The Origin of Metabolic Abnormalities in Primary Calcium Stone Disease — Natural or Unnatural Selection?

Abstract

In the past, most papers on primary calcium stone disease have attempted to attribute this disorder to a single common pathological mechanism. This may take the form of the “abnormally” high excretion of some urinary constituent of stones, such as calcium or oxalate, or an excessively high urinary pH, or an “abnormally” low excretion of some protective factor which inhibits the rate of crystallization of calcium salts, or the occurrence of some “abnormal” promoter of crystallization or gluing agent which either sticks crystals together or anchors them to the wall of the urinary tract. In turn, these “abnormalities” have been attributed to some difference in diet or in metabolic activity or in genetic make-up between stone-formers and normals. Recently, however, it has become apparent that stone-formation is probably a multifactorial disorder and not attributable to any single pathological mechanism possessed by some discrete proportion of the population. In this paper, we have set out to study some of the biochemical and metabolic “abnormalities” described in stone-formers in relation to the values of these variables in the normal population. Only a few of the data can be included in this brief report.