Calculus Disease PDF
Preview Calculus Disease
CALCULUS 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
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