Wikström B, Backman U, Danielson B G, Fellström B, Johansson G, Ljunghall S, Wide L
Scand J Urol Nephrol Suppl. 1981;61:II:1-26.
Patients with idiopathic recurrent calcium nephrolithiasis (n = 57) and controls (n = 16) were investigated regarding the relationship between renal phosphate handling, other renal tubular functions and calcium metabolism. Incomplete renal tubular acidosis (RTA) was disclosed in 13 patients. RTA patients together with stone formers with normal renal acidification capacity (SF) exhibited low values for serum phosphate and renal threshold phosphate concentration (TmP/GFR) compared with controls. TmP/GFR was lower in RTA patients than in stone formers with normal renal acidification. Hypercalciuria of the absorptive type with normal serum PTH and urinary cAMP concentrations was a common finding in both stone patient groups, whereas no patient displayed unequivocal evidence of parathyroid hyperfunction. Fractional excretion of sodium was raised in both SF and RTA patients compared with controls. There was a positive relationship between the fractional excretion of phosphate and sodium in all subjects as a group. TmP/GFR was negatively correlated to fractional excretion of sodium. Twenty-three percent of RTA patients and 8% of SF displayed tubular proteinuria which often was associated with low TmP/GFR levels and enhanced natriuresis. It is concluded that a defective renal tubular phosphate handling is common in calcium stone formers and often associated with signs of other tubular dysfunctions. The altered phosphate handling seems to be unrelated to hypercalciuria.
对57例特发性复发性钙肾结石患者及16例对照者，就肾磷酸盐处理、其他肾小管功能与钙代谢之间的关系展开了研究。13例患者被发现存在不完全性肾小管酸中毒（RTA）。与对照组相比，RTA患者以及肾酸化功能正常的结石形成者（SF）血清磷酸盐及肾磷酸盐阈浓度（TmP/GFR）值较低。RTA患者的TmP/GFR低于肾酸化功能正常的结石形成者。两组结石患者中常见的是血清甲状旁腺激素（PTH）及尿环磷酸腺苷（cAMP）浓度正常的吸收型高钙尿症，然而，没有患者表现出明确的甲状旁腺功能亢进证据。与对照组相比，SF和RTA患者的钠排泄分数均升高。作为一个整体，所有受试者中磷酸盐和钠的排泄分数之间呈正相关。TmP/GFR与钠排泄分数呈负相关。23%的RTA患者和8%的SF表现出肾小管性蛋白尿，这通常与低TmP/GFR水平及增强的钠利尿有关。研究得出结论，肾小管磷酸盐处理缺陷在钙结石形成者中很常见，且常与其他肾小管功能障碍的体征相关。磷酸盐处理的改变似乎与高钙尿症无关。
