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Prevalence of distal renal tubular acidosis in patients with calcium phosphate stones

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Introduction and purpose

Distal renal tubular acidosis (DRTA) is a metabolic disorder that associates urolithiasis and urinary pH > 6. The prevalence of DRTA in patients with calcium phosphate stones is not well known. The objective is to determine the prevalence of DRTA in patients with calcium phosphate stones and urinary pH above 6 based on the furosemide test.


A total of 54 patients with calcium phosphate stones and urinary pH above 6.0 were submitted to the furosemide test. The association of DRTA with age, sex, type of stone, stone recurrence, stone bilaterality, 24-h urine biochemistry, and adverse effects of the furosemide test were examined.


The furosemide test indicated that 19 of 54 patients (35.2%) had DRTA. The sex ratio was similar in the two groups (p < 0.776). The DRTA group was significantly younger (p < 0.001), and had a higher prevalence of bilateral stones (p < 0.001), a higher prevalence of recurrent stones (p < 0.04), a lower plasma potassium level (p < 0.001), a higher urinary Ca level (p ≤ 0.05), and a lower urinary citrate level (p < 0.001). None of the patients reported adverse effects from the furosemide test.


There was a high prevalence of DTRA in patients with urinary pH above 6 and calcium phosphate stones. Young age, bilateral stones, stone recurrence, hypercalciuria, hypocitraturia, and plasma hypokalemia were associated with DRTA. None of the patients reported adverse effects of the furosemide test.

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Authors and Affiliations



JG: protocol/project development, data callection, , manuscript writing. AM: data collection, manuscript writing. VT: data collection. AS: data collection. JLB: data collection. AR: data collection. ML: data collection. FG: project development, manuscript writing. EP: protocol/project development, data callection, manuscript writing.

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Correspondence to Jordi Guimerà.

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None of the contributing authors have any conflicts of interest.

Research involving human participants and/or animals

The study was approved by the ethics committee of H. U. Son Espases (CI-70-15) and by the research ethics committee of the government of the Balearic Islands (IB 3128/15 PI) (CEI-IB), and conducted in accordance with the Declaration of Helsinki.

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All patients voluntarily accepted participation in the study and signed informed consent.

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Guimerà, J., Martínez, A., Tubau, V. et al. Prevalence of distal renal tubular acidosis in patients with calcium phosphate stones. World J Urol 38, 789–794 (2020).

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