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Incomplete renal tubular acidosis as a predisposing factor for calcium phosphate stones in neuropathic bladder: a case report.

Vaidyanathan S, Soni BM, Watson ID, Singh G, Hughes PL, Mansour P - Cases J (2008)

Bottom Line: We present a male tetraplegic patient, who developed stones in neuropathic bladder six times within a span of three years.Unusual features of this case are: (1) This patient started developing stones in urinary bladder thirteen years after sustaining spinal cord injury. (2) He was performing intermittent catheterisation and did not have an indwelling catheter. (3) The presenting symptom of vesical lithiasis was abdominal spasms and not urine infection. (4) The major component of the stones was calcium phosphate; magnesium ammonium phosphate was completely absent in the calculus on four occasions. (5) Proteus species were not grown from urine at any time. (6) This patient failed to acidify urine below a pH of 5.3 after taking simultaneously furosemide (40 mg) and fludrocortrisone (1 mg), which suggested incomplete renal tubular acidosis type 1.We learn from this case that biochemical analysis of stones removed from urinary bladder may be useful.If the major component of vesical calculus is calcium phosphate, complete or incomplete renal tubular acidosis type 1 should be excluded, as it may be possible to reduce the risk of recurrence of calcium phosphate stones by oral potassium citrate therapy or, vegetable and fruit rich diet.

View Article: PubMed Central - HTML - PubMed

Affiliation: Regional Spinal Injuries Centre, District General Hospital, Southport, PR8 6PN, UK. S.Vaidyanathan@southportandormskirk.nhs.uk.

ABSTRACT
We present a male tetraplegic patient, who developed stones in neuropathic bladder six times within a span of three years. Unusual features of this case are: (1) This patient started developing stones in urinary bladder thirteen years after sustaining spinal cord injury. (2) He was performing intermittent catheterisation and did not have an indwelling catheter. (3) The presenting symptom of vesical lithiasis was abdominal spasms and not urine infection. (4) The major component of the stones was calcium phosphate; magnesium ammonium phosphate was completely absent in the calculus on four occasions. (5) Proteus species were not grown from urine at any time. (6) This patient failed to acidify urine below a pH of 5.3 after taking simultaneously furosemide (40 mg) and fludrocortrisone (1 mg), which suggested incomplete renal tubular acidosis type 1.We learn from this case that biochemical analysis of stones removed from urinary bladder may be useful. If the major component of vesical calculus is calcium phosphate, complete or incomplete renal tubular acidosis type 1 should be excluded, as it may be possible to reduce the risk of recurrence of calcium phosphate stones by oral potassium citrate therapy or, vegetable and fruit rich diet.

No MeSH data available.


Related in: MedlinePlus

X-ray of urinary bladder taken on 07 March 2005 shows prostatic calcification. There is a radio opaque shadow in the region of urinary bladder, which is probably a vesical calculus (arrow).
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Figure 1: X-ray of urinary bladder taken on 07 March 2005 shows prostatic calcification. There is a radio opaque shadow in the region of urinary bladder, which is probably a vesical calculus (arrow).

Mentions: This patient attended spinal unit on 24 January 2005 with spasm of abdomen. Chest X-ray, which was taken on 04 March 2005, showed clear lungs. X-ray of abdomen revealed moderate faceal loading of the colon. Ultrasound scan of abdomen showed multiple gallstones; common bile duct was not dilated. Ultrasound examination of urinary tract revealed a simple cyst in the upper pole of right kidney; no renal calculi; no renal scarring or hydronephrosis. There was a calculus in the urinary bladder. Intravenous urography revealed prostatic calcification and a vesical calculus. (Figure 1) Pelvicalyceal systems and ureters were normal. Diverticula were seen in the bladder. (Figure 2) On 18 November 2005, this person underwent external urethral meatotomy, cystoscopy and elctrohydrualic lithotripsy of vesical calculi. (Table 1) Following removal of stones from urinary bladder, spasm of abdomen disappeared and this person could sleep during night.


Incomplete renal tubular acidosis as a predisposing factor for calcium phosphate stones in neuropathic bladder: a case report.

Vaidyanathan S, Soni BM, Watson ID, Singh G, Hughes PL, Mansour P - Cases J (2008)

X-ray of urinary bladder taken on 07 March 2005 shows prostatic calcification. There is a radio opaque shadow in the region of urinary bladder, which is probably a vesical calculus (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2600789&req=5

Figure 1: X-ray of urinary bladder taken on 07 March 2005 shows prostatic calcification. There is a radio opaque shadow in the region of urinary bladder, which is probably a vesical calculus (arrow).
Mentions: This patient attended spinal unit on 24 January 2005 with spasm of abdomen. Chest X-ray, which was taken on 04 March 2005, showed clear lungs. X-ray of abdomen revealed moderate faceal loading of the colon. Ultrasound scan of abdomen showed multiple gallstones; common bile duct was not dilated. Ultrasound examination of urinary tract revealed a simple cyst in the upper pole of right kidney; no renal calculi; no renal scarring or hydronephrosis. There was a calculus in the urinary bladder. Intravenous urography revealed prostatic calcification and a vesical calculus. (Figure 1) Pelvicalyceal systems and ureters were normal. Diverticula were seen in the bladder. (Figure 2) On 18 November 2005, this person underwent external urethral meatotomy, cystoscopy and elctrohydrualic lithotripsy of vesical calculi. (Table 1) Following removal of stones from urinary bladder, spasm of abdomen disappeared and this person could sleep during night.

Bottom Line: We present a male tetraplegic patient, who developed stones in neuropathic bladder six times within a span of three years.Unusual features of this case are: (1) This patient started developing stones in urinary bladder thirteen years after sustaining spinal cord injury. (2) He was performing intermittent catheterisation and did not have an indwelling catheter. (3) The presenting symptom of vesical lithiasis was abdominal spasms and not urine infection. (4) The major component of the stones was calcium phosphate; magnesium ammonium phosphate was completely absent in the calculus on four occasions. (5) Proteus species were not grown from urine at any time. (6) This patient failed to acidify urine below a pH of 5.3 after taking simultaneously furosemide (40 mg) and fludrocortrisone (1 mg), which suggested incomplete renal tubular acidosis type 1.We learn from this case that biochemical analysis of stones removed from urinary bladder may be useful.If the major component of vesical calculus is calcium phosphate, complete or incomplete renal tubular acidosis type 1 should be excluded, as it may be possible to reduce the risk of recurrence of calcium phosphate stones by oral potassium citrate therapy or, vegetable and fruit rich diet.

View Article: PubMed Central - HTML - PubMed

Affiliation: Regional Spinal Injuries Centre, District General Hospital, Southport, PR8 6PN, UK. S.Vaidyanathan@southportandormskirk.nhs.uk.

ABSTRACT
We present a male tetraplegic patient, who developed stones in neuropathic bladder six times within a span of three years. Unusual features of this case are: (1) This patient started developing stones in urinary bladder thirteen years after sustaining spinal cord injury. (2) He was performing intermittent catheterisation and did not have an indwelling catheter. (3) The presenting symptom of vesical lithiasis was abdominal spasms and not urine infection. (4) The major component of the stones was calcium phosphate; magnesium ammonium phosphate was completely absent in the calculus on four occasions. (5) Proteus species were not grown from urine at any time. (6) This patient failed to acidify urine below a pH of 5.3 after taking simultaneously furosemide (40 mg) and fludrocortrisone (1 mg), which suggested incomplete renal tubular acidosis type 1.We learn from this case that biochemical analysis of stones removed from urinary bladder may be useful. If the major component of vesical calculus is calcium phosphate, complete or incomplete renal tubular acidosis type 1 should be excluded, as it may be possible to reduce the risk of recurrence of calcium phosphate stones by oral potassium citrate therapy or, vegetable and fruit rich diet.

No MeSH data available.


Related in: MedlinePlus