Recurrent Renal Calculi Research Articles

Endoscopic removal of staghorn calculi in patient with high urinary diversion

The treatment of recurrent renal calculi in patients after ureteroileal urinary diversion is difficult, especially when urinary stones are formed in the presence of urinary tract infection. In many cases, these patients already have undergone multiple renal operations and more surgery could pose difficult technical problems. We report on a patient with a high urinary diversion in whom bilateral staghorn renal calculi developed, and then were endoscopicady removed. The conversion of ureteroileoeutaneous diversion to a high pyeloileocutaneous diversion is recommended in selected cases as alternate treatment for patients with recurrent stone formation.

Experience with Extracorporeal Renal Operations and Autotransplantation in the Management of Complicated Urologic Disorders

Renal autotransplantation with or without an extracorporeal renal operation was performed 45 times upon 43 patients. Twenty-one patients underwent renal autotransplantation as surgical treatment for renovascular hypertension, all of whom are cured or have improved postoperatively. Sixteen renal autotransplants were performed upon 14 patients with extensive ureteral disease, 14 of which were successful. Six patients with carcinoma centrally located in a solitary kidney underwent extracorporeal partial nephrectomy and autotransplantation. Three of these patients are alive with functioning autografts and are tumor-free from one to five years postoperatively. Two patients with multiple recurrent renal calculi were successfully treated by extracorporeal pyelolithotomy and autotransplantation with pyelovesicostomy. An extracorporeal renal operation and autotransplantation can provide the best solution for selected urologic problems not correctable by conventional methods.

Anatrophic nephrolithotomy for removal of staghorn or branched renal calculi

Forty anatrophic nephrolithotomies were performed in 38 patients between November, 1965, and December, 1977, to remove staghorn or branched renal calculi. Thirty-six (95 per cent) of the patients' preoperative urine cultures were infected, and postoperatively 35 of the cultures (88 per cent) were sterile. Magnesium ammonium phosphate calculi were present in the majority of patients (67 per cent). In 6 patients (15 per cent) transient nephrocutaneous fistulas developed. Thirty-six of the 40 renal units (90 per cent) had improved or stable intravenous pyelograms postoperatively. The patients had been followed for an average of twenty months (four to one hundred and twelve months). In 6 patients (15 per cent) recurrent renal calculi developed, and 3 patients (8 per cent) had residual calculi during this time period.

Incomplete Renal Tubular Acidosis: some Clinical and Physiological Features

17 patients with recurrent calcium-containing renal calculi were studied using the short NH4Cl test and one subject with 'incomplete renal tubular acidosis' was identified. In retrospect the only clue to this diagnosis was a fasting, morning urine pH exceeding 6.0 units. Fasting morning urine pH, which is usually less than 6.0 in subjects who acidify normally, is proposed as a simple screening test for 'incomplete RTA'. Modified high dose NH4Cl tests and Na2SO4 tests were performed in this subject and other patients with either complete or incomplete distal renal tubular acidosis. These studies suggest that the ability to lower urine pH is impaired less with the incomplete than with the complete form of the disease.

Effect of long-term thiazide therapy on intestinal calcium absorption in patients with recurrent renal calculi

Recurrent calcium-containing renal calculi are a common and poorly understood problem. Thiazide diuretics decrease urinary calcium excretion but their effect on other parameters of calcium metabolism is not established. The purpose of this study was to determine the effect of chronic administration of thiazide diuretics on intestinal calcium absorption, skeletal calcium turnover, and urinary calcium excretion, and to use this information to attempt to clarify the pathogenesis of idiopathic hypercalciuria. Forty-one patients with recurrent calcium-containing renal calculi were studied; 73% had hypercalciuria, 44% had increased intestinal absorption, and 7% had increased bone turnover. Thiazide diuretics given to 22 patients for 3–16 mo resulted in a consistent reduction in urinary calcium excretion, while calcium absorption was unchanged (< 6%) in 12 patients and significantly decreased (by 20%) in ten patients. Decreased intestinal absorption appeared to be a secondary effect of thiazides, presumably due to reduced urinary calcium losses. Bone turnover was significantly decreased by thiazides in each case in which it had been elevated and was unchanged in patients with initially normal values. These results indicate that increased bone turnover is probably not the primary defect in idiopathic hypercalciuria. The effects of long-term thiazide diuretic therapy on intestinal calcium absorption suggest that there may be two different subpopulations of patients with hypercalciuria, one with primary intestinal hyperabsorption which persists despite correction of urinary losses, and one with primary renal loss of calcium.

Fine Structural Alterations of the Chief Cells in Hyperparathyroidism in Man

Primary hyperparathyroidism has been associated with several clinical syndromes, of which recurrent renal calculi is by far the most common. To date, there has been a poor correlation between these clinical syndromes and the cell types of the parathyroid gland. In order to determine whether specific u 11rastructural abnormalities exist for the different hyperparathyroid syndromes, we examined by electron microscopy parathyroid tissue from 8 patients (5 renal calculi only, 2 osteitis fibrosa, 1 duodenal ulcer). All patients had hypophosphatemia (&lt;3.1 mg %); seven patients had hypercalcemia (&gt;10.5 mg %) and increased serum immunoreacti ve parathyroid hormone (PTH) concentrations (&lt;1.7 ng/ml); and one patient had normal serum calcium (8.9-10.5 mg %) and PTH (0.74 ng/ml) levels. Light microscopy of the parathyroid glands from the seven patients with hypercalcemia revealed those features characteristic of parathyroid adenomas.

Normocalcemic hyperparathyroidism with "normal" parathyroid glands.

Ten patients with recurrent renal calculi were evaluated for parathyroid function. Each patient had persistently normal serum calcium values, normal or low serum phosphorus values, and increased urinary excretion of calcium, thus satisfying the criteria for idiopathic hypercalcuria. However, each patient had reduced tubular resorption of phosphorus (TRP) in the presence of normal renal function, consistent with hyperparathyroidism. Four grossly normal parathyroids were identified in each patient at operation; three or 3½ glands were removed in each instance. Parathyroid hyperfunction was evident by electron microscopy in six of six patients examined. The clinical and biochemical response to parathyroidectomy corroborated the diagnosis of hyperparathyroidism. The incidence of stone formation was dramatically reduced. There was a prompt and sustained fall in urinary calcium, a rise in TRP, and an insignificant fall in serum calcium value. No patient had persistent hypocalcemia despite removal of 3 or 3½ parathyroid glands. In all four patients in whom serum parathyroid hormone levels were determined, the preoperative level was significantly elevated and fell promptly to normal postoperatively.

A study of the renal excretion of calcium by the production of a constant level of hypercalcemia in normal and abnormal human subjects.

The relationship between urinary calcium excretion and serum calcium was studied at stable serum calcium levels, both normal and elevated. The linearity of this relationship being known, the slope of this line could be determined by sampling only at its lower and upper ends, that is, by measuring urine and serum calcium at a resting level and at a constant level of hypercalcemia produced by a calcium infusion. This method permitted three sets of measurements at each of the two levels, and also tended to eliminate the factor of renal delay time. The procedure was performed with normal subjects, with normals given vitamin D2 or parathyroid extract, and with subjects having hyperparathyroidism, sarcoidosis, and recurrent renal calculi. In the normal subjects the gradient of the slope appeared to indicate that there is no maximal tubular reabsorptive capacity for calcium, in the range sampled at any rate. The slopes of the various abnormal subjects mostly did not differ markedly from those of the normals. One incidental finding was that resting levels of urinary calcium excretion were significantly depressed 24 h following vitamin D2 administration, despite unchanged serum calcium levels.

The effect of oral phosphate in patients with recurrent renal calculus : N. A. Edwards, R. G. G. Russell and A. Hodgkinson. Brit. J. Urol. 37:390, 1965

The effect of oral phosphate in patients with recurrent renal calculus : N. A. Edwards, R. G. G. Russell and A. Hodgkinson. Brit. J. Urol. 37:390, 1965

CORK STOPPERS AND HYPERCALCEMIA.

THE determination of serum calcium has become a common laboratory procedure and remains the single most useful test in the diagnosis of hyperparathyroidism. In the course of evaluation of a patient (K.O.) with recurrent renal calculi many determinations showed markedly elevated serum calcium levels.¶ The patient was subsequently admitted to the hospital for further studies. Repeated serum calcium levels were normal (Table 1). It was then discovered that the blood specimens drawn before admission were spun, and the serum placed into cork-stoppered tubes obtained from the Wasserman Laboratory, Massachusetts Department of Public Health. These test tubes are cleaned with HaemoSol . . .

Recurrent renal calculi and hyperparathyroidism.

SUMMARYThe results of screening fifty individuals with recurrent renal calculi are reported. Five instances of primary hyperparathyroidism due to tumours of these glands have been proven by the operative and histological findings. Reliance on the determination of the serum calcium level will lead to failure of diagnosis in some instances. The diagnosis can best be made by relying on a combination of techniques to measure the urinary excretion of calcium while the individual is on a low intake and at the same time estimating the tubular reabsorption of phosphate.

Recurrent renal and ureteral calculi: Management and prevention

Recurrent renal and ureteral calculi: Management and prevention

Prevention of Recurrent Renal Calculi

Prevention of Recurrent Renal Calculi

Recurrent renal calculus: Its cause and prevention

Recurrent renal calculus: Its cause and prevention

The Prevention of Recurrent Renal Calculi

The Prevention of Recurrent Renal Calculi

Discussion of Dr. Barney's Paper on Recurrent Renal Calculi

Discussion of Dr. Barney's Paper on Recurrent Renal Calculi