Skip to main content
SpringerLink
Log in

Prevalence and densitometric characteristics of incomplete distal renal tubular acidosis in men with recurrent calcium nephrolithiasis

  • Original Paper
  • Published:
Urological Research Aims and scope Submit manuscript

Abstract

The aim of this study was to assess the prevalence of incomplete distal renal tubular acidosis (idRTA) in men with recurrent calcium nephrolithiasis and its potential impact on bone mineral density. We conducted a retrospective analysis of 150 consecutive, male idiopathic recurrent calcium stone formers (RCSFs), which had originally been referred to the tertiary care stone center of the University Hospital of Berne for further metabolic evaluation. All RCSFs had been maintained on a free-choice diet while collecting two 24-h urine samples and delivered second morning urine samples after 12 h fasting. Among 12 RCSFs with a fasting urine pH >5.8, a modified 3-day ammonium chloride loading test identified idRTA in 10 patients (urine pH >5.32, idRTA group). We matched to each idRTA subject 5 control subjects from the 150 RCSFs, primary by BMI and then by age, i.e., 50 patients, without any acidification defect (non-RTA group) for comparative biochemistry and dual energy X-ray absorptiometry (DEXA) analyses. The prevalence of primary idRTA among RCSFs was 6.7% (10/150). Patients with idRTA had significantly higher 2-h fasting and 24-h urine pH (2-h urine pH: 6.6 ± 0.4 vs. 5.2 ± 0.1, p = 0.001; 24-h urine pH: 6.1 ± 0.2 vs. 5.3 ± 0.3, p = 0.001), 24-h urinary calcium excretion (7.70 ± 1.75 vs. 5.69 ± 1.73 mmol/d, p = 0.02), but significantly lower 24-h urinary urea excretion (323 ± 53 vs. 399 ± 114 mmol/d, p = 0.01), urinary citrate levels (2.32 ± 0.82 vs. 3.01 ± 0.72 mmol/d, p = 0.04) and renal phosphate threshold normalized for the glomerular filtration rate (TmPO4/GFR: 0.66 ± 0.17 vs. 0.82 ± 0.21, p = 0.03) compared to non-RTA patients. No significant difference in bone mineral density (BMD) was found between idRTA and non-RTA patients for the lumbar spine (LS BMD (g/cm2): 1.046 ± 0.245 SD vs. 1.005 ± 0.119 SD, p = 0.42) or femoral neck (FN BMD (g/cm2): 0.830 ± 0.135 SD vs. 0.852 ± 0.127 SD). Thus, idRTA occurs in 1 in 15 male RCSFs and should be sought in all recurrent calcium nephrolithiasis patients. Bone mineral density, however, does not appear to be significantly affected by idRTA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

idRTA:

Incomplete distal renal tubular acidosis

Non-RTA:

Non-idRTA recurrent stone formers

BMD:

Bone mineral density

LS:

Lumbar spine

FN:

Femoral neck

DEXA:

Dual energy X-ray absorptiometry

SD:

Standard deviation

References

  1. Pietschmann F, Breslau NA, Pak CY (1992) Reduced vertebral bone density in hypercalciuric nephrolithiasis. J Bone Miner Res 7(12):1383–1388

    Article  PubMed  CAS  Google Scholar 

  2. Hess B, Casez JP, Takkinen R, Ackermann D, Jaeger P (1993) Relative hypoparathyroidism and calcitriol up-regulation in hypercalciuric calcium renal stone formers–impact of nutrition. Am J Nephrol 13(1):18–26

    Article  PubMed  CAS  Google Scholar 

  3. Fuss M, Gillet C, Simon J, Vandewalle JC, Schoutens A, Bergmann P (1983) Bone mineral content in idiopathic renal stone disease and in primary hyperparathyroidism. Eur Urol 9(1):32–34

    PubMed  CAS  Google Scholar 

  4. Jaeger P, Lippuner K, Casez JP, Hess B, Ackermann D, Hug C (1994) Low bone mass in idiopathic renal stone formers: magnitude and significance. J Bone Miner Res 9(10):1525–1532

    Article  PubMed  CAS  Google Scholar 

  5. Gluck SL (1998) Acid–base. Lancet 352(9126):474–479

    Article  PubMed  CAS  Google Scholar 

  6. Hess B (2006) Acid–base metabolism: implications for kidney stones formation. Urol Res 34(2):134–138

    Article  PubMed  CAS  Google Scholar 

  7. Domrongkitchaiporn S, Pongsakul C, Stitchantrakul W, Sirikulchayanonta V, Ongphiphadhanakul B, Radinahamed P, Karnsombut P, Kunkitti N, Ruang-raksa C, Rajatanavin R (2001) Bone mineral density and histology in distal renal tubular acidosis. Kidney Int 59(3):1086–1093

    Article  PubMed  CAS  Google Scholar 

  8. Evan AP, Lingeman J, Coe F, Shao Y, Miller N, Matlaga B, Phillips C, Sommer A, Worcester E (2007) Renal histopathology of stone-forming patients with distal renal tubular acidosis. Kidney Int 71(8):795–801

    Article  PubMed  CAS  Google Scholar 

  9. Osther PJ, Bollerslev J, Hansen AB, Engel K, Kildeberg P (1993) Pathophysiology of incomplete renal tubular acidosis in recurrent renal stone formers: evidence of disturbed calcium, bone and citrate metabolism. Urol Res 21(3):169–173

    Article  PubMed  CAS  Google Scholar 

  10. Weger W, Kotanko P, Weger M, Deutschmann H, Skrabal F (2000) Prevalence and characterization of renal tubular acidosis in patients with osteopenia and osteoporosis and in non-porotic controls. Nephrol Dial Transplant 15(7):975–980

    Article  PubMed  CAS  Google Scholar 

  11. Hess B, Michel R, Takkinen R, Ackermann D, Jaeger P (1994) Risk factors for low urinary citrate in calcium nephrolithiasis: low vegetable fibre intake and low urine volume to be added to the list. Nephrol Dial Transplant 9(6):642–649

    PubMed  CAS  Google Scholar 

  12. Stitchantrakul W, Kochakarn W, Ruangraksa C, Domrongkitchaiporn S (2007) Urinary risk factors for recurrent calcium stone formation in Thai stone formers. J Med Assoc Thai 90(4):688–698

    PubMed  Google Scholar 

  13. Pongchaiyakul C, Domrongkitchaiporn S, Stitchantrakul W, Chailurkit L-O, Rajatanavin R (2004) Incomplete renal tubular acidosis and bone mineral density: a population survey in an area of endemic renal tubular acidosis. Nephrol Dial Transplant 19(12):3029–3033

    Article  PubMed  Google Scholar 

  14. Deutschmann HA, Weger M, Weger W, Kotanko P, Deutschmann MJ, Skrabal F (2002) Search for occult secondary osteoporosis: impact of identified possible risk factors on bone mineral density. J Intern Med 252(5):389–397

    Article  PubMed  CAS  Google Scholar 

  15. Sharma AP, Sharma RK, Kapoor R, Kornecki A, Sural S, Filler G (2007) Incomplete distal renal tubular acidosis affects growth in children. Nephrol Dial Transplant 22(10):2879–2885

    Article  PubMed  Google Scholar 

  16. Nimmannit S, Malasit P, Susaengrat W, Ong-Aj-Yooth S, Vasuvattakul S, Pidetcha P, Shayakul C, Nilwarangkur S (1996) Prevalence of endemic distal renal tubular acidosis and renal stone in the northeast of Thailand. Nephron 72(4):604–610

    Article  PubMed  CAS  Google Scholar 

  17. Prie D, Beck L, Friedlander G, Silve C (2004) Sodium-phosphate cotransporters, nephrolithiasis and bone demineralization. Curr Opin Nephrol Hypertens 13(6):675–681

    Article  PubMed  CAS  Google Scholar 

  18. Lemann J Jr, Litzow JR, Lennon EJ (1966) The effects of chronic acid loads in normal man: further evidence for the participation of bone mineral in the defense against chronic metabolic acidosis. J Clin Invest 45(10):1608–1614

    Article  PubMed  CAS  Google Scholar 

  19. Jehle S, Zanetti A, Muser J, Hulter HN, Krapf R (2006) Partial neutralization of the acidogenic Western diet with potassium citrate increases bone mass in postmenopausal women with osteopenia. J Am Soc Nephrol JASN 17(11):3213–3222

    Article  CAS  Google Scholar 

  20. Sebastian A, Harris S, Ottaway J, Todd K, Morris R (1994) Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. N Engl J Med 330(25):1776

    Article  PubMed  CAS  Google Scholar 

  21. Keven K, Ozturk R, Sengul S, Kutlay S, Ergun I, Erturk S, Erbay B (2007) Renal tubular acidosis after kidney transplantation—incidence, risk factors and clinical implications. Nephrol Dial Transplant 22(3):906–910

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Osteoporosis Policlinic, University Hospital and University of Berne, Freiburgstrasse, Berne, 3010, Berne, Switzerland

    Spyridon Arampatzis, Barbara Röpke-Rieben & Kurt Lippuner

  2. Internal Medicine and Nephrology, Klinik Im Park, Zurich, Switzerland

    Bernhard Hess

  3. University of Zurich, Zurich, Switzerland

    Bernhard Hess

Authors
  1. Spyridon Arampatzis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Barbara Röpke-Rieben
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kurt Lippuner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bernhard Hess
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Spyridon Arampatzis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arampatzis, S., Röpke-Rieben, B., Lippuner, K. et al. Prevalence and densitometric characteristics of incomplete distal renal tubular acidosis in men with recurrent calcium nephrolithiasis. Urol Res 40, 53–59 (2012). https://doi.org/10.1007/s00240-011-0397-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00240-011-0397-3

Keywords

Search

Navigation