Nephrolithiasis and Nephrocalcinosis

  • Joan H. Parks
  • Fredric L. Coe


From time to time in most people, the urine separates into a solid and liquid phase. Unlike birds, which regularly produce a semisolid urine, all mammals have renal tubules and urinary collecting systems whose lumens are narrow and easily obstructed. As long as the solid phase in urine consists of very tiny particles, 0.1 to 10 microns in diameter, phase separation is asymptomatic. Larger particles can block tubule lumens or may adhere to papillary surfaces. Once anchored, a particle can then grow until its dimensions become similar in magnitude to those of the urinary tract, i.e., millimeters to centimeters in diameter. Then it can cause clinical disease.


Uric Acid Calcium Oxalate Stone Disease Renal Tubular Acidosis Calcium Stone 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Coe FL: Renal colic and flank pain. In: SG Massry, RJ Glassock, eds, Textbook of Nephrology. Elsevier, New York, 1980.Google Scholar
  2. 2.
    Bretland PM: Acute Ureteric Obstruction. Appleton-CenturyCrofts, London, 1972.Google Scholar
  3. 3.
    Coe FL: Nephrolithiasis: Pathogenesis and Treatment. Year Book Medical, Chicago, 1978.Google Scholar
  4. 4.
    Greene ML, Fujimoto WY, Seegmiller JE: Urinary xanthine stone: A rare complication of allopurinol therapy. N Engl J Med 280: 426, 1969.PubMedCrossRefGoogle Scholar
  5. 5.
    Coe FL: Calcium-uric acid nephrolithiasis. Arch Intern Med 138: 10–90, 1978.CrossRefGoogle Scholar
  6. 6.
    Schneider AF, Reaven EP, Reaven GA: A comparison of renal calcification produced by parathyroid extract or calcium gluconate. Endocrinology 67: 733–743, 1960.PubMedCrossRefGoogle Scholar
  7. 7.
    Smith LH Jr: Enteric hyperoxaluria and other hyperoxaluria states. In: FL Coe, BM Brenner, JM Stein, eds, Nephrolithiasis. Churchill-Livingstone, New York, 1980.Google Scholar
  8. 8.
    Hare WSC, Poynter JD: The radiology of renal papillary necrosis as seen in analgesic nephropathy. Clin Radiol 25: 423–428, 1974.PubMedCrossRefGoogle Scholar
  9. 9.
    Roylance J, Penry JB, Rhys-Davies E, Roberts M: The radiology of tuberculosis of the urinary tract. Clin Radiol 21: 163–172, 1970.PubMedCrossRefGoogle Scholar
  10. 10.
    Friedenberg RM: Tuberculosis of the genito urinary system. Semin Roentgenol 6: 310–318, 1971.PubMedCrossRefGoogle Scholar
  11. 11.
    Yendt ER, Jarzylo S, Finnis WA, et al.: Medullary sponge kidney (tubular ectasia) in calcium urolithiasis. Presented at the Fourth International Symposium on Urolithiasis Research, Williamsburg, VA, June 22–26, 1980.Google Scholar
  12. 12.
    Blacklock NJ: The pattern of urolithiasis in the Royal Navy. In: A Hodgkinson, BEC Nordin, eds, Renal Stone Research Symposium, JA Churchill, London, pp 33–47, 1968.Google Scholar
  13. 13.
    Yu TF, Gutman AB: Uric acid nephrolithiasis in gout: Predisposing factors. Ann Intern Med 67: 11–33, 1967.Google Scholar
  14. 14.
    Marshall V, White RH, Chaput de Saintonge M, et al.: The natural history of renal and ureteric calculi. Br J Urol 47: 112–124, 1975.Google Scholar
  15. 15.
    Coe FL, Keck J, Norton E: The natural history of calcium urolithiasis. JAMA 238: 1519–1523, 1977.PubMedCrossRefGoogle Scholar
  16. 16.
    Sutherland JW, Parks JH, Coe FL: Recurrence after a single renal stone in a community practice. Miner Electrolyte Metab 11: 267–269, 1985.PubMedGoogle Scholar
  17. 17.
    Williams RE: Long-term survey of 538 patients with upper urinary stone. Br J Urol 35: 416–437, 1963.PubMedCrossRefGoogle Scholar
  18. 18.
    Coe FL, Parks JH, Strauss A: Accelerated nephrolithiasis. JAMA 244: 809–810, 1980.PubMedCrossRefGoogle Scholar
  19. 19.
    Coe FL, Parks JH, Moore E: Familial idiopathic hypercalciuria. N Engl J Med 300: 337–340, 1979.PubMedCrossRefGoogle Scholar
  20. 20.
    Hamed IA, Czerwinski AW, Coats B, Kaufman C, Altmiller DH: Familial absorptive hypercalciuria and renal tubular acidosis. Am J Med 300: 337, 1979.Google Scholar
  21. 21.
    Meches K, Szelid ZS: Autosomal dominant inheritance of hypercalciuria. Eur J Pediatr 133: 239–242, 1980.CrossRefGoogle Scholar
  22. 22.
    Moore E, Coe FL, McMann B, Favus M: Idiopathic hypercalciuria in children: Prevalence and metabolic characteristics. J Pediatr 92: 906–910, 1978.PubMedCrossRefGoogle Scholar
  23. 23.
    Favus MJ, Coe FL: Evidence for spontaneous hypercalciuria in the rat. Miner Electrolyte Metab 2: 150–154, 1979.Google Scholar
  24. 24.
    Peacock M, Nordin BEC: Tubular reabsorption of calcium in normal and hypercalciuric subjects. J Clin Pathol 21: 353, 1968.PubMedCrossRefGoogle Scholar
  25. 25.
    Shen FH, Baylink DJ, Nielsen RL, Sherrard DJ, Ivey JL, Haussler MR: Increased serum 1,25 dihydroxyvitamin D in idiopathic hypercalciuria. J Lab Clin Med 90: 955, 1977.PubMedGoogle Scholar
  26. 26.
    Haussler MR, Baylink DJ, Hughes MR, Brumbough PF, Wergedal JF, Shen FH, Nielsen RL, Counts SJ, Bursac KM, McCain TA: The assay of 1,25-dihydroxyvitamin D3: Physiologic and pathologic modulation of circulating hormone levels. Clin Endocrinol 5: 151s, 1976.Google Scholar
  27. 27.
    Goldberg M, Azuz ZS, Goldfarb S: Renal handling of phosphate, calcium and magnesium. In: BM Brenner, FC Rector Jr, eds, The Kidney, vol. 1. WB Saunders, Philadelphia, pp 344–390, 1976.Google Scholar
  28. 28.
    Pak CYC, Galosy RA: Fasting urinary calcium and adenosine 3’,5’-monophosphate: A discriminant analysis for the identification of renal and absorptive hypercalciuria. J Clin Endocrinol Metab 48: 260, 1979.PubMedCrossRefGoogle Scholar
  29. 29.
    Quamme GA, Wong NLM, Sutton RAL, Dirks JH: Interrelationship of chlorothiazide and parathyroid hormone: A micro-puncture study. Am J Physiol 229: 200, 1975.PubMedGoogle Scholar
  30. 30.
    Costanzo LS, Windhager EE: Calcium and sodium transport by the distal convoluted tubule of the rat. Am J Physiol 235: F492, 1978.PubMedGoogle Scholar
  31. 31.
    Pak CYC, Delea CS, Bartter FC: Successful treatment of recurrent nephrolithiasis (calcium stones) with cellulose phosphate. N Engl J Med 190: 175, 1974.CrossRefGoogle Scholar
  32. 32.
    Sutton RAL, Walker VR: Responses to hydrochlorothiazide and acetazolamide in patients with calcium stones: Evidence suggesting a defect in renal tubular function. N Engl J Med 302: 709–713, 1980.PubMedCrossRefGoogle Scholar
  33. 33.
    Coe FL, Favus MJ, Crockett T, Strauss AL, Parks JH, Porat A, Sen P, Gantt CL, Sherwood LM: Effects of low-calcium diet on urine calcium excretion, parathyroid function and serum 1,25(OH)2D3 level in patients with idiopathic hypercalciuria and normal subjects. Am J Med, 1982.Google Scholar
  34. 34.
    Weber DV, Coe FL, Parks JH, Dun MSL, Tembe V: Urinary saturation measurements in calcium nephrolithiasis. Ann Intern Med 90: 180, 1979.PubMedCrossRefGoogle Scholar
  35. 35.
    Ettinger B: Recurrence of nephrolithiasis: A six-year prospective study. Am J Med 67: 245, 1979.PubMedCrossRefGoogle Scholar
  36. 36.
    Yendt ET, Cohanim M: Prevention of calcium stones with thiazides. Kidney Int 13: 397, 1978.PubMedCrossRefGoogle Scholar
  37. 37.
    Pak CYC, Peters P, Hurt G, Kadesky M, Fine M, et al.: Is selective therapy of recurrent nephrolithiasis possible? Am J Med 71: 615–622, 1981.PubMedCrossRefGoogle Scholar
  38. 38.
    Maschio G, Tessitore N, D’Angelo A, et al.: Prevention of calcium nephrolithiasis with low dose thiazide, amiloride and allopurinol. Am J Med 71: 623–626, 1981.PubMedCrossRefGoogle Scholar
  39. 39.
    Lawoyin S, Sismilich S, Browne R, Pak CYC: Bone mineral content in patients with calcium urolithiasis. Metabolism 28: 1250–1254, 1979.PubMedCrossRefGoogle Scholar
  40. 40.
    Malluche HH, Tschoepe W, Ritz E, Meyer-Sabellek W, Massry SG: Abnormal bone histology in idiopathic hypercalciuria. J Clin Endocrinol Metab 50: 654–658, 1980.PubMedCrossRefGoogle Scholar
  41. 41.
    Barkin J, Wilson DR, Manuel MA, Bayley A, Murray T, Harrison J: Bone mineral content in idiopathic calcium nephrolithiasis. Miner Electrolyte Metab 11: 19–24, 1985.PubMedGoogle Scholar
  42. 42.
    Bataille P, Achard JM, Fournier A, et al.: Diet, Vitamin D and vertebral mineral density in hypercalciuric calcium stone formers. Kidney Int 39: 1193–1205, 1991.PubMedCrossRefGoogle Scholar
  43. 43.
    Gutman AB: Uric acid nephrolithiasis. Am J Med 45: 756, 1968.PubMedCrossRefGoogle Scholar
  44. 44.
    Coe FL: Hyperuricosuric calcium oxalate nephrolithiasis. Kidney Int 13: 418, 1978.PubMedCrossRefGoogle Scholar
  45. 45.
    Coe FL, Strauss AL, Tembe V, Dun SL: Uric acid saturation in calcium nephrolithiasis. Kidney Int 17: 662–668, 1980.PubMedCrossRefGoogle Scholar
  46. 46.
    Mandel NS, Mandel GS: Epitaxis between stone forming crystals at the atomic level. In: FL Coe, BM Brenner, JH Stein, eds, Contemporary Issues in Nephrology: Nephrolithiasis. Churchill Livingstone, New York, 1980.Google Scholar
  47. 47.
    Pak CYC, Holt K: Nucleation and growth of brushite and calcium oxalate in urine of stone formers. Metabolism 25: 665673, 1976.Google Scholar
  48. 48.
    Ito H, Coe FL: Acidic peptide and polyribonucleotide crystal growth inhibitors in human urine. Am J Physiol 233: F455, 1978.Google Scholar
  49. 49.
    Robertson WG, Knowles F, Peacock M: Urinary acid muco-polysaccharide inhibitors of calcium oxalate crystallization. In: R Fleisch, WG Robertson, LH Smith, W Vahlensieck, eds, Urolithiasis Research. Plenum Press, London, 19.Google Scholar
  50. 50.
    Pak CYC, Barella PE, Holt K, et al.: Effect of oral purine load and allopurinol on the crystallization of calcium salts in the urine of patients with hyperuricosuric calcium urolithiasis. Am J Med 65: 593, 1978.PubMedCrossRefGoogle Scholar
  51. 51.
    Smith MJV: Placebo vs. allopurinol for renal calculi. J Urol 117: 690, 1977.PubMedGoogle Scholar
  52. 52.
    Ettinger B, Tang A, Citron JT, Livermore B, Williams T: Randomized trial of allopurinol in the prevention of calcium oxalate calculi. N Engl J Med 315: 1386–1389, 1986.PubMedCrossRefGoogle Scholar
  53. 53.
    Parks JH, Coe FL: A urinary calcium-citrate index for the evaluation of nephrolithiasis. Kidney Int 30: 85–90, 1986.PubMedCrossRefGoogle Scholar
  54. 54.
    Barcelo P, Wuhl O, Servitge E, Rousaud A, Pak CYC: Randomized double-blind study of potassium citrate in idiopathic hypocitraturic calcium nephrolithiasis. J Urol, 1993.Google Scholar
  55. 55.
    Freis ED: Age, race, sex and other indices of risk in hypertension. Am J Med 55: 275–280, 1973.PubMedCrossRefGoogle Scholar
  56. 56.
    Kuiper JJ: Medullary sponge kidney. In: KD Gardner Jr, ed, Cystic Diseases of the Kidney. John Wiley, New York, 1976.Google Scholar
  57. 57.
    Coe FL: The clinical and laboratory assessment of the patient with renal disease. In: BM Brenner, FC Rector Jr, eds, The Kidney, vol 2. WB Saunders, Philadelphia, pp 765–805, 1976.Google Scholar
  58. 58.
    Stella FJ, Massry SG, Kleeman CR: Medullary sponge kidney associated with parathyroid adenoma. Nephron 10: 322–336, 1973.CrossRefGoogle Scholar
  59. 59.
    Golden A, Canary JJ: The parathyroid gland. In: JMB Bloodworth Jr, ed, Endocrine Pathology. Williams and Wilkins, Baltimore, p 181, 1968.Google Scholar
  60. 60.
    Parfitt AM: PTH and osteoblasts, the relationship between bone turnover and bone loss, and the state of the bones in primary hyperparathyroidism. Metabolism 25: 1033–1061, 1976.PubMedCrossRefGoogle Scholar
  61. 61.
    Agus ZS, Chiu PJS, Goldberg M: Regulation of urinary calcium excretion in the rat. Am J Physiol 232: F454 - F460, 1977.Google Scholar
  62. 62.
    Favus MJ, Kathpalia SC, Coe FL, Mond A: Calcium active transport by rat descending colon: Response to dietary calcium restriction and 1,25(OH)2D3. Am J Physiol 238: 675–678, 1980.Google Scholar
  63. 63.
    Parks JH, Coe FL, Favus MJ: Hyperparathyroidism in nephrolithiasis. Arch Intern Med 140: 1479–1481, 1981.CrossRefGoogle Scholar
  64. 64.
    Coe FL, Favus MJ, Kathpalia SC, Jao W, Sherwood LM: Calcium and phosphorus disorders of malignant origin. In: R Reisselbach, ed, Cancer and the Kidney. WB Saunders, Philadelphia, 1981.Google Scholar
  65. 65.
    Broadus AE, Horst RL, Lang R, Rasmussen IH: Distinct pathophysiologic subgroups in primary hyperparathyroidism: Role of serum 1,25(OH)ZDZ and response to phosphorus therapy. Clin Res 27: 363A, 1979.Google Scholar
  66. 66.
    Binder HJ: Intestinal oxalate absorption. Gastroenterology 67: 441, 1974.PubMedGoogle Scholar
  67. 67.
    Hofmann AF, Thomas PI, Smith LH, McCall JT: Pathogenesis of secondary hyperoxaluria in patients with ileal resection and diarrhea. Gastroenterology 58: 960, 1970.Google Scholar
  68. 68.
    Vainder M, Kelly J: Renal tubular dysfunction secondary to jejunoileal bypass. JAMA 235: 1257, 1976.PubMedCrossRefGoogle Scholar
  69. 69.
    Cryer PE, Garber AJ, Hoffstein P, Lucas XX, Wise L: Renal failure after small intestinal bypass for obesity. Arch Intern Med 135: 1610, 1975.PubMedCrossRefGoogle Scholar
  70. 70.
    Anderson K, Jagenburg R: Fat reduced diet in the treatment of hyperoxaluria in patients with ileopathy. Gut 15: 360, 1974.CrossRefGoogle Scholar
  71. 71.
    Dobbins JW, Binder HJ: Effects of bile salts and fatty acids on the colonic absorption of oxalate. Gastroenterology 70: 1896, 1976.Google Scholar
  72. 72.
    Chadwick VS, Phillips JF, Hofmann AF: Measurements of intestinal permeability using low molecular weight polyethylene glycols (PEG 400). Gastroenterology 73: 247, 1977.PubMedGoogle Scholar
  73. 73.
    Hofman AF, Poley JR: Role of bile acid malabsorption in pathogenesis of diarrhea and steatorrhea in patients with ileal resection: I. Response to cholestyramine or replacement of dietary long chain triglycerides by medium chain triglyceride. Gastroenterology 62: 918, 1972.Google Scholar
  74. 74.
    Elliot JS, Soles WP: Excretion of calcium and citric acid in patients with small bowel disease. J Urol 111: 810, 1974.PubMedGoogle Scholar
  75. 75.
    Williams HE, Smith LH Jr: Primary hyperoxaluria. In: JP Stanbury, B Wyngaarden, DS Fredrikson, eds, The Metabolic Basis of Inherited Disease. McGraw-Hill, New York, p 196, 1972.Google Scholar
  76. 76.
    Hockaday TDR, Clayton JE, Frederich EW, Smith LH Jr: Primary hyperoxaluria. Medicine 43: 315, 1964.PubMedGoogle Scholar
  77. 77.
    Hagler L, Herman RH: Oxalate metabolism. Am J Clin Nutr 26:758, 882, 1006, 1242, 1973.Google Scholar
  78. 78.
    Gershoff SN, Faragella FF: Endogenous oxalate synthesis and glycine, serine, deoxypridoxine interrelationships in vitamin B6-deficient rats. J Biol Chem 234: 2391, 1959.PubMedGoogle Scholar
  79. 79.
    Coe FL, Firpo JJ Jr: Evidence for mild reversible hypoerparathyroidism in distal renal tubular acidosis. Arch Intern Med 135: 1485–1488, 1975.PubMedCrossRefGoogle Scholar
  80. 80.
    Lemann J Jr, Litzow JR, Lennon EJ: Studies of the mechanism by which chronic metabolic acidosis augments urinary calcium excretion in man. J Clin Invest 46: 1318, 1967.PubMedCrossRefGoogle Scholar
  81. 81.
    Lemann J Jr, Litzow JR, Lennon EJ: The effect of chronic acid loads in normal man: Further evidence for the participation of bone mineral in the defense against chronic metabolic acidosis. J Clin Invest 45: 1608, 1966.PubMedCrossRefGoogle Scholar
  82. 82.
    Greenberg AJ, McNamara H, McCrory WW: Metabolic balance studies in primary renal tubular acidosis: Effects of acidosis on external calcium and phosphorus balances. J Pediatr 69: 610, 1966.PubMedCrossRefGoogle Scholar
  83. 83.
    Sutton RAL, Wong NLM, Dirks JH: Effects of metabolic acidosis and alkalosis on sodium and calcium transport in the dog kidney. Kidney Int 15: 520–533, 1979.PubMedCrossRefGoogle Scholar
  84. 84.
    Simpson DP: Regulation of renal citrate metabolism by bicarbonate ion and pH: Observations in tissue slices and mitochondria. J Clin Invest 46: 225, 1967.PubMedCrossRefGoogle Scholar
  85. 85.
    Coe FL, Parks JH: Stone disease in hereditary renal tubular acidosis. Ann Intern Med 93: 60–61, 1980.PubMedCrossRefGoogle Scholar
  86. 86.
    Holmes EW Jr: Uric acid nephrolithiasis. In: FL Coe, BM Brenner, JH Stein, eds, Contemporary Issues in Nephrology: Nephrolithiasis, vol 5. Churchill Livingstone, New York, 1980.Google Scholar
  87. 87.
    Pinto B, Rocha E, Ruiz-Marcellan FJ: Isolation and characterization of uricine from uric acid stones. Kidney Int 10: 437, 1976.PubMedCrossRefGoogle Scholar
  88. 88.
    Crawhall JC, Purkiss P, Watts RWE, Young EP: The excretion of amino acids by cystinuric patients and their relatives. Ann Human Genet 33: 149, 1969.CrossRefGoogle Scholar
  89. 89.
    Resnick MJ, Goodman HO, Boyce WH: Heterozygous cystinuria and calcium oxalate urolithiasis. J Urol 122: 52, 1979.PubMedGoogle Scholar
  90. 90.
    Hambraeus L: Comparative studies of the value of two cyanide-nitroprusside methods in the diagnosis of cystinuria. Scand J Lab Clin Invest 15: 657, 1963.CrossRefGoogle Scholar
  91. 91.
    Chute R, Suby HI: Prevalence and importance of ureasplitting bacterial infections of the urinary tract in the formation of calculi. J Urol 44: 590, 1943.Google Scholar
  92. 92.
    Griffith DB, Bruce RR, Fishbein WN: Infection (urease)induced stones. In: FL Coe, BM Brenner, JH Stein, eds, Nephrolithiasis, vol 5. Churchill Livingstone, New York, 1980.Google Scholar
  93. 93.
    Griffith DB: Struvite stones. Kidney Int 13: 372, 1975.CrossRefGoogle Scholar
  94. 94.
    Griffith DB, Gibson JR, Clinton CW, Musher DM: Acetohydroxamic acid: Clinial studies of a urease inhibitor in patients with staghorn renal calculi. J Urol 119: 9, 1978.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Joan H. Parks
    • 1
  • Fredric L. Coe
    • 2
  1. 1.Program in Nephrology Department of MedicineThe University of ChicagoChicagoUSA
  2. 2.Program in Nephrology, Department of MedicineThe University of ChicagoChicagoUSA

Personalised recommendations