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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 taken on 22 October 2007 shows the presence of small stones in urinary bladder (arrow).
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Figure 5: X-ray of abdomen taken on 22 October 2007 shows the presence of small stones in urinary bladder (arrow).

Mentions: This patient again developed spasms of abdomen in September 2007. X-ray of abdomen showed vesical calculi. (Figure 5) Electrohydraulic lithotripsy was performed on 02 November 2007. All fragments of stones were removed from the bladder. Following the procedure, a pressure mark over sacrum was noticed. This was non-blanchable erythema of intact skin, which represented Grade 1 pressure ulcer. The patient was advised to stay in bed and lie on his sides until the pressure mark healed completely.


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 taken on 22 October 2007 shows the presence of small stones in urinary bladder (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: X-ray of abdomen taken on 22 October 2007 shows the presence of small stones in urinary bladder (arrow).
Mentions: This patient again developed spasms of abdomen in September 2007. X-ray of abdomen showed vesical calculi. (Figure 5) Electrohydraulic lithotripsy was performed on 02 November 2007. All fragments of stones were removed from the bladder. Following the procedure, a pressure mark over sacrum was noticed. This was non-blanchable erythema of intact skin, which represented Grade 1 pressure ulcer. The patient was advised to stay in bed and lie on his sides until the pressure mark healed completely.

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