Urolithiasis CLINICAL AND BASIC RESEARCH

Urolithiasis CLINICAL AND BASIC RESEARCH

Edited by

Lynwood H. Smith Mayo Clinic

Rochester, Minnesota

William G. Robertson The Genera/Infirmary

Leeds, England

and

Birdwell Finlayson University of Florida Gainesville, Florida

SPRINGER SCIENCE+BUSINESS MEDIA, LLC

Library of Congress Cataloging in Publication Data

International Symposium on Urolithiasis Research, 4th, Williamsburg, Va., 1980. Urolithiasis, clinica1 and basic research.

"Proceedings of the Fourth International Symposium on Urolithiasis Research, heldJune 22-26, 1980, Williamsburg, Virginia."

Includes bibliographical references and index. 1. Calculi, Urinary-Congresses. 1. Smith, Lynwood H. II. Robertson, William G.

III. Finlayson, Birdwell, 1932- . IV. Title. [DNLM: 1. Kidney-Physiology­Congresses. 2. Urinary calculi-Congresses. W3 IN924XA 4th 1980u/WJ 356 1621980u) RC916.158 1980 616.6'22 80-27716 ISBN 978-1-4684-8979-8 ISBN 978-1-4684-8977-4 (eBook) DOI 10.1007/978-1-4684-8977-4

Proceedings of the Fourth International Symposium on Urolithiasis Research, held June 22-26, 1980, in Williamsburg, Virginia

Organizing Committee L. Cifuentes Delatte, A. deVries, B. Finlayson, H. Fleisch, J. Gillenwater, F. Knox, J. Lemann, Jr., G. H. Nancollas,

C. Y. C. Pak, W. G. Robertson, and H. E. Williams.

Secretary: L. H. Smith

e Springer Science+Business Media New York Originally pub1ished by P1enum Press, New York in 1981 Softcover reprint of the hardcover 1 st edition 1981 A Division of Plenum Publishing Corporation

233 Spring Street, New York, N.Y. 10013

AlI rights reserved

No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanica1, photocopying, microfilming,

recording, or otherwise without written permission from the Publisher

PREFACE

In 1968 Drs. B. E. C. Nordin and A. Hodgkinson organized the First International Symposium on Urolithiasis Research in Leeds, England. One hundred and five participants from continental Europe, Great Britain, and the United States met to review their work and exchange ideas regarding the formation of urinary calculi. This meeting achieved several important goals. It pulled together a nidus of workers in the many scientific disciplines that relate to urolithiasis. This nidus served as the seed for research growth in a complex, interdisciplinary field. It established a forum for con­tinuing communication in urolithiasis research with subsequent sym­posia being held every 4 years.

The Williamsburg Symposium was the fourth in the Leeds-Madrid­Davos series involving 186 participants from throughout the world. A stated emphasis was on clinical research under way in the field. There were no invited speakers and for the first time the 41 papers that were presented orally at the meeting were selected from 184 submitted abstracts. A total of 134 papers were presented in the poster sessions in the afternoons where informal exchange between interested participants and investigators could occur without the restrictions of a plenary session. Virtually all areas of urolithi­asis research from the most fundamental physical chemistry to clinical patterns of disease and specific modes of treatment were presented, reviewed and discussed during the meeting.

This volume presents the Proceedings of the Symposium and includes 40 papers that were presented orally in the plenary ses­sions and 120 papers presented as posters. An additional paper that was the product of a committee of experts on standardized no­menclature for crystal formation is included in the section on Crystal Formation and Physical Chemistry.

The meeting was made possible by the generous support from the National Institute of Arthritis, Metabolism, and Digestive Diseases, NIH; Burroughs Wellcome, Wellcome Foundation, and Deutsche Wellcome; Merck Sharp and Dohme; Smith Kline and French. Eaton Laboratories;

v

~ PREFACE

Willen Drug; Beach Pharmaceuticals; P. Keppler Verlag; and Blaine Company. The Organizing Committee wishes to express their thanks for this most critical support.

Behind any successful meeting are special people who play a critical role in the planning, organization, and conduct of the meeting. Mrs. Sherry Linander filled this role with the Williamsburg meeting. She also typed the entire proceedings of the meeting for publication. To her goes our special gratitude and admiration.

Lynwood H. Smith W. G. Robertson Birdwell Finlayson

Williamsburg, Virginia June 22-26, 1980

ACKNOWLEDGMENTS

This Symposium was supported by:

1. The National Institute of Arthritis, Metabolism and Digestive Diseases, National Institutes of Health, Public Health Service, Department of Health, Education and Welfare, Bethesda, Maryland, U.S.A. Grant No . AM 26949.

2. Burroughs Wellcome Company Research Triangle Park, North Carolina, U.S.A.

Wellcome Foundation, LTD., Sweden.

Deutsche Wellcome, Burgwedel, West Germany.

3. Merck Sharp and Dohme West Point, Pennsylvania, U.S.A.

4. Smith Kline & French Philadelphia, Pennsylvania, U.S.A.

5. Eaton Laboratories Norwich, New York, U.S.A.

6. Willen Drug Company Baltimore, Maryland, U.S.A.

7. Beach Pharmaceuticals Tampa, Florida, U.S.A.

8. P. Keppler Verlag Heusenstornrn, West Germany

9 . Blaine Company, Inc. Ft. Mitchell, Kentucky, U.S.A.

CONTENTS

I. CLINICAL UROLITHIASIS

EVALUATION

The Main Risk Factor for Calcium Oxalate Stone Disease in Man: Hypercalciuria or Mild Hyperoxaluria? ............•..•....•...........

W. G. Robertson, M. Peacock, D. Ouimet, P. J. Heyburn, and A. Rutherford

Prediction of Stone Recurrence .......................... . S. Ljunghall, B. G. Danielson, R. Kallsen,

and A. Fritjofsson

Crystalluria .•••.........••.........................••..• P. G. Werness, J. H. Bergert, and L. H. Smith

Study of Calcium Crystals in Patients with Kidney Stones ••••....•.....•........•........••...•

L. Brandes, D. G. Oreopoulos, H. Husdan, and P. Crassweller

Metabolic Investigations in 407 Recurrent Stone­Formers and Healthy Controls on Condition of Individual as well as Standard Diet •..•....•....

W. Vahlensieck, D. Bach, A. Hesse, and W. Schneeberger

Classification of Stone-Patients and Healthy Persons on the Basis of the Urinary Analysis ..•.•..•.•..••.

R. Hartung, P. Leskovar, J. Riedel, H. Schneider, A. Siebert, and M. Kratzer

Urinary Excretion of Citrate in Normal Subjects and Patients with Urolithiasis •....•.•.•......•.•.•

H. G. Tiselius

ix

3

13

17

23

29

35

39

X

Magnesium Excretion in Urine on Condition of Individual as well as Standard Diet in Healthy Controls and Calcium Oxalate Stone-Formers .••••..•••••••••..••••..•........••..•

D. Bach, A. Hesse, A. Strenge, and W. Vahlensieck

Circadian Excretion of Uric Acid on Condition of Standard Diet after Purine Load in Calcium Oxalate Stone-Formers and Healthy Controls ........ .

W. Schneeberger, D. Bach, A. Hesse, W. Dewes, and W. Vahlensieck

Hypophosphatemia in Recurrent Renal Stone-Formers -Consequence of Arterial Hypertension? ............. .

W. Tschope, E. Ritz, and H. Wesch

Relationship of Urinary Calcium to Sodium Excretion in Calcareous Renal Stoneformers: Effect of Furosemide ...............•...............

R. A. L. Sutton and V. R. Walker

The Clinical Importance of Renal Tubular Acidosis in Recurrent Renal Stone Formers ..............••...

U. Backman, B. G. Danielson, B. Fellstrom, G. Johansson, S. Ljunghall, and B. Wikstrom

Experience with the Short Ammonium Chloride Test ........ . B. G. Danielson, U. Backman, B. Fellstrom,

G. Johansson, S. Ljunghall, and B. Wikstrom

Urinary Excretion of Amino Acids by Subjects with Renal Calculi .••.•....•.......•..•••......•...

W. C. Thomas, Jr., M. H. Malagodi, and 0. M. Rennert

Excretion of the Ca-Binding Amino Acid, y-Carboxyglutamate, in Stone-Formers .............. .

J. Joost, S. Silbernagl, and E. Jarosch

Renal Stone Formation in Primary Hyperparathyroidism - Role of Tubular Dysfunction •.............•......•......•..•........

S. Ljunghall, B. G. Danielson, G. Johansson, and L. Wibell

Short Ammonium Chloride Loading Test for Evaluation of Hyperparathyroidism ........••••.••.•.

P. Alken

CONTENTS

45

51

55

61

67

71

77

81

89

93

CONTENTS

Saturation of Urine in Primary Hyperparathyroidism: Its Role in Renal Stone Formation •••••••.••..•••••••••••••••.. .'

A. Rapado, J. M. Castrillo, and M. Diaz-Curiel

CLINICAL DISORDERS

Medullary Sponge Kidney (Tubular Ectasia)

xi

99

in Calcium Urolithiasis... . ........................ 105 E. R. Yendt, S. Jarzylo, W. A. Finnis,

and M. Cohanim

Clinical and Laboratory Findings in Patients with Medullary Sponge Kidney......... . ............. 113

U. Backman, B. G. Danielson, B. FellstrBm, G. Johansson, S. Ljunghall, and B. Wikstrom

Hereditary Hyperuricosuric Urolithiasis........... . ... . .. 121 0. Sperling

2,8-Dihydroxyadeninuria: Or When is a Uric Acid Stone not a Uric Acid Stone?.................. 125

H. A. Simmonds, K. J. Van Acker, M. J. Dillon, T. M. Barratt, C. F. Potter, A. Sahota, and J. S. Cameron

Renal Calculi in Triamterene Users ..•.......•.•.•...••..• B. Ettinger, N. 0. Oldroyd, and F. Sorgel

Cystine Stone - Therapy with Alpha-Mercapto­Propionylglycine - Ten Years of Experience with Forty-Two Patients ••••..•.••••••••.

R. E. Hautmann

The Natural History of Cystinuria: A 15 Year Follow-Up in 106 Patients •••..•.••••••..•••.• •

F. Linari, M. Marangella, B. Fruttero, and M. Bruno

Glutamine Therapy of Cystinuria •.. • .••..•.••••....•.••••• C. J. Van Den Berg, D. M. Wilson,

L. H. Smith, and J . D. Jones

Urinary Stone Formation in Bowel Disease .•..• • •••..••..•• M. Peacock, C. P. Bambach, W. G. Robertson,

J. E. Aaron, and G. L. Hill

131

139

145

155

159

Prevalence of Nephrolithiasis in Malabsorptive Syndromes............................ 169

K. Dharmsathaphorn, D. Freeman, H. J. Binder, and J. Dobbins

The Influence of Gastrointestinal Anatomy on Oxalate Excretion and Kidney Stone Incidence in Patients with Enteric Hyperoxaluria ••.......•...•..•••••••••....•

B. Nordenvall, L. Backman, and L. Larsson

Therapy for Enteric Hyperoxaluria: A Comparison of Calcium Supplementation and Urinary Alkalinization ....•..••.•.•••..........

J. G. Gregory, K. Y. Park, R. Wilt, and A. Feigl

Retrospective Follow-Up of Patients with Struvite Calculi .•..• • .••.••.....•.•.........•• • ••.

R. R. Bruce and D. P. Griffith

Infected Renal Lithiasis: Results of Long-Term Surgical and Medical Management ......... .

J. W. Segura, S. B. Erickson, D. M. Wilson, C. J. Van Den Berg, and L. H. Smith

Infection-Induced Stones: Status of Clinic Trials with Urostat™ (Acetohydroxamic Acid) ............•..•.........••.... ·.·•······•·••·

D. P. Griffith, P. Moskowitz, and S. Feldman

Urease Inhibitors in the Treatment of Infection Induced Stones: Some Chemical, Pharmacologic and Clinical Considerations •••.......

W. N. Fishbein

Complications and Management of "Neglected" Renal Stones .....••••.....••.••••••.....•...•••••••

S. M. Singh, S. N. Wadhwa, P. Trehan, N. P. Gupta, R. Yadav, and K. K. Malhotra

Field Preventive Program of Bladder Stone .Disease in Thailand •••••••....•.•......••••..

A. Valyasevi, S. Dhanamitta, and S. Watthana-Kasetr

173

179

191

195

199

209

215

221

CONTENTS

TREATMENT

Objective Evidence for the Beneficial Effect of a High Fluid Intake in

xiii

the Management of Nephrolithiasis.................. 227 K. Sakhaee, J. E. Zerwekh, and C. Y. C. Pak

Reduction of Urinary Oxalate Excretion During Chronic Thiazide Therapy.................... 235

M. Cohanim and E. R. Yendt

Long-Term Treatment with Bendroflumethiazide for Prevention of Renal Stones. Clinical Experiences............................... 241

S. Ljunghall, U. Backman, B. G. Danielson, B. Fellstrom, G. Johansson, and B. Wikstrom

Long-Term Treatment with Bendroflumethiazide for Prevention of Stones. Metabolic Effects. . .......................................... 245

S. Ljunghall, U. Backman, B. G. Danielson, B. Fellstrom, G. Johansson, and B. Wikstr5m

Experiences with Thiazides in a Double Blind Study........................................ 249

D. Scholz, P. 0. Schwille, and A. Sigel

Neutral Potassium Phosphate and Thiazide: Combined Treatment in Recurrent Stone Formers. • • • • • • • . • . . • • • • • • . • • . • • • • • • • • • • . • • . • • 253

A. S. Klein and D. P. Griffith

Phosphate Treatment of Idiopathic Calcium Stone Disease...................................... 259

M. Peacock, W. G. Robertson, P. J. Heyburn, A. E. J. Davies, and A. Rutherford

Prophylactic Treatment with Magnesium Hydroxide in Renal Stone Disease. . . . . . . • • • • • • • • • • • • • • • • . • • • • • 2 6 7

G. Johansson, U. Backman, B. G. Danielson, B. Fellstrom, S. Ljunghall, and B. Wikstr5m

Experiences with Long-Term Use of Sodium Cellulose Phosphate for Prevention of Renal Calcium Stones............................ 275

S. Ljunghall, U. Backman, B. G. Danielson, B. Fellstr5m, G. Johansson, B. Wikstr5m, and 0. ~linder

xiv

Long-Term Effects of Campanyl in the Treatment of Patients with

CONTENTS

Recurrent Calcium Urinary Stones................... 283 E. W. Rugendorff, H.-J. Schneider,

and 0. Hallwachs

How to Increase the Lithoprotective and/or Litholytic Properties of Urine. • • • • . . . . . . . . . . . . . . . • . • . . . . . . . . . . • . . . . . . . . . 287

P. Leskovar, R. Hartung, M. Hropot, M. Simmel, R. Allgayer, E. Wellnhofer, and E. Hoffmann

Natural Volatile Oils in the Management of Renal Calcium Stone Disease..................... 293

E. J. Will, G. D. Bell, M. Taylor, C. Richmond, A. Middleton, N. Johnson, and B. Dhillon

Fybranta(R) - A New Approach to the Treatment of Idiopathic Hypercalciuria....................... 297

P. J. R. Shah, G. Williams, and N. A. Green

II. EPIDEMIOLOGY, NUTRITION AND ENVIRONMENT

A Risk Factor Mode l of Stone-Formation: Application to the Study of Epidemiological Factors in the Genesis of Calcium Stones.......................... 303

W. G. Robertson, M. Peacock, P. J. Heyburn, A. Rutherford, V. J. Sergeant, and C. P. Bambach

The Role of Affluence in Recurrent Stone Formation.......................................... 309

0. Zechner and V. Scheiber

Alcohol as an Epidemiological Risk in Urolithiasis. . • • • • • • • • • • • . . • • • • • • • • . • • • . . . • • • • • • . . . 315

0. Zechner and V. Scheiber

Familial Hypercalciuric Urolithiasis...... . .............. 321 A. Weinberger, J. Schechter, J. Pinkhas,

and 0. Sperling

Cause of Primary Bladder Stone in England -A Retrospective Epidemiological Study.............. 325

S. B. Halstead

CONTENTS xv

Endemic Bladder Stones in Indonesia...................... 329 J. G. Brockis, R. C. Bowyer, G. Ryan,

T. A. Taylor, T. Kamardi, and A. Rizal

Future of Tamarind and Tartrate in Preventing Recurrence of Renal Calculi. • . . . . . • • • . • • • • • • • • • • • • • . • . • • . • • • • • • • . • • • • • • 333

B. K. Sur, H. N. Pandey, S. Deshpande, R. Pahwa, R. K. Singh, and Tarachandra

Dietary Structure and Urinary Composition in a Stone-Free Population........... . . . .. . . . ...... 337

M. Modlin, P. J. Davies, and D. Crawford

Idiopathic Hypercalciuria - Its Control with Unprocessed Bran............. . .............. . . 343

P. J . R. Shah, G. Williams, and N. A. Green

Urolithiasis - A Study of Drinking Water Hardness and Genetic Factors. .... .. . .. . . .. . . ....... 347

D. N. Churchill, C. M. Maloney, J. C. Bear, D. G. Bryant, G. Fodor, and M. H. Gault

Urine Chemistry in Renal Stone-Formers in an Area with Soft Drinking Water. . .................... 349

D. N. Churchill, D. P. Black, C. M. Maloney, and M. H. Gault

The Importance of Chronic Cadmium Poisoning in Renal Stone Formation - A Five Year Study....................................... . . 353

R. Scott, 0. P. Fitzgerald-Finch, C. Cunningham, J. M. Ottoway, and G. S. Fell

Should Recurrent Calcium Oxalate Stone Formers Eat Less Animal Protein?................... 359

W. G. Robertson, M. Peacock, P. J. Heyburn, F. A. Hanes, D. Ouimet, A. Rutherford, and V. J. Sergeant

Influence of Purine Content of Diet and Allopurinol on Uric Acid and Oxalate Excretion Levels................................... 363

H. A. Simmonds, K. J. Van Acker, C. F. Potter, D. R. Webster, G. P. Kasidas, and G. A. Rose

xvi CONTENTS

Increased Availability of Dietary Carbohydrate: A Factor in the Genesis of Idiopathic Calcium Oxalate Urolithiasis?...................................... 369

J. A. Thorn, J. E. Morris, A. Bishop, and N. J. Blacklock

Reduction of Urinary Oxalate Excretion in Primary Hyperoxaluria by Diet...................... 373

E. R. Yendt, M. Cohanim, and L. Peters

III. CRYSTAL FORMATION AND PHYSICAL CHEMISTRY

Preface on Standardized Nomenclature..................... 381 B. Finlayson

Paper on Standardized Nomenclature....................... 383 A. D. Randolph and G. Drach

A Constant Composition Method for Modelling Urinary Stone Formation............................ 391

M. Sheehan and G. H. Nancollas

Crystal Growth and Aggregation of Calcium Oxalate in High Ionic Strength Solutions........... 401

H. FUredi-Milhofer, D. Skrtic, M. Markovic, and Lj. Komunjer

The Electrical Double Layer at Calcium Oxalate-Water Interfaces........................... 411

P. A. Curreri, G. Y. Onoda, Jr., and B. Finlayson

Calcium Electrode Measurements of Calcium Oxalate Mineralization: The Effects of Urine and Other Inhibitors...................... 421

W. P. Tew and C. D. Malis

Effect of Urinary Macromolecules on Calcium Oxalate Dihydrate Crystal Growth and Nucleation Rates. • • . • . • • • • • • . • . • • • . • • • • • • • • • • • • • • • • 42 7

A. D. Randolph, z. I. Kraljevich, and G. Drach

Equilibrium-Based Computer Model for the Estimation of Urine Saturation..................... 437

P. G. Daniele and M. Marangella

CONTENTS

The Relation Between Relative Supersaturation and Crystal Aggregation in Urine - An SEM Study and a Computerized Calculation of

xvii

the Ion Equilibrium................................ 441 F. Hering, W. G. Burschardt, N. Pyhel,

and W. Lutzeyer

Determination of the Stability Constant of the Calcium Dioxalate Complex................... 447

J. R. Burns, B. Finlayson, and A. Smith

Calcium Oxalate Hydrates. Dissolution, Transformation and Crystallization Studies......... 453

B. B. Tomazic and G. H. Nancollas

On the Transition Amorphous Calcium Phosphate to Crystalline Octacalcium Phosphate............... 459

J. M. Garcia Ruiz, V. Lopez-Acevedo, and J. L. Amor6s

Stabilizing Factors for Uric Acid Dihydrate -A Contribution to Uric Acid Stone Formation.......................................... 465

R. H. B5rner, H.-J. Schneider, and W. Berg

Epitaxis Between Stone-Forming Crystals at the Atomic Level................................ 469

N. S. Mandel and G. S. Mandel

The Effect of Seed Crystals on Calcium Oxalate Nucleation................................. 481

J. R. Burns and B. Finlayson

The Effect of Urinary pH on the Saturation of Calcium and Oxalate and on Urinary Crystal Formation.................................. 489

J. G. Gregory, M. M. Hoy, K. Y. Park, and A. Feigl

Hyperuricosuria in Calcium Oxalate Urolithiasis and its Possible Relationships with Stone Matrix Formation. • . • • • . • . . • • • • . . • • . • • • • • • • • • • • • . • • • 4 93

J. G. Brockis and R. C. Bowyer

Calcium Oxalate Crystallization in Urothelial-Lined Systems........................... 497

W. B. Gill, K. W. Jones, K. J. Ruggiero, and M. C. Fromes

Intrarenal Calcium and Oxalate Concentration Gradients in Healthy and Stone Forming Kidneys - The Renal Papilla as the Primary Nucleation Site............................ 509

R. E. Hautmann, A. Lehmann, and H. Osswald

Rat Renal Papillary Structure in Oxalate­Induced Microlithiasis, A Scanning Electron Microscope Study.......................... 517

S. R. Khan, B. Finlayson, and R. L. Hackett

The Ultrastructure of Rat Renal Tubules in Experimental Calcium Oxalate Nephrolithiasis......... • • • • • . . . . . . . . . . . . . • . . . • . . . • 523

S. R. Khan, B. Finlayson, and R. L. Hackett

Crystal Formation in the Renal Tubules of Rats Induced by Ethylene Glycol Administration and Magnesium Deficiency........................... 527

H. G. Rushton, M. Spector, A. L. Rodgers, and C. E. Magura

A New View of Stone Formation Under the Aspect of Flow Dynamics........ . . . . . . . . . . • • • . . • • . . . 533

E. Schulz and H.-J. Schneider

Rates and Mechanisms of Dissolution of Renal Calculi. I. Rates and Mechanisms of Dissolution of Pure Calcium Oxalate Monohydrate in Acid and EDTA Solution.............. 539

J. Pawelchak, D. R. Flanagan, and A. P. Simonelli

Rates and Mechanisms of Dissolution of Renal Calculi. II. Development and Discussion of Potential Models for Dissolution of Oxalate Calculi..................... 545

J. Pawelchak, D. R. Flanagan, and A. P. Simonelli

Rates and Mechanisms of Dissolution of Renal Calculi. III. Mechanisms and Rates of Dissolution of Simulated Oxalate Calculi in Acid and EDTA Solutions................. 551

J. Pawelchak, D. R. Flanagan, and A. P. Simonelli

CONTENTS xix

IV. INHIBITORS AND PROMOTERS

Inhibition of PTH-Induced Nephrocalcinosis by Phosphocitrate.................................. 559

W. P. Tew, C. D. Malis, A. L. Lehninger, G. W. Walker, and J. E. Howard

The Sources of Phosphocitrate and its Role as an Inhibitor of Calcium Phosphate and Calcium Oxalate Crystallization................ 569

G. Williams and J. D. Sallis

Characterization of the Calcium Oxalate Crystal Growth Inhibitors in Human Urine........... 579

E. E. Schrier, J. L. Rubin, K. E. Lee, P. G. Werness, and L. H. Smith

Inhibitors of Calcium Oxalate and Calcium Phosphate Crystal Formation in Urine -A Critique and Reappraisal......................... 589

P. C. Hallson, G. A. Rose, and C. T. Samuell

Studies on Inhibitors and Promoters of the Crystallization of Calcium Oxalate in Urine and in Matrix from Calcium Oxalate Stones... . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . 601

D. S. Scurr, C. M. Bridge, and W. G. Robertson

Effect of Different Urinary Constituents on Inhibiting or Accelerating Calcium Oxalate Crystallization............................ 607

B. K. Sur and H. N. Pandey

The Effect of Normal and Stone-Forming Urine on the Growth and Aggregation of Calcium Oxalate Crystals in Relation to Urinary Glycosaminoglycans and Urate Concentrations............................... 611

R. L. Ryall and V. R. Marshall

Urinary Glycosaminoglycan Excretion in Patients with Urolithiasis.................................. 619

J. D. Sallis, K.-H. Bichler, S. Korn, and A. HauSmann

Inhibition of Calcium Oxalate Crystal Growth in Patients with Urolithiasis...................... 623

H. G. Tiselius and L. Larsson

XX

The Effect of Urine and Other Inhibitors on the Growth and Aggregation of Calcium

CONTENTS

Oxalate Crystals in Vitro................... .. .... . 631 R. L. Ryall and V. R. Marshall

Identification of a Small Molecular Weight Inhibitor of the Oxalate Precipitation. . . .... .. ... . 637

B. Pinto and J. Pujol

The Effect of Some Urinary Constituents on the In Vitro Nucleation and Growth Kinetics of Calcium Oxalate.. .. ........ . .... . .. .. . ... ... . . . . 641

A. Rodgers and J. Garside

Isolation of a Urinary Mucoprotein Capable to Precipitate Oxalate............................. 651

B. Pinto, J . L. Paternain, and J. Bernshtam

The Inhibitory Effect of Polymeric Carboxylic Amino-Acids and Urine on Calcium Oxalate Crystallization...................... . ... .. 657

N. Garti, F. Tibika, S. Sarig, and S. Perlberg

Inhibited Precipitation and Growth of Ca-Oxalate Crystals in the Presence of the Alkaline Salts of some Polyhydroxycarboxylic Acids.......... 663

R. Hartung, P. Leskovar, R. Allgayer, H. Schneider, 0. Bender, E. Wellnhofer, and M. Simmel

Interaction of Dyes with Inorganic Constituents of Kidney Stones... . .. . . . . . . . • . . • . • . . • • • • • . • • . • • . . • 669

B. van't Riet and C. E. O'Rear

V. MATRIX

Urinary Calcium Binding Proteins and Renal Calculi....... 675 M. I. Resnick, C. W. Gammon, M. B. Sorrell,

and W. H. Boyce

Excretion of Tamm-Horsfall Urinary Glycoprotein (Uromucoid) in Renal Calcium Stone Formers. . • . . • • • . . • . • . . . . • • • . • . . . • • • . • • • • • • • • . • . • • • • 685

B. Wikstrom and J. Wieslander

CONTENTS

Proteolytic Activity and Organic Substances in Urine ...•.....•..•..•.......•.........••••..••..

H.-J. Schneider and R.-H. Borner

Mechanism of the Heterogeneous Nucleation by a Urinary Mucoprotein .........•••.•.••.•..•••.•.

B. Pinto, J. Bernshtam, and J. L. Paternain

Nephrolithiasis in Dialysed Patients -Evidence for a Peculiar Type of Matrix Stones with Ca-Oxalate Inclusions .•.••.............

J. Bommer, E. Ritz, R. Waldherr, and W. Tschope

The Chemical Composition of a Non-

xxi

691

697

703

Crystalline Feline Kidney Stone.................... 707 U. M. Cowgill

VI. RENAL AND GASTROINTESTINAL PHYSIOLOGY

The Effects of Chlorothiazide on Sodium, Calcium, and Magnesium Transport in the Nephron of the Thyroparathyroidectomized Hamster.............. 715

J. H. Dirks, G. A. Quamme, and N. L. M. Wong

Indomethacin Lowers Urinary Calcium Excretion in Normal Volunteers and Normocalciuric Stone-Formers......... • . . . • . . . • . . . • . . . . . . . . . . . . . . . . 723

W. C. Carter, III, P. V. Halushka, D. Jones, B. Roof, S. N. Rous, and M. Spector

On the Mechanism of Action of 1,25(0H)2D3 in the Intestine................................... 727

H. Rasmussen, 0. Fontaine, T. Matsumoto, and D. B. P. Goodman

Low Phosphate Diet in Rats: A Model for Calcium Oxalate Urolithiasis................... 731

P. G. Werness, F. G. Knox, and L. H. Smith

Intracellular Mechanisms Underlying the Phosphaturic Response to Parathyroid Hormone in the Hamster............................. 735

T. Berndt, S. Czekalski, M. Onsgard, A. Hoppe, and F. G. Knox

xxii

Role of Nicotinamide Adenine Dinucleotide (NAD) in Control of Proximal Renal Tubular

CONTENTS

Phosphate Transport................................ 741 T. P. Dousa and S. A. Kempson

The Incidence of Nephrocalcinosis and the Urinary Excretion of Citrate and Calcium in Patients with Non-Azotemic Type 4 Renal Tubular Acidosis. . . . . . . . . . . . . . . . . . . . . . 7 4 7

E. McSherry, J. Gates, and M. Pialaet

Urinary Citrate Excretion and Acidification Defects in Renal Calcium Stone Formers............. 757

B. Wikstrom, U. Backman, B. G. Danielson, B. Fellstrom, G. Johansson, and S . Lj unghall

Influence of Changes in Calcium Metabolism on Renal Handling of Oxalate in Rats............... 763

H. Osswald, J. A. Haas, R. M. Meyer-Hentschel, and R. Hautmann

Evaluation of a New Oxalate Assay........................ 767 F. E. Cole, S. Snyder, D. J. Bennett,

K. M. Gladden, E. D. Frohlich, and D. T. Erwin

Intestinal Oxalate Absorption in Calcium Oxalate Stone Disease.............................. 775

J. W. Dobbins, K. Cooper, R. Lang, L. H. Smith, H. J. Binder, and A. E. Broadus

Oxalate Loading Test for the Diagnosis of Oxalate Hyperabsorption............................ 779

A. Hesse, A. Strenge, D. Bach, and W. Vahlensieck

Effect of Vitamin B6 Deficiency on the Intestinal Absorption and Excretion of Oxalate in Rats.... . . . • . . . . • . . . . . . . . . . . . . . . . . . . . 783

S. Farooqui, A. Mahmood, R. Nath, and S. K. Thind

Excretion of Oxalic Acid Following the Ingestion of Various Amounts of Oxalic Acid-Rich Foods.............. . . . . . . . . . . . . . . • 789

A. Strenge, A. Hesse, D. Bach, and W. Vahlensieck

CONTENTS xxiii

Response of Gastrointestinal Hormones and Intestinal Calcium Absorption During an Oral Carbohydrate Meal.......................... 795

D. Scholz, P. 0. Schwille, and A. Sigel

How to Prevent the Hyperresorption of Dietary Oxalate and the Oxalate Peaks in Urine. . • . . . . . • . . . . . • . • . . . . . . . . . • . • . . • . • • • . . . . . . . 801

P. Leskovar, R. Hartung, M. Hropot, H. Schneider, H. G. Reichling, and H. Huber

Isolation of the Oxalate Binding Protein................. 807 B. Pinto and J. L. Paternain

VII. METABOLISM

The Pathophysiological Basis of Hypercalciuria in Primary Hyperparathyroidism..................... 813

A. E. Broadus, R. L. Horst, R. Lang, E. T. Littledike, and H. Rasmussen

Plasma 1,25(0H) 2D in Idiopathic and Hyperparathyroid Stone-Formers................... . . 825

M. Peacock, P. J. Heyburn, M. Barnet, G. A. Taylor, W. B. Brown, and A. E. J. Davies

Orthophosphate Therapy Decreases Urinary Calcium Excretion and Serum 1,25-Dihydroxy Vitamin D Concentrations in Idiopathic Hypercalciuria.......................... 831

C. J. Van Den Berg, R. Kumar, D. M. Wilson, H. Heath, and L. H. Smith

Cyclic Nucleotides and Related Variables in Urolithiasis. . • . • . . . . . . • . . . . • . . . . . . • • . . • • • • . • • . . . . . 835

P. 0. Schwille, D. Scholz, W. Engelhardt, K. Schwille, B. Schreiber, I. Goldberg, and A. Sigel

Disturbed Terminal Mineralization of Bone in Idiopathic Hypercalciuria....................... 841

H. H. Malluche, W. Tschope, W. Meyer, E. Ritz, and S. G. Massry

xxiv CONTENTS

Dietary Calcium Restriction may be Good for Patients' Stones - But not for Their Bones. • • . • • • • • . • • . • . • • . . • . • . • . . . . . . • • • • • • . • • . 84 7

C. Velentzas, D. G. Oreopoulos, S. Meema, H. E. Meema, T. Nutsuga, E. Alison, A. Katirtzoglou, and P. Crassweller

The Pathways of Oxalate Biosynthesis..................... 855 K. E. Richardson and M. P. Farinelli

Alterations in Kidney Enzymes of Oxalate Metabolism in Patients with Urolithiasis........... 865

S. K. Thind, R. Nath, G. Verma, M. S. Rao, and B. C. Bapna

Therapeutic Role of Vitamin B6 on Oxalate Metabolism in Urolithiasis and its Effect on Hyperoxaluria Induced in Rats by Ethylene Glycol. . . . . . . . . . . . . . . . . . . . . . . . . . . . 869

S. K. Thind, R. Nath, S. Farooqui, and M. S. R. Murthy

Decomposition of Exogenous 14c-Oxalate (14c-ox) to 14c-carbon Dioxide (14co2) In Vitro and in Animals.................... 875

V. Hagmaier, D. Hornig, C. Bannwart, K. Schmidt, F. Weber, H. Graf, and G. Rutishauser

Enhancement of Urinary Citrate in Oxalate Stone Formers by the Intake of Alkaline Salts..................................... 881

M. Butz and H.-J. Dulce

Magnesium Metabolism in Renal Stone Formers .....•........ G. Johansson, U. Backman, B. G. Danielson,

B. Fellstrom, S. Ljunghall, and B. Wikstrom

Urate Metabolism and Urinary Acidification .•.•.•........• B. Fellstrom, U. Backman, B. G. Danielson,

G. Johansson, S. Ljunghall, and B. Wikstrom

Urate Metabolism in Calcium Stone Disease •...•..•••.•.••. B. Fellstrom, U. Backman, B. G. Danielson,

G. Johansson, S. Ljunghall, and B. Wikstrom

885

889

895

CONTENTS XXV

VIII. STONE MORPHOLOGY AND STRUCTURE

Investigation with Polarizing Microscopy for the Classification of Urinary Stones From Humans and Dogs. . . . • . . . . . . • . • • . • • • . • . • . . . . . • . • 901

W. Hicking, A. Hesse, M. Gebhardt, and W. Vahlensieck

Statistical Results of the Analysis of more than 7,000 Urinary Calculi... . . .. ............. 907

M. A. H. Gebhardt and H.-P. Bastian

"Milk of Calcium": Morphology, Structure, and Mineralogical Composition..... .. ............... 911

R. Diaz-Gonzalez, H. Carvajal, 0. Leiva, P. Paniagua, and V. Borobia

Oolitic Structure of Milk of Calcium Sand and Milk of Calcium Stones............... .. ........ 917

L. Cifuentes Delatte and J. A. Medina

Silica in Urinary Calculi................................ 923 J. A. Medina, J . R. Sanchidrian, and

L. Cifuentes Delatte

Newberyte in Old Renal and Bladder Calculi..... .. ........ 929 M. Min6n Cifuentes and M. Santos

Forms of Ammonium Urate Presentation in Urinary Calculi of Non-Infectious and Infectious Origin........... ... ................ 935

E. Garcia de la Pena and L. Cifuentes Delatte

Prostatic Calculi........................................ 943 M. Spector, C. E. Magura, and J. C. Lilga

IX. ANALYTICAL METHODS

Isotachophoretic Determination of Oxalate in Unprocessed Urine.................................. 951

W. Tschope and E. Ritz

Analytical Isotachophoresis: An Improved Method for Quantitative Determination of Urinary Oxalate..... .... . .. ............... . . • . . . 959

K. Schmidt, V. Hagmaier, G. Bruchelt, and G. Rutishauser

xni CONTENTS

The Effect of Storage on Serum Oxalate Values............ 963 M. Maguire, N. Fituri, B. Keogh, and

J. Costello

Direct Measurement of Ionized Calcium (Standardization, Normal Values and Clinical Results).................................. 969

B. M. Ulshafer and A. Peemoller

New Glass Capillary Gas-Chromatographic Methods for Metabolites in Urine and Serum......... 977

W. Dosch

Comparison of X-ray Diffraction, IR-Spectroscopic, and Polarizing Microscopic Core-Shell Analysis of Urinary Stones ...•.•.............••...•

W. Hicking, A. Hesse, and W. Vahlensieck

Experience with Infrared Analysis of Urinary Tract Calculi in a Clinical Laboratory .......•.....

M. H. Gault, M. Ahmed, J. Kalra, I. Senciall, J. Morgan, W. Cohen, and D. Churchill

High Voltage Electron Microscopy of Urinary Calculi ..... . M. Spector and J. C. Lilga

Physical Investigations of Urinary Calculi .............. . B. E. McConville

Investigations for Characterizing Single Crystal Phases in Urinary Stones by Means of an Arrangement of Light Microscopy in Combination with Scanning Microscopy ............................•...

A. Hesse, W. Hicking, and W. Vahlensieck

List of Participants ......•......•.....•.............•...

Index .....................•...................... . ...••.•

985

993

997

1003

1009

1013

1023