Lindsjö M, Fellström B, Danielson B G, Kasidas G P, Rose G A, Ljunghall S
Department of Internal Medicine, University Hospital, Uppsala, Sweden.
Eur J Clin Invest. 1990 Oct;20(5):546-54. doi: 10.1111/j.1365-2362.1990.tb01900.x.
The role of the kidney in states of hyperoxaluria and hypercalciuria was investigated in seven patients with hyperoxaluria after jejunoileal bypass (JIB) and six patients with idiopathic hypercalciuria (IHC). Eight apparently healthy persons formed a control group. Besides hyperoxaluria, the patients with JIB displayed an elevated plasma concentration of oxalate and the oxalate clearance was increased and higher than creatinine clearance, indicating a net tubular secretion of oxalate. The JIB patients had lower 24-h urinary excretions of calcium, phosphate, magnesium and citrate and higher serum parathyroid hormone (PTH) than controls, indicating increased secretion of PTH to compensate for calcium malabsorption. IHC patients exhibited increased fasting urinary calcium even though their serum values were similar to those in the controls. These results indicate a reduced tubular calcium reabsorption, which was most pronounced in patients with highest PTH values. We conclude that hyperoxaluria in JIB patients is associated both with intestinal hyperabsorption and with enhanced tubular secretion of oxalate, and that in some patients with IHC hypercalciuria is due to reduced tubular reabsorption of calcium.
研究了7例空肠回肠旁路术（JIB）后高草酸尿症患者和6例特发性高钙尿症（IHC）患者肾脏在高草酸尿症和高钙尿症状态下的作用。8名明显健康的人组成了对照组。除高草酸尿症外，JIB患者血浆草酸盐浓度升高，草酸盐清除率增加且高于肌酐清除率，表明肾小管有草酸盐净分泌。JIB患者24小时尿钙、磷、镁和柠檬酸盐排泄量低于对照组，血清甲状旁腺激素（PTH）高于对照组，表明PTH分泌增加以补偿钙吸收不良。IHC患者即使血清值与对照组相似，空腹尿钙也增加。这些结果表明肾小管钙重吸收减少，在PTH值最高的患者中最为明显。我们得出结论，JIB患者的高草酸尿症与肠道草酸盐吸收增加和肾小管草酸盐分泌增强均有关，并且在一些IHC患者中，高钙尿症是由于肾小管钙重吸收减少所致。
