Idiopathic Renal Lithiasis: New Developments in Evaluation and Treatment

  • Charles Y. C. Pak


The term “idiopathic” renal lithiasis refers to the various types of stones formed in the kidney for which there is no clearly identifiable cause. Recent advances in renal stone research, particularly in the clarification of pathogenetic mechanisms, have provided improved definition and necessitated reclassification of causes for Ca stones. The purpose of this discussion is to review our own scheme for classification of Ca urolithiasis, and to consider new developments in pathophysiology, diagnosis, and management.


Primary Hyperparathyroidism Renal Lithiasis Calcium Oxalate Urinary Oxalate Primary Hyperoxaluria 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Koch, J., Stokstad, E.L.R., Williams, H.E. and Smith, L.H., Jr.: Deficiency of 2-oxo-glutarate:glyoxylate carboligase activity in primary hyperoxaluria. Proc. Nat. Acad. Sci. 57: 1123, 1967.PubMedCrossRefGoogle Scholar
  2. 2.
    Williams, H.E. and Smith, L.H., Jr.: L-glyceric aciduria. A new genetic variant of primary hyperoxaluria. New Engl. J. Med. 278: 233, 1968.PubMedCrossRefGoogle Scholar
  3. 3.
    Dowling, R.H., Rose, G.A. and Sutor, D.J.: Hyperoxaluria and renal calculi in ileal disease. Lancet 1:1103, 1971.PubMedCrossRefGoogle Scholar
  4. 4.
    Chadwick, V.S., Modha, K. and Dowling, R.H.: Mechanism for hyperoxaluria in patients with ileal dysfunction. New Engl. J. Med. 289: 172, 1973.PubMedCrossRefGoogle Scholar
  5. 5.
    Smith, L.H., Fromm, H. and Hofmann, A.F.: Acquired hyperoxaluria, nephrolithiasis, and intestinal disease; description of a syndrome. New Engl. J. Med. 286: 1371, 1972.PubMedCrossRefGoogle Scholar
  6. 6.
    Coe, F.L. and Kavalach, A.G.: Hypercalciuria and hyperuricosuria in patients with calcium nephrolithiasis. New Engl. J. Med. 291:1344, 1974.PubMedCrossRefGoogle Scholar
  7. 7.
    Pak, C.Y.C. and Holt, K.: Nucleation and growth of brushite and calcium oxalate in urine of stone-formers. Metab. In press.Google Scholar
  8. 8.
    Pak, C.Y.C., Ohata, M., Lawrence, E.C. and Snyder, W.: The hypercalciurias: causes, parathyroid functions and diagnostic criteria. J. Clin. Invest. 54:387, 1974.PubMedCrossRefGoogle Scholar
  9. 9.
    Pak, C.Y.C., Kaplan, R.A., Townsend, J. and Waters, O.: A simple test for the diagnosis of absorptive, resorptive, and renal hypercalciurias. New Engl. J. Med. 292:497, 1975.PubMedCrossRefGoogle Scholar
  10. 10.
    Nordin, B.E.C., Peacock, M. and Wilkinson, R.: Hypercalciuria and calcium stone disease. In: Clinics in Endocrinology and Metabolism. Vol. 1, No. 1. I. McIntyre, ed. W. B. Saunders Company, Philadelphia, p. 169, 1972.Google Scholar
  11. 11.
    Coe, F.L., Canterbury, J.M., Firpo, J.J. and Reiss, E.: Evidence for secondary hyperparathyroidism in idiopathic hypercalciuria. J. Clin. Invest. 52:134, 1973.PubMedCrossRefGoogle Scholar
  12. 12.
    Pak, C.Y.C., Barilla, D., Bone, H. and Northcutt, C.: Medical management of renal calculi. Symposium on Advances in Endocrinology and Metabolism. Hahnemann Medical College & Hospital of Philadelphia, Philadelphia, Pa., 1976. In press.Google Scholar
  13. 13.
    Coe, F.L. and Raisen, L.: Allopurinol treatment of uric-acid disorders in calcium-stone formers. Lancet 1: 129, 1973.PubMedCrossRefGoogle Scholar
  14. 14.
    Kaplan, R.A., Haussier, M. and Pak, C.Y.C.: In preparation.Google Scholar
  15. 15.
    Haussler, M.R., Bursac, K.M., Bone, H. and Pak, C.Y.C.: Increased circulating lα,25-dihydroxyvitamin D3 in patients with primary hyperparathyroidism. Clin. Res. 23: 322A, 1975.Google Scholar
  16. 16.
    Coe, F.L., Lawton, R.L., Goldstein, R.B. and Tembe, V.: Sodium urate accelerates precipitation of calcium oxalate in vitro. Proc. Soc. Exp. Biol. Med. 149:926, 1975.PubMedGoogle Scholar
  17. 17.
    Pak, C.Y.C. and Arnold, L.H.: Heterogeneous nucleation of calcium oxalate by seeds of monosodium urate. Proc. Soc. Exp. Biol. Med. 149: 930, 1975.PubMedGoogle Scholar
  18. 18.
    Finlayson, B. and Smith, A.: Stability of first dissociable photon of uric acid. J. Chem. Engineer. Data 19:94, 1974.CrossRefGoogle Scholar
  19. 19.
    Pak, C.Y.C.: Sodium cellulose phosphate: Mechanism of action and effect on mineral metabolism. J. Clin. Pharm. 13:15, 1973.Google Scholar
  20. 20.
    Hayashi, Y., Kaplan, R.A. and Pak, C.Y.C.,: Effect of sodium cellulose phosphate therapy on crystallization of calcium oxalate in urine. Metab. 24:1273, 1975.CrossRefGoogle Scholar
  21. 21.
    Pak, C.Y.C.: Effects of cellulose phosphate and of sodium phosphate on the formation product and activity product of brushite in urine. Metab. 21:447, 1972.CrossRefGoogle Scholar
  22. 22.
    Fleisch, H., Bisaz, S. and Care, A.D.: Effect of orthophosphate on urinary pyrophosphate excretion and the prevention of urolithiasis. Lancet 1:1065, 1964.PubMedCrossRefGoogle Scholar
  23. 23.
    Smith, L.H., Thomas, W.C., Jr. and Arnaud, C.D.: Orthophosphate therapy in calcium renal lithiasis. In: Urinary Calculi. International Symposium Renal Stone Research, Madrid, 188–197. Karger, Basel 1973.Google Scholar
  24. 24.
    Shen, F., Baylink, D., Nielson, R., Hughes, M. and Haussler, M.: Increased serum 1, 25-dihydroxycholecalciferol (1, 25-di-OHD3) in patients with idiopathic hypercalciuria (IH). Clin. Res. 23:423A, 1975.Google Scholar
  25. 25.
    Ohata, M. and Pak, C.Y.C.: The effect of diphosphonate on calcium phosphate crystallization in urine in vitro. Kidn. Intern. 4:401, 1973.CrossRefGoogle Scholar
  26. 26.
    Pak, C.Y.C., Ohata, M. and Holt, K.: Effect of diphosphonate on crystallization of calcium oxalate in vitro. Kidn. Intern. 7:154, 1975.CrossRefGoogle Scholar
  27. 27.
    Pak, C.Y.C.: Physicochemical and clinical aspects of nephrolithiasis. International Colloquium on Renal Lithiasis. January 24–26, University of Florida, Gainesville, Florida, 1976. In press.Google Scholar
  28. 28.
    Ohata, M. and Pak, C.Y.C.: Preliminary study of the treatment of nephrolithiasis (calcium stones) with diphosphonate. Metab. 23:1167, 1974.CrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1976

Authors and Affiliations

  • Charles Y. C. Pak
    • 1
  1. 1.Southwestern Medical School, Department Internal MedicineThe University of Texas Health Science Center at DallasDallasUSA

Personalised recommendations