Metabolic Study of Calcium Nephrolithiasis

Kim, Jae Hyung; Chai, Soo Eung

Abstract

Urinary stones are mainly calcium stones and over a half of calcium stone patients are hypercalciuric. And about half of calcium stones are thought to be recurrent in 5 years. Renal tubular acidosis and hyperparathyroidism are the well known causes of the hypercalciuria but majority was categorized as the idiopathic hypercalciuria. Recently, metabolic derangements of idiopathic hypercalciuria were identified and classified according to responses to the calciums restriction, fasting and loading. And reasonable treatments were tried to prevent the recurrence according to the types and notable results were reported. We have performed metabolic study of calcium nephrolithiasis in 50 patients since June 1983. The results were as the followings: 1. In 31 stone analysis, 29 were calcium stones. 14 were calcium oxalate, 4 were calcium phosphate, 10 were calcium oxalate and phosphate and one was calcium oxalate and magnesium ammonium phosphate. 2. 24 of 50 patients were hypercalciuria. 3. One was resorptive type: In usual diet, serum Ca, P, PTH were 13.4 mg%, 2.9mg %, 6053 pg/ ml respectively and urine Ca was 806 mg/day. In fasting, urine Ca was 1.00 mg/mg of urine creatinine 4. 6 were renal type: In usual diet, serum Ca, P, PTH were 9.0+/-0.4 mg%, 3.8+/-0.4 mg%, 535+/-379pg /ml respectively and urine Ca was 226+/-75 mg/day. In fasting, urine Ca was 0.160+/-0.032 mg/ mg of urine creatinine. 5. 2 were absorptive type I : Urine Ca was 254 mg/day in usual, 204 mg/day in restriction, 0.087mg /mg of urine creatinine in fasting and 0.229 mg/mg of urine creatinine in loading. 6. 3 were absorptive type II : Urine Ca was 321+/-96 mg/day in usual, 164+/-18 mg/day in restriction, 0.096 mg/mg of urine creatinine in fasting and 0.215 mg/mg of urine creatinine in loading. 7. 6 were hyperuricosuric and 6 were unclassified hypercalciurias.