Treatment of Renal Obstruction Caused by Cystine Crystals or Stones

Abstract

To the Editor.— In cystinuric subjects, cystine stone formation can be prevented by high fluid intake and alkalinization. 1 Cystine stone dissolution by this treatment has also been described. 2 Dent and Senior 3 had earlier shown that in patients with cystine stones, acute diuresis may increase cystine outputs owing to cystine stone dissolution. Successful conservative treatment of acute renal obstruction due to cystine crystals or stones has not, so far as we know, been reported. In three cystinuric men (aged 26, 28, and 52 years) seen in our department over a period of 20 years, unilateral kidney obstruction was revealed by iodohippurate sodium I 131 (Hippuran I 131) renogram or intravenous pyelogram. Whether the renal obstruction was caused by cystine crystals or stones could not be verified. Treatment was by high fluid intake, and intravenous infusion of sodium bicarbonate, 1.25% in saline solution, to maintain a urinary volume of 4