A STUDY of the distribution of calcium in the human hdney has resulted in the demonstration of a calcium concentration gradient in the renal medulla, with high values in the papilla (Cooke, 1971). This distribution is present both in kidneys analysed immediately after nephrectomy and in specimens obtained at necropsy up to 76 hours after death. The size of the medullary calcium gradient, as measured in necropsy material, varies between individual kidneys, largely due to differences in the amount of calcium in the papilla. The significance of this variation in papillary calcium concentration is unknown, and the nature of calcium binding in the papilla obscure.Gains et al. (1968) have suggested that a calcium concentration gradient in the mammalian renal medulla may result from a physiological process similar to that by which sodium is concentrated in papillary tissue; Hargitay and Kuhn (1951) have explained the hyperosmolarity in the renal papilla in terms of reabsorption from the ascending limb in association with a countercurrent multiplier system involving the loops of Henle, sodium being the main ion involved (Gottschalk and Mylle, 1959).The relatively high concentration of calcium in the papilla is reflected, in the human kidney, in the frequent presence of calcification. The cause of papillary calcification, its relationship to local or systemic disease processes, and to renal stone formation, remain controversial.The object of this study is to investigate factors which might affect the size of the calcium concentration gradient in the human renal medulla. The distribution of calcium is measured in kidneys obtained from 152 subjects at necropsy or operation, and these findings are correlated with clinical and pathological data obtained from the clinical records, post-mortem findings and an histological examination of the kidneys.Materials and Methods.-Renal tissue was obtained from 13 patients at operation and 139 subjects at necropsy. Operative specimens were analysed as they became available during the period of the investigation, and the kidneys selected for study at necropsy were chosen randomly, specimens being obtained within 72 hours of death. In addition to this group of 152 kidneys, specimens from 2 selected cases of hyperca1ca:mia were analysed and the results presented separately. In each kidney, small samples of renal tissue (2Cr50 mg. wet weight) were dissected from the tip of the papilla (P), base of medulla (M) and mid-cortex (C); each was ashed, and then dissolved in N/50 nitric acid. The calcium concentration of these solutions was measured by atomic absorption spectrophotometry after the addition of lanthanum, and the calcium concentration of tissue samples calculated as mM Ca++/kg. wet tissue (Cooke, 1971). In view of sample variation, and in order to increase the accuracy of the method in comparing the distribution in different kidneys, 3 samples from each region were measured in the individual kidneys, and the means of the 3 results quoted. Within the group of 152 kidneys were 20 from s...