Nutahara K, Higashihara E, Ishiii Y, Niijima T
Department of Urology, University of Tokyo, Japan.
J Urol. 1989 Apr;141(4):813-8. doi: 10.1016/s0022-5347(17)41017-2.
Calcium metabolism and renal acidification ability were examined in renal stone patients. On a random diet 33 of 52 patients excreted more than 4 mg. per kg. body weight per day of urinary calcium and were entered into a second study on a 300 mg. calcium diet. Absorptive and renal hypercalciuria was differentiated by fasting urinary calcium (mg. per 100 ml. glomerular filtration). Every absorptive hypercalciuria patient tested and 5 renal hypercalciuria patients had a normal renal acidification ability, and the serum parathyroid hormone and urinary cyclic adenosine monophosphate levels were normal. By calcium restriction urinary calcium decreased more in absorptive hypercalciuria than in renal hypercalciuria (2.48 +/- 0.14 versus 3.34 +/- 0.27 mg. per kg. body weight per day, p less than 0.05). However, urinary calcium remained high in 76 per cent of the patients with absorptive hypercalciuria. Nine patients had a defect in renal tubular acidification and the calcium metabolism was similar to those with renal hypercalciuria. Present studies show that renal hypercalciuria and renal tubular acidification defect cannot be differentiated without an ammonium chloride test.
对肾结石患者的钙代谢和肾脏酸化能力进行了检查。在随机饮食情况下，52名患者中有33名每天每千克体重尿钙排泄量超过4毫克，并进入了第二项研究，采用300毫克钙饮食。通过空腹尿钙（每100毫升肾小球滤过的毫克数）来区分吸收性高钙尿症和肾性高钙尿症。每例接受测试的吸收性高钙尿症患者以及5例肾性高钙尿症患者的肾脏酸化能力均正常，血清甲状旁腺激素和尿环磷酸腺苷水平也正常。通过限制钙摄入，吸收性高钙尿症患者的尿钙减少幅度大于肾性高钙尿症患者（分别为每天每千克体重2.48±0.14毫克和3.34±0.27毫克，p<0.05）。然而，76%的吸收性高钙尿症患者尿钙仍处于高水平。9名患者存在肾小管酸化缺陷，其钙代谢情况与肾性高钙尿症患者相似。目前的研究表明，在没有氯化铵试验的情况下，无法区分肾性高钙尿症和肾小管酸化缺陷。
