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[Tubular dysfunction in renal lithiasis: cause or consequence?].

P Jaeger, L Portmann, P Burckhardt

    Schweizerische Medizinische Wochenschrift
    |February 2, 1985
    PubMed
    Summary
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    Many kidney stone patients exhibit renal tubular dysfunction, particularly phosphate and bicarbonate leaks. This dysfunction appears common across various stone types and may result from nephrolithiasis itself.

    Area of Science:

    • Nephrology
    • Urology
    • Biochemistry

    Context:

    • Urolithiasis, or kidney stone disease, affects a significant population.
    • Understanding the underlying causes and associated conditions is crucial for effective management.
    • Renal tubular function plays a vital role in maintaining overall kidney health.

    Purpose:

    • To investigate the prevalence and nature of renal tubular dysfunction in male patients with urolithiasis.
    • To identify specific tubular defects, such as altered excretion of lysozyme, gamma-glutamyl transpeptidase (gamma-GT), glucose, insulin, bicarbonate, and phosphate.
    • To explore potential correlations between tubular dysfunction and different etiological groups of kidney stones.

    Summary:

    • 124 male stone formers were assessed for renal tubular function using urine parameters including lysozyme, gamma-GT, fractional excretion (FE) of glucose, insulin, and bicarbonate, and theoretical phosphate threshold (TmP/GFR).

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  • Elevated urinary lysozyme and gamma-GT were observed in 14% and 21% of patients, respectively. FE glucose and FE insulin were elevated in 6% and 8%.
  • A significant proportion of patients showed impaired tubular function: 62% had a low TmP/GFR, and 52% had an elevated FE bicarbonate after alkali load. These defects were present across various etiological groups, including primary hyperparathyroidism, medullary sponge kidneys, hyperuricemia, cystinuria, struvite nephrolithiasis, and different types of idiopathic hypercalciuria.

    • Impact:

    • The study reveals that a substantial number of kidney stone patients exhibit signs of renal tubular dysfunction.
    • Phosphate and bicarbonate wasting are the most common tubular defects identified.
    • The findings suggest that nephrolithiasis itself may contribute to or cause renal tubular damage, irrespective of the specific stone etiology.