Harvey J A, Pak C Y
Department of Internal Medicine, Southwestern Medical School, University of Texas Health Science Center, Dallas 75235.
J Urol. 1988 Jun;139(6):1287-9. doi: 10.1016/s0022-5347(17)42895-3.
We describe a patient who initially formed calcium-containing renal stones owing to gouty diathesis and hypocitraturia. On therapy with 300 mg. allopurinol and 60 mEq. potassium citrate daily serum uric acid decreased from 9.2 to 5.8 mg. per dl., urinary pH increased from less than 5.5 to 6.6 and urinary citrate increased from 223 to 1,005 mg. per day. Four months later while still on this medical regimen, the patient presented with hypercalcemia (13.4 mg. per dl.), high serum 1,25-dihydroxyvitamin D (65 pg. per ml.) and hypercalciuria (598 mg. per day), which subsequently were found to result from sarcoidosis. Prednisone therapy normalized the disturbances in calcium metabolism. During 33 months of combined treatment with 7.5 to 10 mg. prednisone a day, allopurinol and potassium citrate, the patient was free of stones and he had normal urinary calcium, pH and citrate. However, a calcium stone formed 1 month after discontinuation of prednisone therapy, although treatment with allopurinol and potassium citrate was continued. The patient had marked hypercalciuria of 447 to 465 mg. per day, despite normal urinary pH, citrate and uric acid. This case represents calcium stone formation in a patient with 2 separate etiologies for stone disease, that is gouty diathesis and sarcoidosis. Therapeutic regimens directed at the correction of both metabolic disturbances were required to control renal stone formation.
我们描述了一名患者，该患者最初因痛风素质和低枸橼酸尿症形成了含钙肾结石。使用每日300毫克别嘌醇和60毫当量柠檬酸钾进行治疗后，血清尿酸从每分升9.2毫克降至5.8毫克，尿液pH值从低于5.5升至6.6，尿枸橼酸盐从每日223毫克增至1005毫克。四个月后，该患者仍在接受此药物治疗方案时，出现了高钙血症（每分升13.4毫克）、高血清1,25 - 二羟维生素D（每毫升65皮克）和高钙尿症（每日598毫克），随后发现这些是由结节病引起的。泼尼松治疗使钙代谢紊乱恢复正常。在每日7.5至10毫克泼尼松、别嘌醇和柠檬酸钾联合治疗的33个月期间，患者未形成结石，其尿钙、pH值和枸橼酸盐均正常。然而，在停用泼尼松治疗1个月后形成了一颗钙结石，尽管继续使用别嘌醇和柠檬酸钾治疗。尽管患者的尿液pH值、枸橼酸盐和尿酸均正常，但仍有每日447至465毫克的明显高钙尿症。该病例代表了一名患有两种不同病因结石病（即痛风素质和结节病）的患者形成了钙结石。需要针对两种代谢紊乱进行纠正的治疗方案来控制肾结石的形成。
