Creatinine, calcium, citrate and acid-base in spinal cord injured patients

Abstract

The aim of this work was to recognise factors responsible for reduced citrate excretion, previously reported in patients with spinal cord lesions and possibly related to the occurrence of urinary tract stone or catheter blockage. Inter alia, a reference range for creatinine in plasma (34-88 .umol/I) was also obtained.Two groups of subjects were studied. The first group consisted of 64 male inpatients with spinal cord lesions and 20 male control sUbjects. The second group were 342 spinal patients who attended an outpatient clinic and 31 control subjects.Plasma calcium was within the normal range but higher in patients within 1 year of onset of the cord lesion than it was later or than was found in control subjects.Plasma pH and bicarbonate were within the normal range but higher in the patients than in the control subjects. When patients with urea-splitting infection were omitted the patients had a higher urinary pH and a lower urinary ammonium than the controls.Urinary and plasma citrate were lower in the patients than in the controls. Urinary citrate was related to urinary potassium and creatinine clearance. Fractional renal tubular reabsorption of citrate did not differ between patients with normal renal function and control subjects. Patients with normal glomerular filtration had lower filtered load of citrate than the controls.The coincidence of relative alkalosis and reduced citrate excretion may be relevant to the understanding of catheter blockage and urinary stone formation in spinal cord injured patients.

Multiple sclerosis and nephrolithiasis: a matched‐case comparative study

“…In our present patient population we did not identify statistically significant differences in any of these parameters to explain our observed risk of calcium phosphate stones. This is in contrast to previous studies in patients with SCI that have shown metabolic changes, including hypercalcemia and hypocitraturia, predisposing patients to increased stone risk . However, our present cohort represents a heterogeneous spectrum of MS in terms of duration and severity of disease, thus it is probably difficult to detect these differences.…”

Conservative bladder management in advanced multiple sclerosis

“…Citrate levels (protective against stone formation) seem to be decreased in spinal cord injury. 40 Bacterial colonization is unavoidable in chronic catheterization. Proteus species have urease-splitting capabilities, which will lead to struvite-stone formation.…”

Dietary therapy for patients with hypocitraturic nephrolithiasis

“…23 The two most important risk factors for the occurrence of this encrustation are the presence of bacterial urease in the urine and elevated urine calcium concentration. Khan et al 24 recently performed a randomized study of patients with catheter encrustation, most of whom had spinal cord injuries, examining the effects of potassium citrate (6 mg in 1l of water daily) and lemonade (60 ml lemon juice diluted in 1 l of water daily).…”