[Metabolic changes in 2612 patients with nephrolithiasis]. / Alteraciones metabólicas en 2612 pacientes con litiasis renal.

Nephrolithiasis is one of the most frequent pathologies of the urinary tract. Its prevalence in the city of Buenos Aires is 4%. Different biochemical and physiological disturbances may create an environment conductive to renal stone formation. We present the results of an ambulatory evaluation in 2612 patients for the purpose of updating the classification of nephrolithiasis. An abnormal urinary biochemistry was observed in 2423 patients (92.8%) that could be classified in 15 categories. A single diagnosis was documented in 61.5% of the patients, and the remaining 31.2% had more than one diagnosis (concurrent abnormalities). No abnormality was found in 189 stone formers (7.2%). Idiopathic hypercalciuria was the most frequent abnormality, it was encountered in 31.2%; hyperuricosuria and gouty diathesis (presence of urine pH < 5.5, with normal or high uricemia) accounted for 9.4% and 5.4% of patients, respectively. On the other hand, hypomagnesuria affected 6.7% of the stone formers and hypocitraturia was observed in 4.5%. Primary hyperparathiriodism, hyperoxaluria and cystinuria were seen less frequently in 2.6%, 1.3 and 0.45% of patients. Low urine volume was found in 12% of the patients. Among those patients with more than one abnormality, we found that hypercalciuria together with hyperuricosuria and hypocitraturia (12%) was the prevalent association followed by hypercalciuria with hyperuricosuria (9.1%). Our results show the importance of studying nephrolithiasis patients from a biochemical point of view, since this is the only way to achieve a diagnosis of the metabolic abnormality and introduce a specific therapy to prevent recurrence.

[Association between Paget's disease and primary hyperparathyroidism]. / Asociación entre enfermedad de Paget e hiperparatiroidismo primario.

Association between primary hyperparathyroidism and Paget's disease of bone is extremely uncommon, despite the relatively high incidence of both entities. The mechanism of this association remains unknown. Dramatic changes in parathyroid function are found in patients with Paget's disease and, on the other hand, the evolution of Paget's disease is influenced by parathyroid functional disorders. We reviewed 175 patients with Paget's disease and 60 with primary hyperparathyroidism, followed during 10 years. We only found 5 cases with the association of the two diseases. Approximately equal number were male and female (ratio: 1.5/1) patients and the average age was 63.60 +/- 2.65 years. Hypercalcemia in Paget's patients, and in increase in alkaline phosphatase in post parathyroid adenoma surgery patients were the clues that suggested the presence of the second disease. Surgical treatment was indicated in 3 patients, and the others were treated with antiresorptive drugs. We also reviewed the cases published since 1934, comparing their diagnostic, clinical, treatment and evolution features with our own cases.