Jaeger P, Portmann L, Ginalski J M, Campiche M, Burckhardt P
Department of Internal Medicine, University Hospital, Lausanne, Switzerland.
Am J Nephrol. 1987;7(4):257-63. doi: 10.1159/000167482.
Out of 89 stone formers with idiopathic hypercalciuria, 51 remained hypercalciuric on a low calcium diet over 5 days: a renal leak of calcium could thus have been suspected in them. Dietary factors such as high sodium or high animal protein intake, and metabolic factors such as obesity with or without hyperinsulinemia, which all might account for the hypercalciuria of these patients, have been evaluated. This evaluation revealed conditions known to be associated with hypercalciuria in 37 of these 51 patients: 15 had hypercalciuria related to a high sodium intake, 7 had severe hyperuricosuria (greater than 1 g/24 h) reflecting a high animal protein intake, 20 were obese (greater than 120% of ideal weight) with (7 cases) or without (13 cases) concomitant high fasting plasma level of insulin (greater than 18 microU/ml). A careful retrospective analysis of the intravenous pyelograms disclosed medullary sponge kidneys in 8 cases which had remained undiagnosed so far. One of them was studied histologically. Only 14 out of 51 patients had an otherwise unexplained hypercalciuria on a low calcium diet. It is concluded that dietary causes appear to play a key role in 'idiopathic' hypercalciuria, that the incidence of a primary renal leak of calcium among idiopathic stone formers is much smaller than initially thought, and that this condition can hide unrecognized medullary sponge kidneys.
在89例特发性高钙尿症的结石形成者中，51例在低钙饮食5天后仍存在高钙尿症：因此可怀疑他们存在钙的肾漏。对可能导致这些患者高钙尿症的饮食因素，如高钠或高动物蛋白摄入，以及代谢因素，如伴有或不伴有高胰岛素血症的肥胖，进行了评估。评估发现，在这51例患者中有37例存在已知与高钙尿症相关的情况：15例高钙尿症与高钠摄入有关，7例有严重高尿酸尿症（超过1 g/24小时），反映出高动物蛋白摄入，20例肥胖（超过理想体重的120%），其中7例伴有空腹血浆胰岛素水平升高（超过18微单位/毫升），13例不伴有。对静脉肾盂造影进行仔细回顾性分析发现，有8例患者存在髓质海绵肾，此前一直未被诊断出来。其中1例进行了组织学研究。51例患者中只有14例在低钙饮食时存在无法解释的高钙尿症。结论是，饮食因素似乎在“特发性”高钙尿症中起关键作用，特发性结石形成者中原发性钙肾漏的发生率远低于最初的设想，而且这种情况可能掩盖未被识别的髓质海绵肾。
