[Excretion of hydrogen ions and uric acid by the kidneys in patients with urate nephrolithiasis].
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A case is presented of a female patient with recurrent calcium renal calculosis, chronic calculous pyelonephritis and chronic renal failure II degree to whom an oral calcium tolerance test was performed. The data of the test are characteristic for parathyroid hyperfunction. The possible cause of these changed is discussed. The conclusion is reached that the oral calcium tolerance test is of differential diagnostic value in patients with initial renal failure, too.
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We compared epidemiological risk factors and urine excretion of calcium, phosphate, uric acid, urea nitrogen, sodium, potassium, and fluid volume in recurrent idiopathic calcium stone-formers and in a control group of age- and sex-matched normal volunteers. Stone-formers were less likely than normal subjects to have followed a low-calorie diet, but body weight did not differ between the two groups. Daily urine calcium excretion was a graded risk factor for stone formation throughout its range. Daily urine urea nitrogen and potassium excretion were lower in stone-formers than in controls, but excretion of uric acid, sodium, phosphate, and creatinine did not differ. However, there were positive associations between urine calcium excretion and the urine excretion of sodium, urea nitrogen, uric acid, phosphate, and creatinine in stone-formers; and these associations were significantly stronger than in normal subjects. We conclude that urine calcium excretion is a major risk factor for idiopathic calcium stone formation, but cannot confirm such a role for urine uric acid excretion. Total dietary protein intake may be lower in stone-formers than in controls. However, stone-formers may be more sensitive than normal subjects to the calciuric effects of protein and sodium. A strong association of urine calcium excretion with urine phosphate excretion in stone-formers is probably independent of dietary protein intake.
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