title: Studies to identify the basis for an alkaline urine pH in patients with calcium hydrogen phosphate kidney stones.
abstract: BACKGROUND
  Patients with CaHPO(4) kidney stones belong to a diagnostic category that has a high urine pH as its common feature. Our objective was to provide a new clinical approach to examine the basis for this high pH.
  
  
  METHODS
  The study group consisted of 26 CaHPO(4) stone formers and 28 normal volunteers. Urine was collected q2h plus an overnight sample to identify patients with a urine pH > 6.5 for 12/24 h. Urine ammonium (U(NH4)), sulphate (U(SO4)) and citrate were measured and diet net alkali was calculated.
  
  
  RESULTS
  Of the 26 patients, 13 had persistently alkaline urine. In 7/13, U(NH4) (68 +/- 13 mEq/day) and U(SO4) (57 +/- 7 mEq/day) were both high. In 6/13 patients, U(NH4) was the usual 31 +/- 3 mEq/day; in 4/6, U(NH4)/U(SO4) was 0.9 +/- 0.1; the cause of the alkaline urine pH seemed to be a dietary alkali load because the rise in urine pH was episodic and coincided with a high net diet alkali load and peak citrate excretion rates. The remaining two patients had a high U(NH4)/U(SO4) (2.2 and 1.6). Citrate excretion was very low in the male, but not in the female patient.
  
  
  CONCLUSIONS
  There are heterogeneous causes for a persistently high urine pH. Two of the patients had a possible molecular basis: the lesion could be a low proximal convoluted tubule cell pH in the male and an increased entry of NH(3) into the late distal nephron in the female.
authors.affiliation: University of Toronto, St. Michael's Hospital, Division of Nephrology, 61 Queen Street, Toronto, Ontario M5B 1A6, Canada. kamel.kamel@utoronto.ca
authors.forename: Kamel S
authors.initials: KS
authors.lastname: Kamel
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Shafiee
authors.forename: Surinder
authors.initials: S
authors.lastname: Cheema-Dhadli
authors.forename: Mitchell L
authors.initials: ML
authors.lastname: Halperin
mesh_terms: D000328:Adult; D000468:Alkalies / Q000378:metabolism; D015415:Biomarkers / Q000652:urine; D002130:Calcium Phosphates / Q000032:analysis*; D019343:Citric Acid / Q000652:urine; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007669:Kidney Calculi / Q000503:physiopathology / Q000652:urine*; D008297:Male; D011379:Prognosis; D000644:Quaternary Ammonium Compounds / Q000652:urine; D013431:Sulfates / Q000652:urine; D014556:Urine / Q000737:chemistry*
chemical_list: D000468:Alkalies; D015415:Biomarkers; D002130:Calcium Phosphates; D000644:Quaternary Ammonium Compounds; D013431:Sulfates; D019343:Citric Acid; D003404:Creatinine; C485829:calcium phosphate, dibasic, anhydrous