Lau Y K, Wasserstein A, Westby G R, Bosanac P, Grabie M, Mitnick P, Slatopolsky E, Goldfarb S, Agus Z S
Miner Electrolyte Metab. 1982;7(5):237-49.
Of 100 consecutive patients with recurrent renal calculi, 43 had idiopathic hypercalciuria (IH) on outpatient evaluation. Hypercalciuria was classified as diet-dependent or fasting; all patients had normal serum iPTH and urinary cyclic AMP, and serum phosphate and TmPO4/GFR were reduced in IH compared to normocalciuric stone formers. In 16 patients with IH, clearance studies revealed an elevated urine flow are factored for GFR (V/GFR) as compared with normal controls (p less than 0.05). In 12 patients, serum PTH was normally suppressed by calcium infusion but TmPO4/GFR was persistently reduced. Acute and chronic phosphate administration significantly reduced urine calcium excretion but did not correct the abnormal V/GFR. We conclude that in IH of both the fasting and the diet-dependent type, there is a defect in the proximal tubular reabsorption of sodium and fluid as well as PTH-independent tubular phosphate wasting. The proximal tubular defect is not a consequence of hypercalciuria nor of phosphate depletion but may be a cause of these abnormalities.
在连续的100例复发性肾结石患者中，门诊评估发现43例患有特发性高钙尿症（IH）。高钙尿症分为饮食依赖性或禁食性；所有患者血清甲状旁腺激素（iPTH）和尿环磷酸腺苷（cAMP）均正常，与正常钙尿性结石形成者相比，IH患者血清磷酸盐和TmPO4/GFR降低。在16例IH患者中，清除率研究显示，与正常对照组相比，校正肾小球滤过率（GFR）后的尿流率（V/GFR）升高（p<0.05）。在12例患者中，钙输注可正常抑制血清PTH，但TmPO4/GFR持续降低。急性和慢性磷酸盐给药可显著降低尿钙排泄，但未纠正异常的V/GFR。我们得出结论，在禁食型和饮食依赖型IH中，近端肾小管对钠和液体的重吸收存在缺陷，以及存在不依赖PTH的肾小管磷酸盐流失。近端肾小管缺陷不是高钙尿症或磷酸盐缺乏的结果，而可能是这些异常的原因。
