Summary
Urinary acidification, bone metabolism and urinary excretion of calcium and citrate were evaluated in 10 recurrent stone formers with incomplete renal tubular acidosis (RTA), 10 recurrent stone formers with normal urinary acidification (NUA) and 10 normal controls (NC). Patients with iRTA had lower plasma standard bicarbonate after fasting (P<0.01) and lower urinary excretion of titratable acid (P<0.05) and citrate (P<0.01) compared with NUA patients and NC, and higher urinary excretion of ammonia (P<0.05) compared with NC (P<0.05). Hypercalciuria was found in 6 of 10 patients with iRTA compared with 3 of 10 with NUA, and O of 10 NC. The citrate/calcium ratio in urine was significantly reduced in iRTA compared with the value in NUA (P<0.01), and in NUA compared with NC (P<0.05). Biochemical markers of bone formation (serum osteocalcin) and bone resorption (urinary hydroxyproline) were significantly increased in iRTA compared with NUA and NC (P<0.01), indicating increased bone turnover in stone formers with iRTA. Stone formers with iRTA thus presented with disturbed calcium, bone and citrate metabolism-the same metabolic abnormalities which characterize classic type 1 RTA. Mild non-carbonic acidosis during fasting may be a pathophysilogical factor of both nephrolithiasis and disturbed bone metabolism in stone formers with iRTA
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Backman U, Danielson BG, Johanson G, Ljunghall S, Wikström B (1980) Incidence and clinical importance of tubular defects in recurrent renal stone formers. Nephron 25:96
Baginski ES, Foà PP, Zak B (1967) Microdetermination of inorganic phosphate, phospholipids, and total phosphate in biological materials. Clin Chem 13:326
Battle D (1983) Renal tubular acidosis. Med Clin North Am 67:859
Buckalew VM Jr (1985) Nephrolithiasis in renal tubular acidosis. J Urol 141:731
Buckalew VM Jr, Caruana RJ (1985) The pathophysiology of distal (type 1) renal tubular acidosis. In: Gonick HC, Buckalew VM Jr. (eds) Renal tubular disorders: pathophysiology, diagnosis, and management. Dekker, New York, p 357
Buckalew VM Jr, McCurdy DK, Ludwig GD, Chaykin LB, Elkinton JR (1968) Incomplete renal tubular acidosis: physiologic studies in three patients with a defect in lowering urine pH. Am J Med 48:32
Caruana RJ, Buckalew VM Jr (1988) The syndrome of distal (type 1) renal tubular acidosis. Medicine (Baltimore) 67:84
Gault MH, Parfrey PS, Robertson WG (1988) Idiopathic calcium phosphate nephrolithiasis. Nephron 48:265
Jørgensen K (1957) Trimetric determination of the net excretion of acid/base in urine. Scand J Clin Lab Invest 9:287
Kildeberg P (1983) Acid-base status of biological fluids: amount of acid, kind of acid, anion-cation difference, and buffer value. Scand J Clin Lab Invest 43:103
McSherry E, Morris RC Jr (1978) Attainment and maintenance of normal stature with alkali therapy in infants and children with classic renal tubular acidosis. J Clin Invest 61:509
Nicar MJ, Skurla C, Sakhaee K, Pak CYC (1983) Low urinary citrate excretion in nephrolithiasis. Urology 21:8
Osther PJ, Hansen AB, Røhl HF (1988) Renal acidification defects in medullary sponge kidney. Br J Urol 61:392
Osther PJ, Hansen AB, Røhl HF (1989) Screening renal stone formers for distal renal tubular acidosis. Br J Urol 63:581
Parks JH, Coe FL (1986) A urinary calcium-citrate index for the evaluation of nephrolithiasis. Kidney Int 30:85
Pødenphant J, Larsen N-E, Christiansen C (1984) An easy and reliable method for determination of urinary hydroxyproline. Clin Chim Acta 142:145
Pohlman T, Hruska KA, Menon M (1977). Renal tubular acidosis. J Urol 132:431
Preminger GM, Sakhaee AK, Skurla C, Pak CYC (1985) Prevention of recurrent calcium stone formation with potassium citrate therapy in patients with distal renal tubular acidosis. J Urol 134:20
Richards P, Chamberlain MJ, Wrong OM (1972) Treatment of osteomalacia of renal tubular acidosis by sodium bicarbonate alone. Lancet II:994
Rodríguez-Soriano J, Vallo A, Castillo G, Oliveros R (1985) Pathophysiology of primary distal renal tubular acidosis. Int J Pediatr Nephrol 6:77
Schneeberger W, Hesse A, Vahlensieck W (1992) Recurrent nephrolithiasis in renal tubular acidosis: metabolic profiles, therapy and course. Urol Res 20:98
Sebastian A, Morris RC Jr (1977) Renal tubular acidosis. Clin Nephrol 7:216
Seldin DW, Wilson JD (1966) Renal tubular acidosis. In: Stanbury JB, Wyngaarden JB, Fredrickson DS (eds) The metabolic basis of inherited disease. McGraw-Hill, New York, p 1230
Steinicke T, Mosekilde L, Christensen MS, Melsen F (1989) A histomorphometric determination of iliac bone remodeling in patients with recurrent renal stone formation and idiopathic hypercalcuria. APMIS 97:309
Tannen RL, Falls WF, Brackett NC (1975) Incomplete renal tubular acidosis: some clinical and physiological features. Nephron 15:111
Warty VS, Busch RP, Virji MA (1984) A kit for citrate in foodstuffs adapted for assay of serum and urine. Clin Chem 30:1231
Williams G, Chisholm GD (1976) Stone screening and follow-up are necessary? Br J Urol 47:745
Wrong O, Davies HEF (1959) The excretion of acid in renal disease. Q J Med 28:259
Wrong OM, Feest TG (1980) The natural history of distal renal tubular acidosis. Contrib Nephrol 21:137
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Osther, P.J., Bollerslev, J., Hansen, A.B. et al. Pathophysiology of incomplete renal tubular acidosis in recurrent renal stone formers: evidence of disturbed calcium, bone and citrate metabolism. Urol. Res. 21, 169–173 (1993). https://doi.org/10.1007/BF00590032
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DOI: https://doi.org/10.1007/BF00590032