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Citrate and recurrent idiopathic calcium urolithiasis

A longitudinal pilot study on the metabolic effects of oral potassium sodium citrate administered as short-, medium- and long-term to male stone patients

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Summary

In male patients with idiopathic recurrent calcium urolithiasis (RCU) the effects of oral potassium sodium citrate (PSC) on acid-base, citrate and mineral metabolism were investigated. There were 17 normocitraturic and 15 hypocitraturic patients. The examination time points in our clinical laboratory were prior to medication and after 3, 6 and over 12 months of medication. Urine collection periods were over 24 h, 2 h — after an overnight fast — 3 h postprandially. Acceptance by the patients was poor, a large number refusing to take PSC for 12 months. Compliance of the patients continuing with the study was adequate as assessed by the urinary excretion of potassium and sodium. No unwanted side effects were observed. After 3 months of PSC medication a compensated metabolic alkalosis developed; in the urine calcium was decreased, while citrate, pH and oxalate were increased, as were hydroxyapatite supersaturation and calcium phosphate particles. After more than 12 months of PSC medication, citrate and pH tended toward the pretreatment baseline values, while hydroxyapatite supersaturation and calcium had already returned to pretreatment values. Despite ongoing PSC intake, patients with pre-existing hypocitraturia had lower urinary citrate than patients with previous normocitraturia, while the concomitant pH and hydroxyapatite supersaturation in the urine of the former remained at levels close to those of the latter. Under the influence of PSC, parathyroid gland function remained unchanged, but serum levels of bone alkaline phosphatase and osteocalcin were low, and urinary hydroxyproline was high. We conclude that (1) PSC shifts the acid-base status toward metabolic alkalosis, and also modulates bone metabolism; (2) over the long term, PSC may be unable to achieve a constantly high urinary citrate, in particular in RCU with pre-existent hypocitraturia — in contrast to its short- and medium-term effects. Long-term interrupted medication with PSC is proposed for the metaphylaxis of RCU. A regimen of this type may also be expected to yield more insight into the mechanism(s) underlying hypocitraturia.

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References

  1. Ahlstrand C, Tiselius HG, Larsson L (1984) Studies on crystalluria in calcium oxalate stone formes. Urol Res 12:103

    Google Scholar 

  2. Balagura-Baruch S, Burich RL, King VF (1973) Effects of alkalosis on renal citrate metabolism in dogs infused with citrate. Am J Physiol 225:385

    Google Scholar 

  3. Berger IH, Meister RH, Schwille PO (1990) Urinary citrate excretion in healthy and stone forming women-influence of the ovarian cycle. In: Vahlensieck W, Gasser G, Hesse A, Schoeneich G (eds) Urolithiasis (Proceedings of the 1st European Symposium on Urolithiasis). Excerpta Medica, Amsterdam, p 45

    Google Scholar 

  4. Breslau NA, McGuirre JL, Zerwekh UE, Pak CYC (1982) The role of dietary sodium on renal excretion and intestinal absorption of calcium and on vitamin D metabolism. J Clin Endocrinol Metab 55:369

    Google Scholar 

  5. Butz M (1982) Oxalatsteinprophylaxe durch Alkali-Therapie. Urologe [A] 21:142

    Google Scholar 

  6. Dahlberg CJ, Kurzt SB, Wilson DM, Smith LH (1977) Clinical features and management of cystinuria. Mayo Clin Proc 52:533

    Google Scholar 

  7. Finlayson B (1978) Physicochemical aspects of urolithiasis. Kidney Int 13:344

    Google Scholar 

  8. Gehron RP, Terumie ID (1991) Biochemical markers of metabolic bone disease. In: Avioli LV, Krane MS (eds) Metabolic bone disease and clinically related disorders. Saunders, Philadelphia, London, Toronto, Montreal, Syndney, Tokyo, p 244

    Google Scholar 

  9. Gundenberg CM, Lian JB, Gallop PM, Steinberg JJ (1983) Urinary y-Carboxyglutamic acid and serum osteocalcin as bone markers: studies in osteoporosis and Paget's disease. J Clin Endocrinol Metab 57:1221

    Google Scholar 

  10. Häusinger D (1990) Organization of hepatic nitrogen metabolism and its relation to acid-base homeostasis. Klin Wochenschr 68:1096

    Google Scholar 

  11. Hamm LL (1990) Renal handling of cirate. Kidney Int 38:728

    Google Scholar 

  12. Hallson PC, Rose GA, Sulaiman S (1983) Raising urinary citrate lowers calcium oxalate and calcium phosphate crystal formation in whole urine. Urol Int 38:179

    Google Scholar 

  13. Herrmann U, Schwille PO, Kuch P (1991) Crystalluria determined by polarization microscopy — technique and results in healthy control subjects and patients with idiopathic recurrent calcium urolithiasis classified in accordance with calciuria. Urol Res 19:151

    Google Scholar 

  14. Hosking DH, Wilson JWL, Liedtke RR, Smith LH, Wilson DM (1985) Urinary citrate excretion in normal persons and patients with idiopathic calcium urolithiasis. J Lab Clin Med 106:682

    Google Scholar 

  15. Johansen JS, Thomsen K, Christiansen C (1987) Plasma bone Gla protein concentration in healthy adults. Dependence on sex, age, and glomerular filtration. Scand J Clin Lab Invest 47:345

    Google Scholar 

  16. Massry SG, Coburn JW, Chapman LW, Kleeman CR (1968) Role of serum Ca, parathyroid hormone, and NaCl infusion on renal Ca and Na clearances. Am J Physiol 214:1403

    Google Scholar 

  17. Pak CYC (1987) Citrate and renal calculi. Min Electr Metab 13:257

    Google Scholar 

  18. Pak CYC (1989) Physicochemical action and extrarenal manifestations of alkaly therapy. In: Walker VR, Sutton RAL, Cameron ECB, Pak CYC, Robertson W (eds) Urolithiasis. Plenum Press, New York, p 511

    Google Scholar 

  19. Pak CYC, Diler EC (1969) Ionic interaction with bone mineral. V. Effect of Mg2+, Citrate3-, F- and SO4 2- on the solubility, dissolution and growth of the bone mineral. Calc Tissue Res 4:69

    Google Scholar 

  20. Rümenapf G, Schwille PO (1987) The influence of oral alkali citrate on intestinal calcium absorption in healthy men. Clin Sci 73:117

    Google Scholar 

  21. Rümenapf G, Schwille PO (1988) The influence of citrate on the duodenal absorption of calcium in the rat. Calc Tiss Int 42:326

    Google Scholar 

  22. Sachs L (1984) Angewandte Statistik, 6th edn. Springer, Berlin Heidelberg New York

    Google Scholar 

  23. Scholz D, Schwille PO (1981) Klinische Laboratoriumsdiagnostik der Urolithiasis. Dtsch Med Wochenschr 106:99

    Google Scholar 

  24. Schwille PO (1989) Citrate and idiopathic recurrent calcium urolithiasis: an approach to the origin of hypocitraturia and correction by two alkali citrates. In: Walker VR, Sutton RAL, Cameron ECB, Pak CYC, Robertson WG (eds) Urolithiasis. Plenum Press, New York, p 517

    Google Scholar 

  25. Schwille PO, Scholz D, Paulus M, Engelhardt W, Sigel A (1979) Citrate in daily and fasting urine: results on controls, patients with recurrent idiopathic calcium urolithiasis, and primary hyperparathyroidism. Invest Urol 16:457

    Google Scholar 

  26. Schwille PO, Scholz D, Schwille K, Leutschaft R, Goldberg I, Sigel A (1982) Citrate in urine and serum and associated variables in subgroups of urolithiasis-results from a stone clinic. Nephron 31:194

    Google Scholar 

  27. Schwille PO, Rümenapf G, Schmidtler J, Köhler R (1987) Fasting and post-calcium load serum calcium, parathyroid hormone, calcitonin in male idiopathic calcium urolithiasis —evidence for a basic disturbance in calcium metabolism. Exp Clin Endocrinol 90:71

    Google Scholar 

  28. Schwille PO, Rümenapf G, Schwarzländer H, Kuch P, Berens H (1988) Medium-term treatment of idiopathic recurrent calcium urolithiasis by oral sodium-potassium citrate — a preliminary report on metabolic effects. In: Martelli A (ed) Inhibitors of crystallization in renal lithiasis and their clinical application. Acta Medica Edizioni e Congressi, Rome, p 177

  29. Schwille PO, Töpper K, Schwille K, Herrmann U (1991) Recurrent idiopathic calcium urolithiasis (RCU) — blood levels of two vitamin D metabolites in males. In: Norman AW, Bouillon R, Thomasset M (eds) Vitamin D. Gene regulation, structure-function analysis and clinical application. de Gruyter, Berlin New York, p 932

    Google Scholar 

  30. Schwille PO, Herrmann U, Wolf C, Berger I, Meister R (1991) Citrate and recurrent idiopathic urolithiasis: I. A longitudinal pilot study on the metabolic effects of oral potassium citrate administered over the short-, medium- and long-term medication of male stone patients. Urol Res 20:145

    Google Scholar 

  31. Simpson DP (1983) Citrate excretion: a window of renal metabolism. Am J Physiol 244:F223

    Google Scholar 

  32. Stern PH (1990) Vitamin D and bone. Kidney Int 38 [Suppl 29]:S17

  33. Sutton RAL, Walker VR (1986) Bone resorption and hypercalciuria in calcium stoneformers. Metabolism 35:485

    Google Scholar 

  34. Sutton RAL, Wong NLM, Dirks JH (1979) Effects of metabolic acidosis and alkalosis on sodium and calcium transport in the dog kidney. Kidney Int 15:520

    Google Scholar 

  35. Walton RJ, Bijvoet OLM (1975) Nomogram for the deviation of renal threshold phosphate concentration. Lancet II:309

    Google Scholar 

  36. Welshman SG, McGeown MG (1976) Urinary citrate excretion in stoneformers and normal controls. Br J Urol 48:7

    Google Scholar 

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Authors and Affiliations

  1. Mineral Metabolism and Endocrine Research Laboratory, Department of Surgery, University of Erlangen, Erlangen, FRG

    U. Herrmann, P. O. Schwille, H. Schwarzlaender, I. Berger & G. Hoffmann

  2. Department of Urology, University of Erlangen, Erlangen, FRG

    U. Herrmann, P. O. Schwille, H. Schwarzlaender, I. Berger & G. Hoffmann

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  1. U. Herrmann
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  2. P. O. Schwille
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  3. H. Schwarzlaender
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  4. I. Berger
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  5. G. Hoffmann
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Herrmann, U., Schwille, P.O., Schwarzlaender, H. et al. Citrate and recurrent idiopathic calcium urolithiasis. Urol. Res. 20, 347–353 (1992). https://doi.org/10.1007/BF00922747

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