Urinary calculi. Clinical, biochemical and radiological studies in 619 patients.

Abstract

1. Six hundred and nineteen consecutive patients (399 males, 220 females) with urinary calculi were investigated. 2. Sixty-nine per cent of the patients first developed symptoms of urolithiasis between the ages of 20 and 49 years. The age onset of symptoms was significantly higher in male than in female stone-formers. 3. Stone-formers gave a history of diarrhœa significantly more often than did the controls. Attacks of diarrhoea occurred amongst patients with calcium stones as well as amongst uric-acid stone formers. 4. A family history of renal calculi was obtained significantly more often from the stone-formers than from the controls. 5. Nineteen patients (2.9%) had primary hyperparathyroidism proven histologically. This condition was strongly suspected in five further cases. 6. One hundred and forty-seven normocalcæmic patients (28% of those with adequate data) were hypercalciuric on at least one occasion. One hundred and twenty-seven of these were males. They were significantly heavier than male stone-formers without demonstrable metabolic abnormalities. 7. The 24-hour urinary excretion of magnesium was significantly higher amongst hypercalciuric patients than amongst those who were normocalciuric. 8. Twenty-nine patients (4.7%) were considered to have uric-acid stones. These patients were significantly older and heavier than the patients whose stones consisted of material other than urate. 9. Medullary sponge kidneys were diagnosed in 16 cases. In the large majority of these cases, the the urine was acidified normally. 10. Ten patients had renal tubular acidosis (1.6%). This condition was suspected in 10 further patients. 11. Urinary tract infection was more common amongst stone formers than amongst control subjects. Female stone-formers had urinary infections more commonly than male stone-formers, and female patients with a history of analgesic consumption had urinary infections more frequently than female patients without such a history. 12. Nephrocalcinosis was observed in 53 patients. Twenty-four of these either had a history of analgesic abuse or showed radiological evidence of medullary sponge kidney. 13. There were four cystinurics. Three of these developed symptoms before the age of 20 years. 14. In half the cases, no cause for stone formation was found.