubule calcium reabsorption, and IHSF differ from N in the magnitude of the response. Parathyroid hormone is not likely to be a sufficient explanation for this difference.

Adult↗
PubMed2006

[Clinical and laboratory tests characteristics in children with nephrolithiasis: case control study].

OBJECTIVES: To evaluate the clinical and laboratory findings in pediatric patients with urolithiasis in a case control study and to obtain variables predicting a low risk of having urolithiasis. METHODS: Retrospective analysis of 24 cases of children with urolithiasis (age range 3 to 17 years old) admitted to the pediatric emergency room or the hospital ward. Clinical and laboratory information was obtained from the clinical charts and compared with a control group of 29 patients with history of abdominal pain admitted to the hospital. Binary logistic regression and recursive partitioning analysis were used to obtain variables predicting a low risk of having urolithiasis. RESULTS: There was no difference in age, gender, dysuria or nausea (p > 0. 2) between groups. A difference regarding the presence of fever (p = 0.007), haematuria (p = 0.001), costovertebral angle tenderness (p = 0.004), family history (p = 0.007) and abdominal pain lasting more than 48 hs (p = 0.04) was detected. After logistic regression and using recursive partitioning, the presence or history of fever, absence of gross haematuria and no family history of urolithiasis showed a 100% negative predictive value and sensitivity (95% CI 84.7 to 100 and 89.2 to 100 respectively). CONCLUSIONS: Children with abdominal pain present a low risk of having urolithiasis if there is a history or presence of fever, absence of gross haematuria and a negative family history of urolithiasis in a first degree relative.

Adolescent↗