Clinical Investigation

Kidney International (1987) 32, 749–753; doi:10.1038/ki.1987.270

Reduced glomerular filtration rate and hypercalciuria in primary struvite nephrolithiasis

Cynthia Kristensen, Joan H Parks, Marshall Lindheimer and Fredric L Coe

Renal Program, Pritzker School of Medicine, University of Chicago, Chicago, Illinois, and Department of Medicine, University of Texas Medical School, San Antonio, Texas, USA

Correspondence: Fredric L Coe MD, Renal Section, Box 28, University of Chicago, 5841 S. Maryland Avenue, Chicago, Illinois 60637, USA.

Received 18 July 1986; Revised 23 January 1987; Re-revised 18 June 1987.

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Abstract

Reduced glomerular filtration rate (GFR) and hypercalciuria in primary struvite nephrolithiasis. Struvite nephrolithiasis is caused by infection with bacteria that possess the enzyme urease, and convert urea to ammonia that raises urine pH and crystallizes with magnesium and tri valent phosphate ion. Of the 75 of our 1431 stone patients with struvite stones 52 were women. Struvite stones occurred almost exclusively in women; a minority of women and most men had mixed stones of struvite and calcium oxalate. Increased serum creatinine levels and reduced creatinine clearance were common in patients with struvite stones, not in those with mixed stones; both were rare in calcium stone disease. Men and women with mixed struvite, calcium oxalate stones were hypercalciuric, but women with struvite stones were not. Patients with mixed stones usually had initial symptoms of stone passage, and were less likely to need surgery, including nephrectomy, or to form contralateral stones. Patients with struvite stones usually presented with infection or no symptom, not passage. We conclude that struvite stones occur in two forms. The struvite stone is a disease of women, presumably occurring de novo from infection. The mixed stones occur in both sexes, presumably from secondary infection in hypercalciuric patients who begin with calcium–oxalate stone disease.

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