Recurrent Calcium Nephrolithiasis Research Articles

Recurrence of autonomous hyperparathyroidism in calcium nephrolithiasis

In a woman with bilateral recurrent calcium nephrolithiasis and hypercalciuria, hypercalcemia developed and she underwent parathyroid surgery, which led to excision of a histologically-confirmed adenoma. The patient became normocalcemic but remained hypercalciuric despite reduction of dietary calcium intake. Several calculi recurred in both kidneys. Four to six years after parathyroidectomy, hypercalcemia recurred and the patient underwent a new surgical exploration; a parathyroid gland with diffuse adenomatous aspects and another gland with pure hyperplasia were excised. Once again, after surgery the patient became normocalcemic but remained hypercalciuric. Evidence for a “renal calcium leak” hypercalciuria was obtained, and thiazide administration led to normalization of urinary calcium excretion. In calcium nephrolithiasis, persistent hypercalciuria may lead to recurrence of autonomous hyperparathyroidism.

Effects of Magnesium Oxide on the Crystallization of Calcium Salts in Urine in Patients with Recurrent Nephrolithiasis

AbstractThe effect of oral administration of magnesium oxide on the crystallization in urine of calcium oxalate and brushite was determined in 4 cases of recurrent calcium nephrolithiasis. Each patient was evaluated while on a constant metabolic diet before, during and after therapy with magnesium (1,000mg. magnesium as magnesium oxide per day). During magnesium therapy urinary hydrogen ion concentration increased by approximately 0.5 unit in all 4 patients and urinary calcium increased about 50mg. per day in 2. Urinary oxalate decreased significantly in 1 patient and urinary phosphorus was reduced in 2. The urinary activity product ratio of brushite (state of saturation) increased, owing largely to the rise in urinary hydrogen ion concentration but that of calcium oxalate was not changed significantly by magnesium treatment. Although urinary magnesium increased significantly there was no significant change in the urinary formation product ratio (limit of metastability) or the rate of crystal growth of brushite or calcium oxalate. Thus, no beneficial effect of magnesium therapy could be demonstrated in thisshort-term study.

Endoscopic Removal of an Ulcerated Appendiceal Stump

INVERTED appendiceal stump is part of the differential diagnosis of a radiologically demonstrated cecal mass in patients after appendectomy. We report the colonoscopic removal of an inverted appendiceal stump employing standard snare and electrocautery technique. Of special interest, the appendiceal stump was invaded by unusual fungi producing an ulcerated-granulomatous inflammatory reaction. Report of a Case A 23-year-old man was admitted with a ten-month history of intermittent right lower quadrant abdominal pain occasionally associated with black, tarry stools. On the day of admission, after ingestion of considerable alcohol, the patient had severe epigastric pain and hematemesis. Past medical history included recurrent calcium and uric acid nephrolithiasis for six years and an appendectomy one year ago. The latter was uneventful with complete recovery. The physical examination was unremarkable except for mild epigastric and right lower quadrant tenderness, an appendectomy scar, and guaiac-positive stools. The complete blood cell count, ESR, and multiphasic profile

Treated and Untreated Recurrent Calcium Nephrolithiasis in Patients with Idiopathic Hypercalciuria, Hyperuricosuria, or No Metabolic Disorder

Two hundred two recurrent calcium oxalate stone-forming patients with idiopathic hypercalciuria or hyperuricosuria, or both, were treated for an average of 2.91 years (1 to 7 years) with thiazide or allopurinol, or both. The frequency of new stone formation was drastically reduced. During the treatment period of 625 patient years, 220.0 new stones should have occurred, whereas 22 were actually formed (chi-square=178, P less than 0.001). Thirty-four patients without discernible metabolic disturbances and treated only with increased fluid intake and dietary advice formed 29 new stones compared to a predicted 33.2 stones (87.3%). Thirty similar patients treated with thiazide and allopurinol formed six stones compared to a predicted 31.8, P less than 0.001. Chronic reversal of idiopathic hypercalciuria and hyperuricosuria with thiazide and allopurinol is an effective way to prevent recurrent calcium oxalate stones. Conservative measures are only of marginal effectiveness in treating metabolically normal stone forming patients; however, thiazide and allopurinol appear to decrease new stone formation.