URINARY TRACT STONE DISEASE

Aims & Objectives: Geographical variation in the rates of kidney stones has been observed for many years. Pakistan is situated in stone belt. Calculus diseases is endemic in Pakistan, perhaps the incidence in Pakistan is highest in the world. Purpose: To evaluate etiology and biochemical risk factors (inorganic phosphate) in the Peshawar. Subjects & Methods: Study was conducted at LHR and Hayatabad Hospitals of Peshawar for the period of nine months. Two hundred patients and same number of controls were selected. Results: The mean value of mean inorganic phosphate in non stone formers were less than that of stone formers. The mean of urinary inorganic phosphate excretion in stone formers was greater than that of non-stone formers. Conclusions: We conclude that inorganic phosphate is an independent risk factor for renal stone formation.

Renal responses of trout to chronic respiratory and metabolic acidoses and metabolic alkalosis

Exposure to hyperoxia (500–600 torr) or low pH (4.5) for 72 h or NaHCO3 infusion for 48 h were used to create chronic respiratory (RA) or metabolic acidosis (MA) or metabolic alkalosis in freshwater rainbow trout. During alkalosis, urine pH increased, and [titratable acidity (TA) −[Formula: see text]] and net H+ excretion became negative (net base excretion) with unchanged [Formula: see text] efflux. During RA, urine pH did not change, but net H+ excretion increased as a result of a modest rise in [Formula: see text] and substantial elevation in [TA −[Formula: see text]] efflux accompanied by a large increase in inorganic phosphate excretion. However, during MA, urine pH fell, and net H+excretion was 3.3-fold greater than during RA, reflecting a similar increase in [TA −[Formula: see text]] and a smaller elevation in phosphate but a sevenfold greater increase in[Formula: see text] efflux. In urine samples of the same pH, [TA − [Formula: see text]] was greater during RA (reflecting phosphate secretion), and[Formula: see text] was greater during MA (reflecting renal ammoniagenesis). Renal activities of potential ammoniagenic enzymes (phosphate-dependent glutaminase, glutamate dehydrogenase, α-ketoglutarate dehydrogenase, alanine aminotransferase, phospho enolpyruvate carboxykinase) and plasma levels of cortisol, phosphate, ammonia, and most amino acids (including glutamine and alanine) increased during MA but not during RA, when only alanine aminotransferase increased. The differential responses to RA vs. MA parallel those in mammals; in fish they may be keyed to activation of phosphate secretion by RA and cortisol mobilization by MA.

Renal responses to parathyroid hormone in young chickens

Renal clearance studies were performed in chicks 1, 5, and 9 days after hatching. Calcium gluconate was infused to block endogenous parathyroid hormone (PTH) secretion, whereas ethylene glycol-bis(beta-aminoethyl ether)-N,N,N',N'-tetraacetic acid (EGTA) was infused to stimulate endogenous PTH secretion. PTH, dibutyryl adenosine 3',5'-cyclic monophosphate (DBcAMP), or vehicle was administered intravenously. In 9-day-old birds, urinary cAMP and inorganic phosphate excretion fell dramatically after calcium loading and rose significantly after PTH, DBcAMP, or EGTA administration. These manipulations had no significant effect on excretion of calcium or inorganic phosphate in 1-day-old hatchlings. Five day-old-chicks gave an intermediate response. All three age groups, as well as 15-day-embryos, showed sharp increases in urinary cAMP values after PTH administration. Thus the adult response pattern to PTH appears to develop gradually during the first week after hatching or to be suppressed during the perinatal period, whereas the second-messenger response to the hormone, indicating hormone-receptor interaction, is present from late embryogenesis onward.

Changes in inorganic phosphate excretion induced by renal arterial infusion of calcium

Calcium chloride in varying concentrations was infused at a slow and constant rate into the renal artery of one kidney in the dog. The opposite kidney served as a control. In 20 experiments, the mean glomerular filtration rate and effective renal plasma flow diminished in the infused relative to the noninfused kidneys. Mean phosphate excretion was decreased in the infused relative to the control kidneys by both a fall in filtered phosphate and a rise in the net tubular reabsorption of phosphate. Mean calcium, sodium, and water excretion did not change in the infused relative to the control kidneys during calcium infusion. The data indicate that hypercalcemia acts directly on the kidney to decrease phosphate excretion by decreasing glomerular filtration rate and increasing net tubular reabsorption of phosphate.