Document Detail


Intra-tubular deposits, urine and stone composition are divergent in patients with ileostomy.
MedLine Citation:
PMID:  19710630     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with ileostomy typically have recurrent renal stones and produce scanty, acidic, sodium-poor urine because of abnormally large enteric losses of water and sodium bicarbonate. Here we used a combination of intra-operative digital photography and biopsy of the renal papilla and cortex to measure changes associated with stone formation in seven patients with ileostomy. Papillary deformity was present in four patients and was associated with decreased estimated glomerular filtration rates. All patients had interstitial apatite plaque, as predicted from their generally acid, low-volume urine. Two patients had stones attached to plaque; however, all patients had crystal deposits that plugged the ducts of Bellini and inner medullary collecting ducts (IMCDs). Despite acid urine, all crystal deposits contained apatite, and five patients had deposits of sodium and ammonium acid urates. Stones were either uric acid or calcium oxalate as predicted by supersaturation, however, there was a general lack of supersaturation for calcium phosphate as brushite, sodium, or ammonium acid urate because of the overall low urine pH. This suggests that local tubular pH exceeds that of bulk urine. Despite low urine pH, patients with an ileostomy resemble those with obesity bypass, in whom IMCD apatite crystal plugs are found. They are, however, unlike these bypass patients in having interstitial apatite plaque. IMCD plugging with sodium and ammonium acid urate has not been found previously and appears to correlate with formation of uric acid stones.
Authors:
Andrew P Evan; James E Lingeman; Fredric L Coe; Sharon B Bledsoe; Andre J Sommer; James C Williams; Amy E Krambeck; Elaine M Worcester
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2009-08-26
Journal Detail:
Title:  Kidney international     Volume:  76     ISSN:  1523-1755     ISO Abbreviation:  Kidney Int.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-30     Completed Date:  2010-04-16     Revised Date:  2013-12-25    
Medline Journal Info:
Nlm Unique ID:  0323470     Medline TA:  Kidney Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1081-8     Citation Subset:  IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Biopsy
Calcium Oxalate / analysis,  urine
Child
Female
Humans
Ileostomy*
Kidney Calculi / chemistry*,  urine*
Kidney Medulla / pathology*
Kidney Tubules / chemistry*
Male
Middle Aged
Uric Acid / analysis,  urine
Young Adult
Grant Support
ID/Acronym/Agency:
P01 DK056788/DK/NIDDK NIH HHS; P01 DK56788/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
2612HC57YE/Calcium Oxalate; 268B43MJ25/Uric Acid
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Hemodialysis access failure: a call to action--revisited.
Next Document:  Neurocircuitry of addiction.