PubMed · 3962794
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R Caudarella, E Rizzoli, N Malavolta, B Severi, V Vasi, G Biagini. 1986. [Urinary crystalluria. A debatable problem].. https://pubmed.ncbi.nlm.nih.gov/3962794/
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There is considerable clinical evidence that the oral administration of potassium citrate significantly reduces the incidence of calcium oxalate stone formation in the urinary tract. The effectiveness of citrate ions in preventing stone formation could be due to the reduction in the concentrations of calcium and oxalate ions caused by complex ion formation with the citrate ions and/or due to the inhibition of the crystallisation of calcium oxalate. This paper reports an experimental study aimed at elucidating the role of citrate complexes in preventing urolithiasis. An experimental method is described which allows the identification of two hitherto unknown complexes CaOx cit3- and (Ca cit2)4-. The stability constants of these complexes have been determined, respectively, as log K = 4.54 +/- 0.08 and beta 2 cit = 5.15 +/- 0.14 (25 degrees C, I = 0.16). The inclusion of these complexes in ion-equilibrium calculations led to the conclusion that the effectiveness of the citrate ion in preventing calcium oxalate stone formation is due to its inhibition of agglomeration or growth of calcium oxalate crystals rather than any significant reduction in the degree of supersaturation of urine.
A 58-year-old female patient admitted to hospital for advanced renal failure had a 40 years' history of Crohn's disease and had undergone ileocecal resection. Nevertheless, chronic diarrhea persisted. Subsequently calcium oxalate stones in the urine were repeatedly observed. Progressive renal failure developed. The investigation of the patient showed severe steatorrhea and pronounced hyperoxaluria, and renal biopsy showed severe chronic interstitial nephritis with calcium oxalate crystals. The skin biopsy revealed severe calcium oxalate vasculitis. The pathophysiology and therapy of secondary hyperoxaluria due to small bowel resection are discussed.
Certain important aspects of the urine oxalate tolerance test (OTT) have been revised. The stirring system has been changed and the test has been adapted to the kinetics of calcium oxalate precipitation. True equilibrium conditions are now ensured during the measurements. Furthermore, the endogenous oxalate concentration is determined and taken into consideration. As a result of these changes, the significance of the test results has greatly improved. The effects of the addition of small amounts of zinc on the precipitation of calcium oxalate have been used in a new variation of the OTT. This new test makes it possible to discriminate much faster and more simply between recurrent stone-formers and other subjects. Tamm-Horsfall protein (THP) has been tested for its effect on the precipitation of calcium oxalate by means of OTT. THP inhibits the precipitation of calcium oxalate, but THP of stone-formers has a diminished inhibitory activity. The inhibitory activity of this protein strongly depends on the method by which it is isolated.