The Role of Inhibitors and other Factors in the Pathogenesis of Recurrent Calcium-Containing Renal Stones

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Abstract
The importance of possible pathogenetic factors in the formation of Ca-containing renal stones in a group of 18 patients (12 men, 6 women) with active, recurrent stone disease were compared with 16 age-matched control subjects (10 men, 6 women) given an identical diet. Fifteen (83%) of the patients showed at least 1 abnormality, 8 (44%) showed 2, and 1 (6%) patient showed 3 abnormalities that might predispose to stone formation. Increased urinary Ca excretion was the most common abnormality (11 patients, 61%), particularly in the women (83%). A diminished excretion of inhibitors of crystal formation of calcium phosphate was the next most common abnormality, which occurred in 8 patients (44%), all of whom were men. It was largely attributed to a diminished excretion of PPi. The PPi/Pi ratios were also lower in the stone-formers. Significant differences in residual inhibitory activity after enzymatic removal of PPi between control subjects and stone-formers was not found in 24 h urine samples but were present during certain times of the day. PPi showed a higher inhibitory activity in urine than in control solutions, this enhancement being absent in stone-formers. Nine (50%) of the patients, but only 1 of the control subjects, produced crystal aggregates greater than 50 .mu.m in diameter after an oral load of oxalate.

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