Table Of ContentCALCULUS DISEASE
Other titles in the New Cl&icalApplications Series:
Dermatology (Series EditorDrJ.L.Verbov)
Dermatological Surgery
Superficial FungalInfections
TalkingPoints in Dermatology- I
Treatment inDermatology
Current Concepts in ContactDermatitis
TalkingPoints in Dermatology- H
Cardiology (Series EditorDrD. Longmore)
Cardiology Screenhzg
Rheumatology (Series Editors Dr J.J. Calabro and Dr W. Carson
Dick)
AnkylosingSpondylitis
Infections andArthritis
Nephrology (Series Editor Dr G. R. D. Catto)
Continuous Ambulatory PeritonealDialysis
ManagementofRenal Hypertension
Chronic RenalFailure
Calculus Disease
Pregnancy andRenal Disorders
Multisystem Diseases
Glomerulonephritis I
Glomerulonephritis II
NEW
CLINICAL
A PPL/CA TIONS
NEPHROLOG YI
CALCULUS
DISEASE
Editor
G. R. D. CATTO
MD, FRCP, FRCP(G)
Reader in Medicine
Un iversity of Aberdeen
UK
KLUWER ACADEMIC PUBLISHERS
DORDRECHT- BOSTON - LONDON
NEW
CLINICAL
A PPL/CA TIONS
NEPHROLOG YI
CALCULUS
DISEASE
Editor
G. R. D. CATTO
MD, FRCP, FRCP(G)
Reader in Medicine
Un iversity of Aberdeen
UK
KLUWER ACADEMIC PUBLISHERS
DORDRECHT- BOSTON - LONDON
CONTENTS
List ofAuthors vi
Series Editor'sForeword vii
About the Editor viii
1. Hypercalcaemic Disorders
S. H. Ralston
2. Hypercalciuria
V. L. Sharman 33
3. Recurrent calculi
C. A. C. Charlton 59
4. Cystinuria
R. S. C. Rodger 73
Index 89
LIST OF AUTHORS
C. A. C. Charlton R. S. C. Rodger
Department ofUrology RenalUnits
RoyalUnitedHospital Stobhill General Hospitaland
CombePark,Bath Western Infirmary
BA1 3NG Glasgow
UK UK
S. H. Ralston V.L. Sharman
University Department of Medicine Department ofRenal Medicine
Glasgow Royal Infirmary St. Mary's Hospital
10 Alexandra Parade Milton Road
Glasgow G31 2ER Portsmouth, HantsPO3 6AD
UK UK
vi
SERIES EDITORS' FOREWORD
Renalstone disease remains a common clinical problem. Patients may
attend either medical or surgical clinics and not infrequently present
as acute abdominalemergencies to general practitioners, physicians,
surgeons and even gynaecologists. Recent urinary calculi continue
to cause considerable morbidity despite the recent advances in our
understanding of the pathogenesis of the different types of stones
involved and despite improvements in treatment- by appropriate
drug therapy, byultrasound techniques and by lithotripsy.
This volumediscusses the investigation and management ofpatients
with calculusdisease. Eachchapterhas been written by an experienced
clinician and provides information of considerable relevance and
importance for alldoctors engaged in clinical practice. The technical
developments of the last few years have clearly demonstrated that
renal stone disease, even when recurrent, should be an uncommon
cause of chronic renal failure. Knowledge of the recent developments
in this field is important for all practising doctors and even more
important fortheir patients.
G. R. D. CATTO
vii
ABOUT THE EDITOR
Dr Graeme R.D. Catto is Reader in Medicine at the University of
Aberdeen and Honorary Consultant Physician/Nephrologist to the
Grampian Health Board. His current interest in transplant immu-
nology was stimulated as a Harkness Fellow at Harvard Medical
School and the Peter Bent Brigham Hospital, Boston, USA. He is
a member of many medical societies including the Association of
Physicians of Great Britain and Ireland, the Renal Association
and theTransplantation Society. He has published widely on trans-
plant and reproductive immunology, calcium metabolismandgeneral
nephrology.
viii
HYPERCALCAEMIC DISORDERS
S. H. RALSTON
INTRODUCTION
Although most patientswith calcium-containing renalstones are nor-
mocalcaemic, many hypercalcaemic disorders are associated with an
increased risk ofrenalstone disease. Theseconditions areimportant
to recognize, sincetheir identification and treatment invariably cor-
rects the tendency to renalstoneformation. Theinitial section ofthis
chapter deals with the presentation, investigation and treatment of
hypercalcaemic states in general. Subsequently, specific hyper-
calcaemic disorders are discussed, with particularemphasis on those
associated with renalstone disease (Table 1.1).
HYPERCALCAEMIA- PRESENTATION AND CLINICAL FEATURES
Hypercalcaemia has been recognized with increasing frequency in
recent years, due to the widespread introduction of multichannel
biochemical autoanalysers which routinely measure plasma calcium
concentrations even when they have not been specifically requested
by the clinician. Patientswith mild hypercalcaemia (<3.00mmolL-~)
areusually asymptomatic, atleast with respectto theirraisedplasma
calcium level, and generally present with features of an unrelated
medical condition. On theother hand, thosewith moreseverehyper-
calcaemia oftenhave symptoms whichare directly attributable to the
elevation in plasmacalciumlevels. In the kidney, moderate or severe
hypercalcaemia (>3.20mmolL-~) results in impairment of urinary
CALCULUS DISEASE
TABLE 1.1 Causes of hypercalcaemia
ENDOCRINE CONDITIONS
Primary hyperparathyroidism*
Thyrotoxicosis
Addison's disease
Phaeochromocytoma
Acromegaly*
MALl GNANT DISEASE
Any malignanttumour with orwithout bone metastases
GRANULOMATOUS CONDITIONS
Sarcoidosis*
Tuberculosis
Coccidiomycosis
Histoplasmosis
Systemic candidiasis
Eosinophilic granuloma
Berryliosis
IATROGENIC OR DRUG RELATED
Vitamin D intoxication*
Milk-alkali syndrome*
Lithium
Vitamin A intoxication
Parenteral nutrition
ASSOCIATED WITH RENAL FAILURE
Recoveryphase of acuterenalfailure
Aluminium toxicity
Tertiary hyperparathyroidism*
MISCELLANEOUS
Familial benign hypercalcaemia
Immobilization*
*Indicates an association with an increased risk of renal stone disease
and/or nephrocalcinosis
