The Effects of Orthophosphate and Ion Binders
The composition and amount of our daily diet along with intestinal absorption plays an important role in determining the composition of urine. The concentration of the major urinary ions is related, at least in part, to dietary intake1–3. With this in mind it is not surprising that compounds that complex normal dietary ions such as calcium, oxalate or phosphate within the intestinal tract and prevent their absorption have been used in the management of specific disorders complicated by the formation of urinary calculi. Shorr suggested the use of phosphate-binders in association with a low phosphate diet for the management of patients with phosphatic stones4. This program was suggested particularly for the control of struvite infection stones. Sodium phytate was used in conjunction with dietary calcium restriction for the management of idiopathic hypercalciuria by several groups5,6. Later, cellulose phosphate was suggested for the complexation of calcium although in the initial report it seemed to be most useful as adjunctive therapy to thiazide diuretics when suppressing hypercalciuria7. Since these early reports other compounds that can complex the important crystal ions within the intestinal tract have been suggested but characteristic of each has been their lack of specificity in terms of ion complexation resulting in multiple changes in the composition of the urine with both adverse and beneficial effects. As a result of these inter-related changes it is not sufficient to consider only the effect of these compounds on the specific ion of interest, i.e., calcium or oxalate. Instead, one must observe the effect on all of the major ions present in urine as well as the physical chemical factors including the state of supersaturation and inhibitors.
KeywordsIrritable Bowel Syndrome Primary Hyperparathyroidism Stone Formation Renal Tubular Acidosis Urinary Calculus
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