The Relation Between the Urinary Excretion of Citric Acid and Calcium; Its Implications for Urinary Calcium Stone Formation

Shorr, Ephraim; Almy, Thomas P.; Sloan, Margaret H.; Taussky, Hertha H.; Toscani, Vincent

doi:10.1126/science.96.2504.587

Cited by 81 publications

(12 citation statements)

References 4 publications

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“…In addition to this function, Shorr and his associates (24) emphasized that citrate excretion appears to play an important role in the solubilization of calcium in the urine and thus the prevention of renal calcinosis. Harrison and Harrison (7) in a different approach to the problem have ob-served in rats that the administration of Diamox® causes a profound inhibition of citrate excretion without a concomitant reduction in urinary calcium.…”

Section: Discussionmentioning

confidence: 99%

THE EXCRETION OF l-MALIC ACID IN RELATION TO THE TRICARBOXYLIC ACID CYCLE IN THE KIDNEY*

Vishwakarma¹,

Lotspeich²

1959

J. Clin. Invest.

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Section: Discussionmentioning

confidence: 99%

THE EXCRETION OF l-MALIC ACID IN RELATION TO THE TRICARBOXYLIC ACID CYCLE IN THE KIDNEY*

Vishwakarma¹,

Lotspeich²

1959

J. Clin. Invest.

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“…Crystallographic examinations reveal the similarity of urinary calculi to the inorganic fraction of bone.12 ' 16 It has been demonstrated that the diffusible fraction of blood calcium, i.e., the ionized calcium, increases with recumbency. 28,29,30 have conducted studies on the relationship between calcium excretion and the excretion of citric acid. They point out that citrate tends to keep calcium in solution, enhanced by an alkaline medium, but diminished by the presence of bacteria which reduce the citrate content.…”

Section: Discussionmentioning

confidence: 99%

The Metabolism of Calcium in Patients With Spinal Cord Injuries

Lw¹

1949

Annals of Surgery

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RECUMBENCY HAS BEEN RECOGNIZED as an important factor in the genesis of urinary tract calculi.5 11,21 The literature concerning the factors involved in calculus formation is very extensive.3 17, 20, 22, 23 Considering that the major factors include recumbency, stasis, infection, and dietary dyscrasias, it is not at all surprising that patients suffering from injury to the spinal cord should have a high incidence of calculi in the urinary tract. The following report is based on observations made on over 700 young male adults (ages i8-50) who had suffered injury to the spinal cord during and shortly after World War II.In the first world-wide conflict, concentration of patients with spinal cord injury at special hospitals led Head and Riddoch'5 to list the course of paraplegia in four stages. These were: (I) The stage of flaccidity which began with the onset of the injury and continued for about six weeks; (2) The stage of spasticity when reflex activity developed and gradually increased in severity;(3) The stage of paraplegia in flexion when the spastic contractions had continued to the point where contractures had developed; and (4) The stage of loss of reflex activity which developed as debility and sepsis advanced, with death aS the final culmination. Undoubtedly, the history of the patients from the recent war would have been the same were it not for the advent of antibacterial agents and the recognition of the need for highly supervised bladder care such as that described by Munro.26 As a consequence of these advances, the outlook for the patient with spinal cord injury was improved. Despite this, two grave problems remained-the high incidence of urinary tract calculi with the concomitant presence of severe urinary tract infection, and the debilitating effect of huge decubitus ulcers.

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“…Cit and magnesium act as potent complexors with calcium and oxalate, respectively, thereby diminishing the amount of free calcium and oxalate ions available for nucleation processes [see ref. 2].Urinary Cit as reported by stone research laboratories, is contradictory as it has been found to be normal [5,6], low [7][8][9][10], and, in primary hyperparathyroidism (pHPT) with out stone formation, elevated [11], The differences may in part be explained by the lack of prior classification into the calciurias [12], which in some reports precl udes the possi bility of focussing on the relative roles of stone-inhibiting Cit among stone-promoting factors (hypercalciuria; hyper oxaluria). In addition, there had been variations in the diet consumed during the examination, suggesting that oral intake of Cit varied, too.…”

mentioning

confidence: 99%

Citrate in Urine and Serum and Associated Variables in Subgroups of Urolithiasis

Schwille

Scholz

Schwille

et al. 1982

Nephron

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Outpatient renal stone formers belonging to the established urolithiasis subgroups and controls were examined with respect to urinary and serum citrate (Cit) and several associated variables. Only in the normocalciuric majority of calcium and in uric acid stone formers was Cit in 24-hour urine decreased, but was normal in 2-hour fasting morning, and in 3-hour postprandial urine following a Cit-free test meal. Serum Cit was elevated in normocalciuria, renal and resorptive hypercalciuria. This Cit constellation was associated with either normal (absorptive, renal hypercalciuria) or low (normocalciuria, uric acid stone formers) parathyroid gland function as assessed by serum parathyroid hormone and nephrogenous urinary cyclic AMP, except in patients with primary hyperparathyroidism. In 2-hour morning urine the magnesium/creatinine ratio (normocalciuria) and ammonia excretion (uric acid stone formers) were decreased, while ammonia in 24-hour urine was low in all stone formers. It is suggested that Cit metabolism is altered in renal stone disease in general, and that in normocalciuria, stone inhibitors (Cit; magnesium) may be deficient.

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The Relation Between the Urinary Excretion of Citric Acid and Calcium; Its Implications for Urinary Calcium Stone Formation

Cited by 81 publications

References 4 publications

THE EXCRETION OF l-MALIC ACID IN RELATION TO THE TRICARBOXYLIC ACID CYCLE IN THE KIDNEY*

THE EXCRETION OF l-MALIC ACID IN RELATION TO THE TRICARBOXYLIC ACID CYCLE IN THE KIDNEY*

The Metabolism of Calcium in Patients With Spinal Cord Injuries

Citrate in Urine and Serum and Associated Variables in Subgroups of Urolithiasis

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