RT Journal Article
SR Electronic
T1 Urine citrate and renal stone disease
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP 217
OP 221
VO 141
IS 3
A1 Goldberg, H.
A1 Grass, L.
A1 Vogl, R.
A1 Rapoport, A.
A1 Oreopoulos, D. G.
YR 1989
UL http://www.cmaj.ca/content/141/3/217.abstract
AB Calcium stone disease is attributable to supersaturation of the urine with calcium and other salts, the presence of substances that promote crystallization and a deficiency of inhibitors of crystallization. Citrate is a potent inhibitor of calcium oxalate and calcium phosphate stone formation whose excretion is diminished in some patients with stone disease owing to idiopathic causes or secondary factors such as bowel disease and use of thiazides. The pH within the proximal tubule cells is an important determinant of citrate excretion. Multivariate analysis has shown that the urine concentrations of calcium and citrate are the most important factors in stone formation. In uncontrolled studies potassium citrate, which increases urinary citrate excretion, appears to be promising as a therapeutic agent for patients with stone disease and hypocitraturia refractory to other treatment. On the other hand, there are potential drawbacks to sodium alkali therapy, such as the precipitation of calcium phosphates.