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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 abdomen (27 October 2006) reveals several calcified stones in urinary bladder (arrow).
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Figure 3: X-ray of abdomen (27 October 2006) reveals several calcified stones in urinary bladder (arrow).

Mentions: In August 2006, he developed severe spasms in the stomach. X-ray of abdomen revealed several calculi in urinary bladder. (Figure 3) Cystoscopy and electrohydraulic lithotripsy were carried out on 08 December 2006. (Table 1) In May 2007, he developed spasms of abdomen once again. Not surprisingly, X-ray of abdomen showed several stones in urinary bladder. (Figure 4) Electrohydraulic lithotripsy was carried out on 18 May 2007. The stones were very hard to break. This observation, which was made during lithotripsy, corroborated with the biochemical analysis of the stone. (Table 2) The stone was found to contain 100% calcium phosphate.


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 abdomen (27 October 2006) reveals several calcified stones in urinary bladder (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: X-ray of abdomen (27 October 2006) reveals several calcified stones in urinary bladder (arrow).
Mentions: In August 2006, he developed severe spasms in the stomach. X-ray of abdomen revealed several calculi in urinary bladder. (Figure 3) Cystoscopy and electrohydraulic lithotripsy were carried out on 08 December 2006. (Table 1) In May 2007, he developed spasms of abdomen once again. Not surprisingly, X-ray of abdomen showed several stones in urinary bladder. (Figure 4) Electrohydraulic lithotripsy was carried out on 18 May 2007. The stones were very hard to break. This observation, which was made during lithotripsy, corroborated with the biochemical analysis of the stone. (Table 2) The stone was found to contain 100% calcium phosphate.

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