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PubMedDate not supplied

Pathogenesis of renal calculi in distal renal tubular acidosis. Possible role of parathyroid hormone.

Elevated circulating levels of immunoreactive parathyroid hormone (PTH), hypercalciuria and renal calculi were found in 3 patients with distal renal tubular acidosis (RTA). Treatment with alkali resulted in a fall of PTH toward normal and a reduction in urinary calcium, but the frequency of urolithiasis was unchanged. In one patient in whom prolonged follow-up was possible, a subtotal parathyroidectomy was performed. This was followed by virtual cessation of stone formation despite persistence of the acidification defect. This study suggests that RTA may be associated with secondary hyperparathyroidism and that the consequent elevation in PTH may play a contributory role in the pathogenesis of renal calculi.

Acidosis, Renal Tubular↗
PubMed1979

Dissolution of bilateral staghorn cystine renal calculi.

Bilateral staghorn renal calculi in a 7-year-old girl with cystinuria were dissolved over a period of 6 months, using a high fluid intake, urinary alkalinisation, and D-penicillamine. Even in children with extensive cystine urolithiasis, medical management may avert the need for surgery.

Child↗
PubMed1975

The effects of thiazides on serum and urinary zinc in patients with renal calculi.

Urine zinc (Zn) excretion was significantly higher in 338 male patients with renal calculi than in 21 normal male subjects, but there was no significant difference between 102 female patients with renal calculi and 15 normal female subjects. In 33 patients with renal calculi urinary Zn was less than 50% of the mean normal value; in these patients there is a possibility that lower urine Zn excretion contributes to the formation of renal calculi. Hydrochlorothiazide produced a striking and sustained increase in urinary Zn excretion, which might contribute to the efficacy of this drug in the prevention of calcific renal stones. Serum Zn levels remained normal in the majority of subjects on long term thiazide therapy, but the occasional finding of subnormal levels suggests that long term thiazide therapy carries with it the hazard of Zn deficiency.

Female↗
PubMed1975

The influence of calcium content of water, intake of vegetables and fruit and of other food factors upon the incidence of renal calculi.

An area of high incidence of renal calculi in Northern England and Scotland has been found to coincide with an area of soft water supply. However, in Wales and South West England the equation of soft water with high incidence of urolithiasis is lacking, and an enquiry into regional variations in diet reveals that a high intake of fruit and vegetables may protect against renal calculi.

Calcium, Dietary↗
PubMed1978

Effects of ethylenediaminetetraacetic acid-4 sodium solution on the surface of renal calculi and the uroepithelium.

Tetrasodium ethylenediaminetetraacetic acid is one of the most effective agents that dissolve renal calculi, especially calculi containing calcium. To study the dissolving process of calculi in solutions, with or without trypsin, serial thin sections of renal calculi composed of calcium oxalate and/or phosphate were prepared and observed by polarizing microscopy. The effects of the solution on the surface of human renal calculi and rat uroepithelium also were studied by scanning electron microscopy. A remarkable difference in solubility was noted between the crystalline and the amorphous components in struvite calculi. Under the polarizing microscope the dissolving effect of 5 per cent tetrasodium ethylenediaminetetraacetic acid solution on struvite after 30 minutes of incubation was equivalent to the use of saline for 24 hours. The effect of trypsin was not apparent. However, under the scanning electron microscope trypsin accelerated the dissolving effect of the tetrasodium ethylenediaminetetraacetic acid solution in struvite and calcium oxalate calculi. The contradictory findings of the ineffectiveness of trypsin on the thin sections as opposed to the pronounced changes seen on the surface of the calculi could be attributed to the difference in the exposed area. The results suggest that trypsin does not seem to dissolve calculi but mainly facilitates the solution to permeate the calculi. The cellular arrangement of the uroepithelium was preserved in tetrasodium solution and in 0.04 per cent trypsin tetrasodium ethylenediaminetetraacetic acid solution.

Animals↗
PubMed1978

Ultrasonic evaluation of renal calculi.

Nine patients with radiographic evidence of renal calculi were evaluated with gray scale renal ultrasonography. A characteristic "sonic shadow" caused by the calculus was adequately demonstrated in each case. This paper discusses the advantage of ultrasound in evaluating the presence of nonopaque and opaque renal stones.

Humans↗
PubMed1976

Branched renal calculi.

Surgical operation on 30 kidneys was carried out for branched renal calculi, with no operative mortality. Of 23 kidneys in which conservative surgical procedures were used, 83 percent are now stone-free. When all stones were successfully removed, cultures of urine were sterile in 80 percent of cases, but when fragments remained, no patient was infection-free. It was found that impaired renal function need not be a contraindication to surgical operation, and indeed that in five of seven patients with impaired renal function, serum creatinine levels either remained stable or improved. We believe that surgical removal is the most conservative management of branched renal calculi.

Adult↗
PubMed1978

Ultrasonic detection of nonopaque renal calculi.

Four patients with 5 nonopaque renal calculi composed of uric acid were examined by ultrasound. The calculi varied in size from a 1.5 X 1.5-cm intrapelvic stone to a staghorn calculus measuring 4 cm. All stones were satisfactorily imaged by ultrasound, allowing a diagnosis of nephrolithiasis to be made with confidence in each case. In 2 patients with poor excretion on urography, the diagnosis was not suspected prior to the ultrasound examination. The authors feel that ultrasound has great potential value in the investigation of nonopaque filling defects of the renal pelvis and in patients with urographic nonvisualization who have a high risk of uric acid lithiasis.

Adult↗
PubMed1975

Renal calculi and biochemical abnormalities. In children with myelomeningocele and heoconduit diversion.

Of 38 pediatric cases of ileoconduit urinary diversion of myelomeningocele, 4 with renal calculi are presented. An increased risk of renal calculus formation may be imposed on children with myelomeningocele with ileoconduit urinary diversion especially so in functionally and anatomically abnormal kidneys and in chronic renal infection with urea-splitting bacteria. It is not clear why the ileoconduit procedure should increase the incidence of renal calculi in such children.

Adolescent↗
PubMed1978

[Advances in the surgical treatment of renal calculi (author's transl)].

The most important advances in the surgical management of renal calculi are reviewed and the following current concepts are discussed: operation of the kidney in situ with dorsal muscle-sparing lumbotomy; intrasinusal pyelolithotomy as a modern principle of stone surgery; modern techniques for the localization and removal of stones from the renal pelvis (X-ray, ultrasound, coagulum pyelotomy); methods of hypothermal kidney preservation and operative techniques for staghorn calculi; and modes of surgical stone prophylaxis.

Humans↗
PubMed1979

Primary renal calculi: Anderson-Carr-Randall progression?

Although numerous reports deal with the histology of renal medullary calcification, there has been only limited application of radiographic methods for its description. From routine autopsy material, findings on 61 kidneys studied by high resolution radiography are presented and related to those of Randall (1937), Anderson (1945), Carr (1954), and others. Histologically Anderson found microscopic plaques formed from coalesced calcific "droplets" in the pyramids of practically all of 168 kidneys, including some very young infants. Carr, using microradiographic techniques, also found calcific deposits in nearly all of 209 kidneys from patients over 9 years of age. Anderson and Car separately concluded that the calcific deposits they demonstrated could, by migration, form the subepithelial plaques that Randall observed earlier. The present work illustrates some radiologic aspects of renal calcification which seem to support a hypothesis that primary renal calculi result, under certain circumstances, from the migration of calcific deposits from the substance to the surface of renal papillae. In order to emphasize the pathogenetic sequence of the work of the previously mentioned authors, it is proposed that the sequence of events be referred to as the Anderson-Carr-Randall morphologic progression of primary renal calculus formation. Proposals are made for additional experimental work.

Adolescent↗
PubMed1976

Oral methylene blue and the dissolution of renal calculi.

Oral methylene blue therapy was not effective in dissolving non-obstructive renal calculi in 26 patients but it may prevent new stone formation in patients with metabolically active urolithiasis. The use of methylene blue therapy in combination with other regimens having different mechanisms of stone inhibition is recommended to further improve results.

Administration, Oral↗
PubMed1975

The effect of thiazide diuretics on carbohydrate-induced calciuria in patients with recurrent renal calculi.

Thiazide diuretics could have a beneficial effect in the prevention of recurrent renal calculi by decreasing the exaggerated calciuria which follows carbohydrate ingestionin patients who form calcium oxalate stones. The calciuric response to 100Gm. or oral glucose was studied in 21 patients with recurrent calcium stones before and after 6 months of hydrochlorothiazide therapy...

Adult↗
PubMed1979

The qualitative analysis of renal calculi with the polarising microscope.

The crystallographic method of Prien and Frondel for the qualitative analysis of renal calculi has been employed for seventeen years. The method was supplemented by occasional chemical tests. Advantages of the crystallographic method over other procedures are the ability to identify specific minerals even in trace amounts, the capability to analyse very small stones, and the rapidity with which analyses can be performed. Data are presented for 1653 calculi.

Humans↗
PubMed1977

Intraoperative localization of renal calculi during nephrolithotomy by ultrasound scanning.

An ultrasound B-scan probe has proved to be useful in the intraoperative localization of renal calculi. The probe is small, readily available and produces an anatomical cross-sectional image of the kidney. The use of a 10 MHz. frequency probe enables 2 to 3 mm. stones to be detected readily. Calibration of the screen and the use of a fine needle inserted into the kidney under ultrasound control provide for precise 3-dimensional localization of the stone to facilitate its removal. The method has been successful in accomplishing the complete removal of small stones or residual fragments in 7 of 11 patients in whom it has been used. The method requires some experience in the use of the probe and in the interpretation of the ultrasound image.

Adult↗
PubMed1976

Subcapsular pyelolithotomy for recurrent renal calculi.

Subcapsular pyelolithotomy was performed in 28 patients who had earlier undergone either one or more operations in the same kidney for renal calculi. This approach was useful in salvaging the kidney even in the presence of dense perirenal and periureteric adhesions obscuring the normal anatomy of these structures. Serious consideration should be given to this procedure before making the decision to perform nephrectomy in such cases. Surgical technique and the results are discussed.

Adult↗