Urine pH in renal calcium stone formers who do and do not increase stone phosphate content with time
Urine pH in renal calcium stone formers who do and do not increase stone phosphate content with time
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DOI：
10.1093/ndt/gfn420
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发表时间：
2009-01-01
影响因子：
6.1
通讯作者：
Worcester, Elaine M.
中科院分区：
文献类型：
--
作者：
Parks, Joan H.;Coe, Fredric L.;Worcester, Elaine M.
背景资料。磷酸钙(CAP)肾结石的患病率似乎在增加，这是由遗传性高钙尿和高尿pH引起的高尿帽过饱和度引起的。结石或手术或结石治疗对肾脏的损害可能会提高尿液的酸碱度；或者，有些人的尿液酸碱值可能天生就很高，因此容易导致结石封堵。为了区分这些替代方案，我们对尿液pH值和结石帽含量的变化进行了排序，询问哪种情况最先发生在结石随时间推移显示结石帽逐渐增加的患者。从4767名患者中，我们发现62名患者可以记录从草酸钙(CaOx)到帽状结石的转化，134名CaOx对照组没有转化。比较两组患者的实验室和临床表现。即使当患者形成相对纯的CaOx结石时，那些注定要增加结石帽的人的尿液pH值也比从未这样做的对照组高。在防止新结石形成的治疗之前和治疗期间，它们的PH值都较高。冲击波碎石术与结石帽增加密切相关，但尿液pH值与手术次数无关。我们的结论是，高pH可能不是结石或其治疗的结果，而是可能先于CaOx转化为帽状结石，并可能由饮食或遗传引起。
Background. Calcium phosphate (CaP) renal stones appear to be increasing in prevalence, and are caused by high urine CaP supersaturation, which arises from genetic hypercalciuria and high urine pH. Renal damage from stones or procedures, or treatments for stone could raise urine pH; alternatively pH may be intrinsically high in some people who are thereby predisposed to CaP stones.Methods. To distinguish these alternatives we sequenced changes in urine pH and stone CaP content asking which occurs first in patients whose stones showed progressive increase in CaP over time. From 4767 patients we found 62 in whom we could document transformation from calcium oxalate (CaOx) to CaP stones, and 134 CaOx controls who did not transform. Laboratory and clinical finding were contrasted between these groups.Results. Even when patients were forming relatively pure CaOx stones, those destined to increase stone CaP had higher urine pH than controls who never did so. Their higher pH was present before and during treatments to prevent new stone formation. Shock wave lithotripsy was strongly associated with increasing stone CaP but urine pH bore no relationship to number of procedures.Conclusion. We conclude that high pH may not be acquired as a result of stones or their treatments but may precede transformation from CaOx to CaP stones and arise from diet or possibly heredity.