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HERO ID
4115217
Reference Type
Journal Article
Title
Studies to identify the basis for an alkaline urine pH in patients with calcium hydrogen phosphate kidney stones
Author(s)
Kamel, KS; Shafiee, MA; Cheema-Dhadli, S; Halperin, ML
Year
2007
Is Peer Reviewed?
1
Journal
Nephrology, Dialysis, Transplantation
ISSN:
0931-0509
EISSN:
1460-2385
Volume
22
Issue
2
Page Numbers
424-431
Language
English
PMID
17107965
DOI
10.1093/ndt/gfl588
Web of Science Id
WOS:000243805400020
Abstract
BACKGROUND:
Patients with CaHPO(4) kidney stones belong to a diagnostic category that has a high urine pH as its common feature. Our objective was to provide a new clinical approach to examine the basis for this high pH.
METHODS:
The study group consisted of 26 CaHPO(4) stone formers and 28 normal volunteers. Urine was collected q2h plus an overnight sample to identify patients with a urine pH > 6.5 for 12/24 h. Urine ammonium (U(NH4)), sulphate (U(SO4)) and citrate were measured and diet net alkali was calculated.
RESULTS:
Of the 26 patients, 13 had persistently alkaline urine. In 7/13, U(NH4) (68 +/- 13 mEq/day) and U(SO4) (57 +/- 7 mEq/day) were both high. In 6/13 patients, U(NH4) was the usual 31 +/- 3 mEq/day; in 4/6, U(NH4)/U(SO4) was 0.9 +/- 0.1; the cause of the alkaline urine pH seemed to be a dietary alkali load because the rise in urine pH was episodic and coincided with a high net diet alkali load and peak citrate excretion rates. The remaining two patients had a high U(NH4)/U(SO4) (2.2 and 1.6). Citrate excretion was very low in the male, but not in the female patient.
CONCLUSIONS:
There are heterogeneous causes for a persistently high urine pH. Two of the patients had a possible molecular basis: the lesion could be a low proximal convoluted tubule cell pH in the male and an increased entry of NH(3) into the late distal nephron in the female.
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