Therapeutic Modalities for the Prevention of Nephrolithiasis

  • Wolfgang Tschöpe
  • Reinhold Horsch
  • Eberhard Ritz
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 208)


For a critical analysis of recurrent calcium nephrolithiasis, it is useful to view the problem in broader phylogenetic perspective. Ridding the organism of Ca, Pi and oxalate is a formidable task. Lower species, e.g. bryozoa or tunicates pack their excreta, including calcium, into excretory cells of the cuticule or the gastrointestinal tract from which they are shed into the ambient sea water (1). In insects, calcium is normally excreted in the form of microconcrements via the Malpighian tubules, i.e. their aglomerular excretory ducts. The work of Wessing et al. (2) demonstrated that Malpighian tubule fluid contains numerous small microliths, 5 µm across, with concentric lamellae containing Ca, Pi or oxalate within a mucopolysaccharide matrix. Such phylogenetic examples illustrate the difficulty of excreting Ca and oxalate without incurring the risk of nephrolithiasis. Viewed against this background it is remarkable that mammalians acquired the ability to excrete supersaturated urine without formation of concrements. Indeed it is surprising that nephrolithiasis, i.e. breakdown of protective systems against crystal growth in the mammalian excretory ducts, does not occur more frequently.


Malpighian Tubule Magnesium Hydroxide Stone Recurrence Calcium Stone Idiopathic Hypercalciuria 
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Copyright information

© Plenum Press, New York 1986

Authors and Affiliations

  • Wolfgang Tschöpe
    • 1
  • Reinhold Horsch
    • 1
  • Eberhard Ritz
    • 1
  1. 1.Department Internal Medicine and UrologyUniversity of HeidelbergGermany

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