Alkali action on the urinary crystallization of calcium salts: contrasting responses to sodium citrate and potassium citrate.

Abstract

Alkali therapy is used commonly to prevent recurrent stone formation in patients with distal renal tubular acidosis. We compared the effects of potassium citrate to those of sodium citrate in 6 well defined cases of incomplete distal renal tubular acidosis. The patients were studied during a control phase, during potassium citrate treatment (80 mEq. per day) and during sodium citrate treatment (80 mEq. per day) chosen in random order. Potassium citrate caused a decrease in urinary calcium and a significant increase in urinary citrate that resulted in a significant decrease in the urinary saturation of calcium oxalate. It did not alter the saturation of brushite and sodium urate. However, while sodium citrate also was able to increase the urinary citrate level, there was no decrease in the urinary calcium (owing to the increased sodium load). Thus, the urinary saturation of calcium oxalate did not decrease as much as with potassium citrate and the saturation of brushite increased significantly. Moreover, the urinary saturation of sodium urate increased significantly owing to the enhanced sodium excretion. The results suggest that potassium citrate therapy may retard the crystallization of calcium oxalate and may not cause calcium phosphate crystallization. In contrast, sodium citrate may have no effect or it sometimes may accentuate the crystallization of calcium salts. Thus, our study supports the potential clinical advantage of potassium citrate therapy over sodium alkali treatment in patients with incomplete distal renal tubular acidosis and recurrent calcium nephrolithiasis.

• Authors: G M Preminger, K Sakhaee, C Y Pak
• Journal: The Journal of urology (J Urol) Vol. 139 Issue 2 Pg. 240-2 (Feb 1988) ISSN: 0022-5347 [Print] United States
• PMID: 3339718 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Alkalies
• Calcium Phosphates
• Citrates
• Calcium Oxalate
• Citric Acid
• Sodium
• Calcium

Topics

• Acidosis, Renal Tubular (complications, drug therapy, urine)
• Adult
• Alkalies (therapeutic use)
• Calcium (urine)
• Calcium Oxalate (urine)
• Calcium Phosphates (urine)
• Citrates (therapeutic use)
• Citric Acid
• Crystallization
• Female
• Humans
• Hydrogen-Ion Concentration
• Kidney Calculi (analysis, etiology, physiopathology)
• Male
• Middle Aged
• Recurrence
• Sodium (urine)