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Pathophysiology of hypocitraturic nephrolithiasis
L Lee Hamm1, Kathleen S Hering-Smith
1Section of Nephrology and Hypertension, Department of Medicine, Tulane University Health Sciences Center, 1430 Tulane Avenue, New Orleans, LA 70112, USA. Lhamm@tulane.edu
Endocrinology and Metabolism Clinics of North America
|December 12, 2002
Summary
Urinary citrate is key to preventing calcium stones by binding calcium and altering crystal growth. Low levels are a known risk factor, but new research clarifies renal handling and therapeutic benefits of oral citrate.
Area of Science:
- Nephrology
- Urology
- Biochemistry
Background:
- Urinary citrate plays a vital role in inhibiting calcium stone formation.
- Low urinary citrate is a recognized risk factor for kidney stone development.
- Recent research has improved understanding of citrate's renal handling and its role in various conditions.
Purpose of the Study:
- To review the mechanisms by which urinary citrate inhibits calcium stone formation.
- To discuss the derangements in renal citrate handling associated with stone formation.
- To explore the therapeutic potential of oral citrate supplementation.
Main Methods:
- Literature review of studies on urinary citrate and kidney stone formation.
- Analysis of mechanisms of citrate's effect on calcium complexation and crystal growth.
- Examination of renal citrate transport and its regulation.
Main Results:
- Citrate inhibits stones by solubilizing calcium and modifying crystal aggregation.
- Dysfunctional renal citrate handling contributes to stone disease.
- Oral citrate increases urinary citrate and offers additional benefits for stone prevention.
Conclusions:
- Understanding citrate's role is crucial for managing calcium nephrolithiasis.
- Targeting urinary citrate levels, particularly with oral supplementation, is a promising therapeutic strategy.
- Further research into renal citrate handling can lead to improved stone prevention methods.