Urolithiasis pp 517-522 | Cite as

Citrate and Idiopathic Recurrent Calcium Urolithiasis: An Approach to the Origin of Hypocitraturia and Correction by Two Oral Alkali Citrates

  • P. O. Schwille

Abstract

Research on urinary citrate in idiopathic recurrent calcium urolithiasis (RCU) initiated in 1949 (1) expanded in the 1980’s. Although the existence of hypocitraturia among RCU patients has long been recognized, its origin is not fully understood and, surprisingly, has had little attention by researchers. Only very recently were there reports available on basal (2) and, possibly, decreased serum citrate values following an oral citrate load in RCU (3), on the critical role of low intracellular pH in creating a citrate deficit (4), and on the low urinary pH underlying hypocitraturia (5, 6). Based on these factors, hypotheses have been put forward. Whether they apply to citraturia in man has been substantiated by data from our laboratory.

Keywords

Calcium Oxalate Amorphous Calcium Phosphate Potassium Citrate Urinary Citrate Citrate Excretion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    NS Conway, AIL Maitland, and JB Rennie, The urinary citrate excretion in nephrolithiasis, Br. J. Urol. 21: 30 (1949).PubMedCrossRefGoogle Scholar
  2. 2.
    PO Schwille, D Scholz, and K Schwille, Ultrafiltrable serum citrate and the relationship between serum citrate and urinary citrate. Results in controls and renal calcium stone formers, J. Clin. Chem. Clin. Biochem. 20: 169 (1982).PubMedGoogle Scholar
  3. 3.
    DM Cowley, BC McWhinney, JM Brown, and AH Chalmers, Chemical factors important to calcium nephrolithiasis: evidence for impaired hycroxycarboxylic acid absorption causing hyperoxaluria, Clin. Chem. 33: 243 (1987).PubMedGoogle Scholar
  4. 4.
    DP Simpson, Influence of plasma bicarbonate concentration and pH on citrate excretion, Am. J. Physiol. 206: 875 (1984).Google Scholar
  5. 5.
    KJ Ullrich, Driving forcesfor the transport of organic solutes, in: “Renal Transport of Organic Substances”, R Greger, F Lang, and S Silbernagl, eds., Springer, Berlin-Heidelberg-New York (1981).Google Scholar
  6. 6.
    P Deetjen, The renal handling of citrate, in: “Urolithiasis and Related Clinical Research”, PO Schwille, LH Smith, WG Robertson, and W Vahlensieck, eds., Plenum Press, New York (1985).Google Scholar
  7. 7.
    MI Nicar, K Hill, and CYC Pak, Inhibition by citrate of spontaneous precipitation of calcium oxalate in vitro, J. Bone Min. Res. 2: 215 (1987).CrossRefGoogle Scholar
  8. 8.
    CYC Pak, Citrate and renal calculi, Min. Electr. Metab. 13: 257 (1987).Google Scholar
  9. 9.
    DJ Kok, SE Papapoulos, and OLM Bijvoet, Low inhibition of crystal aggregation and citrate excretion in recurrent calcium oxalate stone formers, Contr. Nephrol. 58: 73 (1987).Google Scholar
  10. 10.
    JR Oster, DL Stemmer, GO Perez, and CA Vaamonde, Comparison of effects of sodium bicarbonate versus sodium citrate on renal acid excretion, Min. Electr. Metab. 14: 97 (1988).Google Scholar
  11. 11.
    PO Schwille, G Rümenapf, H Schwarzländer, P Kuch, and H Berens, Mediumterm treatment of idiopathic recurrent calcium urolithiasis by oral sodium-potassium citrate-a preliminary report on metabolic effects, in: “Inhibitors of Crystallization in Renal Lithiasis and their Clinical Application”, A Martelli, ed., Acta Medica Edizioni e Congressi, Roma (1988).Google Scholar
  12. 12.
    D Scholz, PO Schwille, W Engelhardt, and A Sigei, Idiopathic uric acid lithiasis-some less knwon epidemiologic and metabolic findings, Fortschr. Urol. Nephrol. 16: 66 (1981).Google Scholar
  13. 13.
    P Jaeger, L Portmann, AF Jacquet, and P Burckhardt, Study of the mechanisms of hypocitraturiain idiopathic stone formers, in: “Inhibitors of Crystallization in Renal Lithiasis and their Clinical Application”, A Martelli, ed., Acta Medica Edizioni e Congressi, Roma (1988).Google Scholar
  14. 14.
    NP Curthys, Role of glutamyltranspeptidase in the renal metabolism of glutathione, Min. Electr. Metab. 9: 236 (1983).Google Scholar
  15. 15.
    D Rudman, JL Dedonis, MT Fountain, JB Chandler, GG Gerron, GA Gleming, and MH Kutner, Hypocitraturia in patients with gastrointestinal malabsorption, NEJM 303: 657 (1980).PubMedCrossRefGoogle Scholar
  16. 16.
    D Rudman, MH Kufner, SC Redd, WC Waters, GG Gerron, and J Bleier, Hypocitraturia in calcium nephrolithiasis, J. Clin. Endocrinol. Metab. 55: 1052 (1982).PubMedCrossRefGoogle Scholar
  17. 17.
    PO Schwille, Citrate and urolithiasis-preliminary results of treatment with two oral alkali citrates, Urol. Res. 16: 247 (1988).Google Scholar
  18. 18.
    PO Schwille. In preparation (1988).Google Scholar

Copyright information

© Springer Science+Business Media New York 1989

Authors and Affiliations

  • P. O. Schwille
    • 1
  1. 1.Mineral Metabolism and Endocrine Research Laboratory Departments of Surgery and UrologyUniversity of ErlangenErlangenGermany

Personalised recommendations