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Nephrol Dial Transplant (1994) 9: 642-649
© 1994 European Renal Association-European Dialysis and Transplant Association

research-article

Risk factors for low urinary citrate in calcium nephrolithiasis: low vegetable fibre intake and low urine volume to be added to the list

B. Hess1,, R. Michel1, R. Takkinen1, D. Ackermann2 and Ph. Jaeger1

1Policlinic of Medicine University Hospital Berne, Switzerland 2Department of Urology, University Hospital Berne, Switzerland

Correspondence and offprint requests to: Correspondence and offprint requests to: B. Hess MD, Policlinic of Medicine, University Hospital, CH-3010 Berne, Switzerland

Risk factors for low urinary citrate excretion were assessed in 34 consecutive male recurrent idiopathic calcium stone formers (RCSF) who collected two 24-h urines while on free-choice diet. Overt hypocitraturia (hypo-cit) was defined as UCitxV<1.70 mmol/day, and ‘low’ citraturia (low-cit) as UCitxV between 1.70 and 2.11 mmol/day. Twenty-three RCSF had normocitraturia (normo-cit), six low-cit and five hypo-cit. UCitxV positively correlated with urine volume (VOLUME, r=0.44, P=0.009), vegetable fibre intake (fibers, r=0.46, P=0.009) and GI-alkali absorption (alkali, r=0.47, P=0.006), and volume, fibres and alkali tended to be lower among RCSF with low-/hypo-cit. A 3-day NH4Cl loading test (0.95 mEq/kg BW daily in 3 doses) was performed in RCSF as well as in 14 age-matched healthy male controls (C). On a plot of urine pH versus serum bicarbonate, 10 of 11 RCSF with low-/hypo-cit, but only six of 23 with normo-cit (P=0.0004) fell off the normal range, indicating incomplete RTA. Two or more risk factors simultaneously occurred in only four of 23 RCSF with normo-cit, but in eight of 11 with low-/hypo-cit (P= 0.002). In conclusion, incomplete RTA is the most prevalent risk factor for low-/hypo-cit in RCSF, and decreases in vegetable fibres and urine volume emerge as two new risk factors for low urinary CIT.

Keywords: calcium nephrolithiasis; citrate; gastrointestinal alkali absorption; renal tubular acidosis; urine volume; vegetable fibres


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