(特別講演) 尿路結石症に関する検討 特にカルシウム結石を中心にして

Abstract

It is well known that about 90 percent of urinary stones contain calcium as main component. We studied calcium metabolism in urolithiasis patients from endocrinological aspects. In patients with primary hyperparathyroidism, which accompanies urinary stones frequently, positive correlation could be demonstrated between excretion of urinary cyclic AMP and the serum parathyroid hormone value (p<0.01). On the other hand, excretion of the urinary cyclic AMP in urolithiasis patients without endocrinologic and metabolic disorders correlated negatively with urinary excretion of calcium. Therefore in hypercalciuric stone formers parathyroid function seems to be somewhat suppressed in comparison with the normal control. These hypercalciuric patients exhibited no changes in cyclic AMP excretion and serum PTH but an increase in serum calcitonin by calcium loading after fasting. According to these results, idiopathic hypercalciuria in these patients seems to be absorptive type. However, as practical problems it is difficult to treat urinary stone formers with absorptive hypercalciuria by rigid dietary calcium restriction alone. So, recurrent calcium-stone formers were treated to reduce .calcium excretion with thiazide in addition to magnesium oxide, allopurinol and orthophosphate by cases. During these treatment, recurrent stone formers showed a considerable reduction in stone formation.