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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 (17 March 2008) shows four or five small stones (arrow).
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Figure 6: X-ray of urinary bladder (17 March 2008) shows four or five small stones (arrow).

Mentions: He attended spinal unit on 26 March 2008 with abdominal spasms. Radiograph of abdomen revealed several vesical calculi. (Figure 6) Electrohydraulic lithotripsy was carried out on 18 April 2008. It was ensured that no piece of stone was left behind in the bladder or in vesical diverticula. He did very well after lithotripsy. But this patient came back on 09 June 2008 with abdominal spasms. X-ray of abdomen showed stones in urinary bladder. (Figure 7) Electrohydraulic lithotripsy was performed on 27 June 2008. This patient did well after the sixth operation for removal of recurrent vesical calculi.


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 (17 March 2008) shows four or five small stones (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: X-ray of urinary bladder (17 March 2008) shows four or five small stones (arrow).
Mentions: He attended spinal unit on 26 March 2008 with abdominal spasms. Radiograph of abdomen revealed several vesical calculi. (Figure 6) Electrohydraulic lithotripsy was carried out on 18 April 2008. It was ensured that no piece of stone was left behind in the bladder or in vesical diverticula. He did very well after lithotripsy. But this patient came back on 09 June 2008 with abdominal spasms. X-ray of abdomen showed stones in urinary bladder. (Figure 7) Electrohydraulic lithotripsy was performed on 27 June 2008. This patient did well after the sixth operation for removal of recurrent vesical calculi.

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