Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0451641 (urolithiasis)
 3,973 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 52-year-old man with an acromegalic appearance of prolonged duration suffered abdominal colic attacks and hematuria during the middle of the course of the disease. The patient was diagnosed as having urolithiasis caused by increased urinary calcium. The calcium metabolic disorder was not considered to be due to hyperparathyroidism because serum calcium and PTH levels were within the normal range and no abnormality was observed in a parathyroidal scintigraph. The serum 1,25-dihydroxyvitamin D (1,25-(OH)2D) levels (55.0 and 73.0 pg/ml) were higher than the normal range (27.2-53.8 pg/ml). A selective adenomectomy by the transsphenoidal route (Hardy's method) was performed, resulting in an improvement in the hypercalciuria and urolithiasis, and a decrease in the levels of serum 1,25-(OH)2D (23.0 and 23.0 pg/ml). These findings suggest that GH may promote the activation of vitamin D in the kidney in acromegaly, resulting in an acceleration of calcium absorption in the intestine through the action of activated vitamin D and the induction of increased urinary calcium excretion by the urinary excretion of excessive blood calcium.
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PMID:An acromegalic patient with recurrent urolithiasis. 384 20

Sonographic localization of enlarged parathyroid gland was performed in 37 patients suspected of hyperparathyroidism who underwent surgical exploration of the neck. Nine of those patients were clinically asymptomatic. Most of the others presented with urolithiasis. The sonograms were obtained by conventional and high resolution realtime (10 mHz). Of the 37 patients, 31 patients had a single adenoma, three patients had two adenomas, and two patients had hyperplasia. Analysis of the results has shown accuracy of 84 per cent. The sensitivity of the procedure was 79.5 per cent and the specificity was 98 per cent. The exact side and location of the enlarged parathyroid in relation to the thyroid gland was predicted in 91 per cent. The false-negative cases were due to abnormal location (gland in mediastinum or incorporated within the thyroid). The false-positive findings were all colloid cysts located at the periphery of the thyroid parenchyma. Preoperative confirmation and localization of enlarged parathyroid glands facilitated the decision for surgical intervention, especially in hypercalcemic asymptomatic patients and in high operative risk patients. The duration of operation and postoperative complications were significantly reduced.
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PMID:Parathyroid localization. Sonographic-surgical correlation. 388 18

Due to a hypercalcaemia and changeably appearing hypercalciuria 13 patients with relapsing urolithiasis were under suspicion of a primary hyperparathyroidism. After selective sounding and withdrawal of blood from the cervical veins in all cases the determination of parathormones was performed and always an increased activity of parathormones was found. The exploration of the cervical region carried out could in 11 performed operations in 8 cases prove an adenoma and in 3 cases a hyperplasia as cause of hyperparathyroidism. A localization of the suspected adenoma was in 5 cases possible in combination with the angiography of the thyroid gland. By equally high activity in 3 cases no clear evidence was possible. An improvement of the diagnostics of localization might be achieved by supraselective sounding of the veins. On principle the authors recommend to perform a selective determination of parathormones before operation, which in case of need is to be supplemented by a selective angiography of the thyroid gland.
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PMID:[Diagnosis of primary hyperparathyroidism by selective determination of parathyroid hormones]. 403 77

We evaluated the efficacy of selective treatment in 126 patients with recurrent calcium urolithiasis who were chosen on the basis of ability to correct underlying physiochemical disturbances. Patients with hyperparathyroidism underwent an operation. Patients with renal hypercalciuria were treated with thiazide and those with absorptive hypercalciuria were given a low calcium, low oxalate diet with or without thiazide. The only treatment for normocalciuric patients was high fluid intake, which was suggested also to the other groups. A significant individual mean reduction in stone formation was observed in all groups after 5 years of treatment. However, only 48 per cent of the normocalciuric patients were in remission after 5 years of high fluid intake therapy and 45 per cent of those with absorptive hypercalciuria were free of recurrence with diet only. Thiazide treatment seemed to be effective despite the type of hypercalciuria. The effect of the treatment on stone formation was mediated through reduction of risk factors in the urine. Conversely, a high level of risk factors commonly predicted stone recurrence.
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PMID:Five years of experience with selective therapy in recurrent calcium nephrolithiasis. 608 13

Twelve children with urolithiasis or unexplained episodes of gross hematuria, hypercalciuria, and normal serum calcium levels were examined with an oral calcium loading test. Eight patients displayed elevated fasting urinary calcium excretion, consistent with renal hypercalciuria; four exhibited normal fasting calcium excretion, which increased excessively with calcium loading, suggesting hyperabsorption of intestinal calcium. Evidence of secondary hyperparathyroidism was detected in three children with renal hypercalciuria on the basis of urinary cyclic adenosine monophosphate (cAMP) excretion. Serum calcium concentrations obtained four hours after loading increased significantly in children with renal hypercalciuria and were directly correlated with fasting urinary calcium excretion. Among patients with renal hypercalciuria, serum calcium level was higher in patients with normal fasting cAMP excretion. These results suggest that hyperabsorption of intestinal calcium occurs in renal hypercalciuria and may account for the lower-than-predicted incidence of secondary hyperparathyroidism in these patients. Idiopathic hypercalciuria may arise from one fundamental metabolic disturbance with varying degrees of expression, rather than from two separate pathogenic mechanisms.
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PMID:Idiopathic hypercalciuria. Renal and absorptive subtypes in children. 632 Jun 35

Changes in the alveolar lamina dura in 134 patients have been analysed. They included 32 cases with urolithiasis in whom generalised bone disease had been excluded, 37 cases of primary hyperparathyroidism, 31 cases of secondary hyperparathyroidism and 34 with primary osteoporosis. The state of the lamina dura was related to biochemical, radiological and histological findings in the various groups. The value of the lamina dura in the diagnosis of generalised skeletal abnormalities has been defined.
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PMID:[The diagnostic value of the alveolar lamina dura in generalised bone disease (author's transl)]. 645 55

In a retrospective study of 120 patients with surgically proved primary hyperparathyroidism, 71 patients who were normotensive and 49 patients (41 percent) who were either hypertensive at the time of parathyroidectomy or had a history of hypertension were compared. The mean serum calcium levels in the normotensive and hypertensive patients were very similar (11.6 +/- 0.1 [SEM] mg/dl, and 11.8 +/- 0.1), ruling against the hypothesis that hypercalcemia per se is the dominant cause of the hypertension of hyperparathyroidism. The mean serum creatinine levels in the two groups were also very similar (1.02 +/- 0.05 and 1.09 +/- 0.05 mg/dl), indicating that the hypertension of hyperparathyroidism is not the consequence of advanced renal parenchymal damage. The hypertensive patients did not have a significantly higher prevalence of urolithiasis. A review of the data in this and related studies leads to the conclusion that the hypertension of hyperparathyroidism is heterogeneous in origin. The mean serum phosphate level in the hypertensive patients was significantly lower than that in the normotensive patients (2.20 +/- 0.06 mg/dl versus 2.69 +/- 0.09 mg/dl, p less than 0.02), which may be due to a decrease in renal tubular phosphate reabsorption secondary to hypertension.
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PMID:Hypertension and hyperparathyroidism. Inverse relation of serum phosphate level and blood pressure. 685 80

Serum immunoreactive PTH (iPTH) was measured in 74 patients with urolithiasis and correlated to the corresponding serum calcium values. Serum iPTH was measured using a rooster antibovine iPTH antiserum which crossreacted with the human hormone within the 44-68 amino acid residue region. Sixty-six of these patients had normal serum iPTH and calcium concentrations. Their calcium values varied from 2.2 mmol/l to 2.6 mmol/l and their serum iPTH concentrations were less than 0.6 micrograms/l. The remaining 8 patients with urolithiasis were judged to have primary hyperparathyroidism because of an abnormal iPTH/calcium relationship. These patients had serum calcium concentrations varying from 2.6 mmol/l to 3.4 mmol/l and iPTH concentrations between 0.35 micrograms/l and 3.03 micrograms/l. The diagnosis was verified histologically in 7 patients after operation. In the last patient iPTH was reduced from 1.01 micrograms/l to 0.21 micrograms/l after surgery, and serum calcium changed from 2.6 mmol/l to 2.2 mmol/l. The combined evaluation of serum iPTH and calcium may improve the diagnosis for hyperparathyroidism and was in our series helpful in making a correct diagnosis in 2 out of 7 patients who had histologically verified disease. In addition, iPTH measurements are valuable to rule out hyperparathyroidism as the cause of hypercalcaemia.
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PMID:Diagnosis of hyperparathyroidism in patients with urolithiasis using measurement of serum immunoreactive parathyroid hormone and serum calcium. 686 14

Urolithiasis is a rare complication following kidney transplantation. Experience with this complication in 6 of 426 transplantations performed from 1968 to 1979 is reviewed. The clinical symptoms are different from the disease in non-transplant patients. Three major predisposing causes for the development of calculi after kidney transplantation were found in our patients--urodynamic disorders following complications of the ureterovesical anastomosis, persistent bacteriuria and renal tubular acidosis and, less importantly, the presence of hypercalcemia and hypercalciuria as a result of secondary hyperparathyroidism. Crystal-optical and x-ray-diffraction studies contributed to the interpretation of the constituents and texture of the calculi and of the aetiological factors concerned.
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PMID:Urolithiasis after kidney transplantation--clinical and mineralogical aspects. 701 27

The review of 340 own cases of hyperparathyroidism surgery shows, that only the concentrations of calcium and parathormone in serum are of interest for the diagnosis. Further biochemical analyses and function tests are not specific enough to serve as indicators for hyperparathyroidism and serve only as secondary reinforcements of the diagnosis. There are many methods for the preoperative localisation but only the computer tomography with simultaneously given contrast medium or a refined sonography seem to be reproducible. 94% of the cases are cured by surgery. The further development of urolithiasis is certainly reduced after the successful operation, however, in about one third of the cases with normocalcemia, a recurrent and marked increase in size of the stones present was observed postoperatively. The possibility of such a continuous growth gives reason to observe closely the development of urolithiasis in order to be able to react promptly by means of lithotomy.
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PMID:[Problems of hyperparathyroidism in urology (author's transl)]. 720 98


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