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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

Urine cytology: higher power view shows benign urothelial cells (left middle and left bottom) and squamous cells (middle and middle right). No keratinising squamous cells are present. (Cytospin preparation, Papanicolau stain)
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Figure 9: Urine cytology: higher power view shows benign urothelial cells (left middle and left bottom) and squamous cells (middle and middle right). No keratinising squamous cells are present. (Cytospin preparation, Papanicolau stain)

Mentions: Since bladder stone disease is a risk factor for vesical malignancy in patients with spinal cord injury, a sample of urine was sent for cytology. Cytology showed benign epithelial cells; no suspicious or malignant cells were seen. No keratinising squamous cells were identified. (Figures 8 and 9)


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)

Urine cytology: higher power view shows benign urothelial cells (left middle and left bottom) and squamous cells (middle and middle right). No keratinising squamous cells are present. (Cytospin preparation, Papanicolau stain)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 9: Urine cytology: higher power view shows benign urothelial cells (left middle and left bottom) and squamous cells (middle and middle right). No keratinising squamous cells are present. (Cytospin preparation, Papanicolau stain)
Mentions: Since bladder stone disease is a risk factor for vesical malignancy in patients with spinal cord injury, a sample of urine was sent for cytology. Cytology showed benign epithelial cells; no suspicious or malignant cells were seen. No keratinising squamous cells were identified. (Figures 8 and 9)

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