Consecutive Stone Former With Questions

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REP - 25 Oct 2005 00:01 GMT

40 yr old F, 15+ yr hx of nephrolithiasis (pass stones every 30-45
days); 5 yr hx nephrotic syndrome (FSGS by biopsy), hx 2yrs+
recurring/chronic nephritis.

Last two stones: 7/05: 80% weddellite, 10% whewellite, 10% apatite
10/05 70% weddellite, 15% whewellite, 15% apatite; nidus absent from
both stones. Weddelite/whewellite were white crystals on black apatite
'core.'

Urinary pH is 4.5 - 5.5; never above 6.

Last stone panel was:

Calcium urine
585mg/TV normal range 50-300

Oxalate urine
30.2mg/TV normal range 3.6 - 38.0

Citrate urine
746mg/TV normal range > 100

Uric acid urine
1950mL
1287mg/TV normal range 250 - 750

Creatinine, Random 108mg/dL
24 hr 2106mg/dL normal range 800-1800
Volume creat 1950mL

Sodium Urine random 16mEq/L
Sodium, 24 hr 207mEq normal range 40-220
Volume sodium 1950mL

Tried and failed/allergic to/didn't work: Allopurinol, Poly-Citra K,
HCTZ, some big honking potassium pill I forgot the name of and baking
soda in water.

Parathyroid seems to be normal.

Is there a name for this, other than "sucks to be you"?

Any ideas on how to slow this down? My internist, nephrologist,
urologist and I are all open to suggestions.

This stone panel was done four years ago; at the time, I was just
producing CaOx and uric acid stones with no apatite. Should I ask about
having another one done?

Is it possible that the small amounts of apatite are somehow related to
this kidney infection that never really goes away? My imperfect
understanding of stone morphology is that apatite usually forms in pHs
of 7.3 or higher, and mine is never that high and that 'infection
stones' are more exciting than what I'm having (which are painful, but
low on drama).

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"Did Father shoot him? I will eat Grandfather for dinner."
- Helen Keller, on learning of the death of her grandfather

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just Ed - 25 Oct 2005 05:23 GMT

<snip>

> Tried and failed/allergic to/didn't work: Allopurinol, Poly-Citra K,
> HCTZ, some big honking potassium pill I forgot the name of and baking
[quoted text clipped - 6 lines]
> Any ideas on how to slow this down? My internist, nephrologist,
> urologist and I are all open to suggestions.

hello REP,
you didn't mention magnesium tests or sups so the following studies
look interesting:

The effects of potassium and magnesium supplementations on urinary risk
factors of renal stone patients.
J Med Assoc Thai. 2004 Mar;87(3):255-63.
PMID: 15117041

Changes in urinary parameters after oral administration of
potassium-sodium citrate and magnesium oxide to prevent urolithiasis.
Urology. 2004 Jan;63(1):7-11; discussion 11-2.
PMID: 14751336

Potassium-magnesium citrate is an effective prophylaxis against
recurrent calcium oxalate nephrolithiasis.
J Urol. 1997 Dec;158(6):2069-73.
PMID: 9366314

Physicochemical action of potassium-magnesium citrate in
nephrolithiasis.
J Bone Miner Res. 1992 Mar;7(3):281-5.
PMID: 1585829

my search was 'potassium magnesium citrate stone'

Phytate looks promising also, but I didn't see any studies using
it as a sup in stone formers like some of the mag studies above.
Lots of animal & in vitro studies seems reason for optimism.
Here's a couple to whet/wet your appetite/apatite (sorry):

Dietary factors and the risk of incident kidney stones in men: new
insights after 14 years of follow-up.
J Am Soc Nephrol. 2004 Dec;15(12):3225-32.
PMID: 15579526
(null effect of dietary phytate on risk)

Urinary phytate in calcium oxalate stone formers and healthy
people--dietary effects on phytate excretion.
Scand J Urol Nephrol. 2000 Jun;34(3):162-4.
PMID: 10961468

Effects of phytate and pyrophosphate on brushite and hydroxyapatite
crystallization. Comparison with the action of other polyphosphates.
Urol Res. 2000 Apr;28(2):136-40.
PMID: 10850638

Phytate (IP6) is a powerful agent for preventing calcifications in
biological fluids: usefulness in renal lithiasis treatment.
Anticancer Res. 1999 Sep-Oct;19(5A):3717-22. Review.
PMID: 10625946

I noticed that the bulk of the studies in my search (stone phytate)
use true IP6 or the sodium salt. A number of sup. brands provide
a mix of the cal/mag. salts which may not do as well (Check the
label). See what your herd of MDs has to say. Ed

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REP - 27 Oct 2005 06:50 GMT

> <snip>
> >
[quoted text clipped - 12 lines]
> you didn't mention magnesium tests or sups so the following studies
> look interesting:

It was a magnesium/K huge honking pill that I can't remember the name of
that was tried and failed.

> my search was 'potassium magnesium citrate stone'

My particular stone morphology is little more complex, since it's
complicated by a chronic kidney infection and I'm very acidic and
probably have idiopathic hypercalciuria.

> Phytate looks promising also, but I didn't see any studies using
> it as a sup in stone formers like some of the mag studies above.
[quoted text clipped - 6 lines]
> PMID: 15579526
> (null effect of dietary phytate on risk)

Interesting but irrelevant - I'm not a man.

> I noticed that the bulk of the studies in my search (stone phytate)
> use true IP6 or the sodium salt. A number of sup. brands provide
> a mix of the cal/mag. salts which may not do as well (Check the
> label). See what your herd of MDs has to say. Ed

Part of the problem is finding something I can take safely and that
falls within the guidelines of the renal diet restrictions. The stones
are suspected of either causing or comlicating my chronic kidney
infection, which has caused scarring. Add to this that I'm already in
early failure from FSGS and stopping or at least slowing down the stones
and clearing the infection is becoming more and more important!

Thanks for the reply.

Signature

"Did Father shoot him? I will eat Grandfather for dinner."
- Helen Keller, on learning of the death of her grandfather

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