Nephrolithiasis. Current concepts in pathogenesis and management.
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Biomedical subjects
Publications and source records attributed to L H Smith.
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The effect of hydroxypyruvate on synthesis of oxalate and glycolate from glyoxylate was studied in in vitro preparations from normal human erythrocytes and leukocytes, rat liver, and with purified lactate dehydrogenase from beef heart. In the presence of reduced nicotinamide adenine dinucleotide, hydroxypyruvate stimulated the oxidation of glyoxylate to oxalate and decreased the reduction of glyoxylate to glycolate. These findings may explain the hyperoxaluria seen in L-glyceric aciduria (type II primary hyperoxaluria).
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Serum immunoreactive parathyroid hormone (IPTH) was measured by radioimmunoassay in 54 patients with primary hyperparathyroidism and in 18 consecutive patients with ectopic hyperparathyroidism due to nonparathyroid cancer without apparent skeletal metastasis. Although serum calcium concentration was higher in the group with ectopic hyperparathyroidism, serum IPTH was lower (rank sum test, P < 0.001) and was undetectable in eight. A second anti-PTH antiserum also differentiated between IPTH in the two groups, although IPTH was undetectable in only 1 of 14 sera. When IPTH values in serial dilutions were plotted, slopes for the two patients with ectopic hyperparathyroidism who had relatively high IPTH were less (P < 0.001) than slopes for standard hyperparathyroid sera. By using differences in either IPTH rank or slope of the dilutional curve of sera, primary hyperparathyroidism could be excluded as a cause of the hypercalcemia in 16 of the 18 patients with ectopic hyperparathyroidism. The data are interpreted as indicating that PTH-like material in the serum of these patients with ectopic hyperparathyroidism is immunologically different from the PTH in the serum of patients with primary hyperparathyroidism.
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