- Email: [email protected]
Renal Calculi
586
RENAL CALCULI
permanent sutures. However, it is not certain whether the penis will remain straight when the child goes through puberty. I have limited experience with young children. In older children or young adults I prefer placing 4 to 6, 2-zero or 1-zero braided nonabsorbable sutures between the dorsal arteries and the deep dorsal vein after the penis has been made erect with intracavernous papaverine. To prevent priapism intracavernous phenylephrine is injected to induce detumescence after surgery. Multiple sutures give a better correction of curvature and avoid the dog-ear formation. Sutures between the arteries and vein also have the advantages of being away from nerve branches and of plicating the thicker portion of the tunica albuginea since lateral aspects have the thinnest tunica. In young adults this outpatient procedure is often performed using local anesthesia with less expense and minimal morbidity. Tom F. Lue, M.D.
RENAL CALCULI Long-Term Stone Regrowth and Recurrence Rates After Extracorporeal Shock Wave Lithotripsy C. Yu, Y. H. LEE, J. K. HUANG, M. T. CHEN, K. K. CHEN, A. T. L. LIN AND L. S. CHANG, Division of Urology, Department of Surgery, Veterans General Hospital, Kaohsiung and National Yang-Ming Medical College, Taipei, Taiwan, Republic of China Brit. J. Urol., 72: 688-691, 1993 We reviewed 1055 patients with symptomatic urinary calculi treated by extracorporeal shock wave lithotripsy (ESWL) monotherapy to determine the long-term stone regrowth and recurrence rates as correlated with the pre-treatment stone burden, site and multiplicity. Long-term follow-up (mean 75.8 months) was available in 94 patients, representing 106 renal units. The recurrence of stone was defined as reappearance of stone on follow-up plain abdominal radiographs. The regrowth of stone was defined as stone regrowing larger than one-third of the original residual size. A stone-free rate of 53% was achieved. The overall stone regrowth and recurrence rates were 26 and 15% respectively. It was concluded that the stone recurrence rate after ESWL was not influenced significantly by the stone size or the multiplicity, but that the regrowth rate was. Stone recurrence and regrowth rates after ESWL were both influenced by the stone location.
C.
Editorial Comment: This study examines long-term stone regrowth and recurrence rates in patients undergoing ESWL* at the Veterans General Hospital in Taipei, Taiwan. At a followup of about 6 years 26% of patients showed stone regrowth and Hi% had stone recurrence. Since by definition stone growth occurs only in patients with residual stones, the true recurrence rate was 15% in a group of 94 patients undergoing ESWL who were followed for 6 years. Surprisingly, the authors found that the recurrence rate after ESWL was not influenced significantly by stone size or multiplicity but the regrowth rate was affected. This is an important study with considerable long-term information. The study can be compared to that of Henriksson et al, which examines stone recurrence in patients undergoing percutaneous stone extraction. 1 At followup of up to 5 years about a third of the patients were found to have recurrent calcifications on plain film radiography. Mani Menon, M.D. 1. Henriksson, C., Geterud, K., Pettersson, S. and Zachrisson, B. F.: Stone recurrences in kidneys made
stone-free by percutaneous extraction. Scand. J. Urol. Nephrol., 27: 151, 1993.
The Effect of Warfarin on Urine Calcium Oxalate Crystal Growth Inhibition and Urinary Excretion of Calcium and Nephrocalcin E. M. WORCESTER, J. L. SEBASTIAN, J. G. HIATT, A. M. BESHENSKY AND J. A. SADOWSKI, Section of Nephrology
and Medical and Pharmacy Service, Zablocki VA Medical Center and Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, and USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts Calcif. Tissue Int., 53: 242-248, 1993 Urine contains inhibitors of calcium oxalate (CaOx) crystal growth. One such inhibitor is nephrocalcin (NC), a glycoprotein which is made in the kidney and contains several residues of gamma-carboxyglutamic acid (Gla) per molecule. The presence ofGla may be important to its ability to inhibit crystal growth. Several * Dornier Medical Systems, Inc., Marietta, Georgia.
RENAL CALCULI
studies suggest that vitamin K-dependent proteins may also play a role in renal calcium (Ca) handling, and that vitamin D deficiency may lead to excess urinary Ca loss, but the effect of the vitamin K antagonist warfarin on urinary Ca excretion and CaOx growth inhibition in humans is not known. We studied 11 men while they were taking warfarin for a mean of 252 days, and again a mean of 64 days after its discontinuation. Urinary Ca excretion did not differ between those on or off warfarin, or between those on warfarin and normal controls. The ability of the subjects' urine to inhibit CaOx crystal growth did not differ on or off warfarin, or from that of control urine, and the excretion of immunoreactive NC also did not differ between these groups. NC was found to be responsible for approximately 16% of the CaOx growth inhibition seen. These results do not suggest that vitamin K-dependent proteins play a major role in renal Ca excretion in men, or that interference with vitamin K alters NC excretion or inhibitory activity of the urine.
Editorial Comment: A major inhibitor of calcium oxalate crystal growth is nephrocalcin, a glycoprotein containing several residues of y-carboxyglutamic acid. The y-carboxyglutamic acid content of the molecule is important to its function, since nephrocalcin isolated from the urine of stone formers is lacking in y-carboxyglutamic acid residues. y-Carboxylation of target proteins is controlled by a vitamin K dependent carboxylase and, thus, it may be theorized that inhibition of vitamin K may affect renal calcium handling and calcium oxalate crystal growth. These investigators studied 11 men taking the vitamin K antagonist, warfarin, for a mean of 252 days and again 64 days after discontinuing medication. They demonstrated no difference in urinary calcium excretion or calcium oxalate crystal growth inhibition between these men and control patients. Mani Menon, M.D. Citrate and Calcium Effects on Tamm-Horsfall Glycoprotein as a Modifier of Calcium Oxalate Crystal Aggregation B. HESS, L. ZIPPERLE AND P. JAEGER, Policlinic of Medicine, University Hospital, Bern, Switzerland Amer. J. Physiol., part 2, 265: F784-F791, 1993 We measured the effects of Tamm-Horsfall glycoprotein (THP) on calcium oxalate monohydrate (COM) crystal aggregation (Ac) in vitro as well as intrinsic viscosities (Vi) ofTHP at pH 5.7 and 200 mM NaCl and studied the effects of calcium and citrate on these parameters. THP were isolated from 24-h urines of seven male recurrent calcium stone formers (RCSF) and eight age-matched male healthy volunteers (N, normal). At basal conditions, RCSF-THP inhibited~ by 28 ::!:: 10% and normal THP by 60 ::!:: 6% (P = 0.028). In the presence of calcium, increasing THP concentrations from 16 to 28 and 40 mg/1 progressively lowered inhibition by RCSF-THP, but not by N-THP. At 40 mg/1, inhibition by N-THP was 27 ::!:: 9% vs. -43 ::!:: 8% by RCSF-THP (P = 0.001), i.e., all stone former THP promoted Ac. With an additional 3.5 mM of citrate, inhibition of~ was 56 ::!:: 5% by normal and 34 ::!:: 6% by stone former THP (P = 0.021), and all seven stone former THP again inhibited~- Vi of RCSF-THP was higher than that of N at basal conditions (162 ::!:: 21 vs. 93 ::!:: 15 ml/g, P = 0.021) and in the presence of 5 mM calcium (352 ::!:: 54 vs. 118 ::!:: 17 ml/g, P = 0.001), i.e., RCSF-THP were more self-aggregated, but not when citrate was added (185 ::!:: 29 vs. 123 ::!:: 19 ml/g). An inverse correlation between Ac and Vi (r = -0.948, P = 0.0001) was found, i.e., more self-aggregated THP molecules were weaker inhibitors (or even promoters) of Ac. These findings offer a possible new explanation for the role of citrate in calcium oxalate Ac.
Editorial Comment: Tamm-Horsfall protein, which is the most abundant protein in urine from healthy people, is an important modifier of calcium oxalate monohydrate crystallization. Depending on the experimental conditions used, it inhibits or promotes crystallization. The authors measured the effects of Tamm-Horsfall protein on calcium oxalate monohydrate crystal aggregation. The protein isolated from 7 male recurrent calcium stone formers inhibited aggregation by about 40% of control inhibition. By alternating experimental conditions and concentrations of Tamm-Horsfall protein a scenario was created in which the protein from stone formers actually promoted crystal aggregation. Under these experimental conditions TammHorsfall protein from normal subjects continued to inhibit aggregation. Self-aggregated Tamm-Horsfall protein molecules were weaker inhibitors or even promoters of crystal aggregation. With the addition of citrate the Tamm-Horsfall protein in stone formers inhibited crystal aggregation normally. Hess et al have shown previously that Tamm-Horsfall protein from male patients with recurrent calcium oxalate nephrolithiasis exhibits an increased tendency to self-aggregate. 1 This study extends the earlier observations and shows that self-aggregated Tamm-Horsfall protein molecules do not inhibit calcium oxalate monohydrate crystal aggregation. Mani Menon, M.D 1. Hess, B., Nakagawa, Y., Parks, J. H. and Coe, F. L.: Molecular abnormality of Tamm-Horsfall glycoprotein in calcium oxalate nepholithiasis. Amer. J, Physiol., part 2, 260: F569, 1991. .
587
588
RENAL TUMORS, RETROPERITONEUM, URETER, AND URINARY DIVERSION AND RECONSTRUCTION
The Effects of Citrate and Urine on Calcium Oxalate Crystal Aggregation H.-G. TISELIUS, A.-M. FORNANDER AND M.-A. NILSSON, Department of Urology and Clinical Research Centre, University Hospital, Linkoping, Sweden Urol. Res., 21: 363-366, 1993 The rate of crystal sedimentation in a suspension of calcium oxalate monohydrate (COM) crystals was determined spectrophotometrically in the presence and absence of dialysed urine and citrate. A reduced rate of crystal sedimentation after stirring was recorded in suspensions containing citrate in concentrations between 0.33 and 1.67 mmol/1. The sedimentation rate was reduced in the presence of a 0.3-3.3% concentration of dialysed urine, with increased inhibition of crystal sedimentation when the concentration of urine was increased. A comparison of the inhibition of COM crystal sedimentation in whole urine and in dialysed urine from normal subjects and stone-formers disclosed significantly higher values (P <0.05) in the dialysed urine. The results support previous observations that physiological concentrations of citrate might efficiently inhibit the aggregation of COM crystals. Furthermore even low concentrations of both whole urine and dialysed urine are apparently very efficient inhibitors of COM crystal aggregation.
Editorial Comment: These authors demonstrate that physiological concentrations of citrate inhibit calcium oxalate monohydrate crystal sedimentation or aggregation. Combining this information with that derived from the article by Hess et al, citrate appears to have a direct inhibitory effect on crystal aggregation and an indirect effect by increasing the inhibitory potential of Tamm-Horsfall protein. Mani Menon, M.D. Evidence of a Link Between Erythrocyte Band 3 Phosphorylation and Anion Transport in Patients with 'Idiopathic' Calcium Oxalate Nephrolithiasis B. BAGGIO, L. BORDIN, G. GAMBARO, A. PICCOLI, G. MARZARo AND G. CLARI, Institutes of Internal Medicine and
Biological Chemistry, University of Padova, School of Medicine, Padova, Italy Miner. Electr. Metab., 19: 17-20, 1993 This study was carried out to verify the hypothesis of a link between faster endogenous phosphorylation of band 3 protein, the anion carrier, and anomalous oxalate transmembrane self-exchange found in erythrocyte from calcium oxalate renal stone formers. Agents able to modify 32P-labelling of band 3 protein induced a concurrent modification in oxalate transmembrane flux. Cyclic AMP- and phospholipid-sensitive Ca 2 + -independent protein kinases seem to be critical modulators of band 3 function. These observations demonstrate a close link between the band 3 phosphorylation state and its anion transport function, and provide new insights into the pathogenetic mechanisms of the cellular anomalies observed in calciumoxalate renal stone disease.
Editorial Comment: Patients with idiopathic calcium oxalate nephrolithiasis exhibit higher oxalate and urate transmembrane self-exchange rates and faster endogenous phosphorylation of band 3 protein, which is the anion carrier. It has been suggested that increased phosphorylation of band 3 is linked to increased transmembrane oxalate transport. This study shows that agents that modify phosphorylation of band 3 induce a concurrent modification in oxalate transmembrane flux, whereas agents that mediate phosphorylation of bands 4.1 and 4.9 do not induce a similar change. Mani Menon, M.D.
RENAL TUMORS, RETROPERITONEUM, URETER, AND URINARY DIVERSION AND RECONSTRUCTION Localized Renal Cell Carcinoma Treated by Radical Nephrectomy. Influence of Pathologic Data and the Importance of DNA Ploidy Pattern on Disease Outcome G. RAVIV, I. LEIBOVICH, Y. MoR, D. NASS, 0. MEDALIA, B. GOLDWASSER AND 0. NATIV, Departments of Urology and Pathology, The Chaim Sheba Medical Center, Tel Hashomer and Department of Cell Biology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Cancer, 72:2207-2212, 1993 Background. The course of patients with renal cell carcinoma may be considerably different. Approximately 50% with presumed localized disease have metastases after nephrectomy. Pathologic stage at diagnosis, histologic grade, and histologic type have been considered the most important predictors of prognosis. Nevertheless, subsets of patients within a specified stage and grade may have considerable differences in disease progression and survival.
RENAL CALCULI
permanent sutures. However, it is not certain whether the penis will remain straight when the child goes through puberty. I have limited experience with young children. In older children or young adults I prefer placing 4 to 6, 2-zero or 1-zero braided nonabsorbable sutures between the dorsal arteries and the deep dorsal vein after the penis has been made erect with intracavernous papaverine. To prevent priapism intracavernous phenylephrine is injected to induce detumescence after surgery. Multiple sutures give a better correction of curvature and avoid the dog-ear formation. Sutures between the arteries and vein also have the advantages of being away from nerve branches and of plicating the thicker portion of the tunica albuginea since lateral aspects have the thinnest tunica. In young adults this outpatient procedure is often performed using local anesthesia with less expense and minimal morbidity. Tom F. Lue, M.D.
RENAL CALCULI Long-Term Stone Regrowth and Recurrence Rates After Extracorporeal Shock Wave Lithotripsy C. Yu, Y. H. LEE, J. K. HUANG, M. T. CHEN, K. K. CHEN, A. T. L. LIN AND L. S. CHANG, Division of Urology, Department of Surgery, Veterans General Hospital, Kaohsiung and National Yang-Ming Medical College, Taipei, Taiwan, Republic of China Brit. J. Urol., 72: 688-691, 1993 We reviewed 1055 patients with symptomatic urinary calculi treated by extracorporeal shock wave lithotripsy (ESWL) monotherapy to determine the long-term stone regrowth and recurrence rates as correlated with the pre-treatment stone burden, site and multiplicity. Long-term follow-up (mean 75.8 months) was available in 94 patients, representing 106 renal units. The recurrence of stone was defined as reappearance of stone on follow-up plain abdominal radiographs. The regrowth of stone was defined as stone regrowing larger than one-third of the original residual size. A stone-free rate of 53% was achieved. The overall stone regrowth and recurrence rates were 26 and 15% respectively. It was concluded that the stone recurrence rate after ESWL was not influenced significantly by the stone size or the multiplicity, but that the regrowth rate was. Stone recurrence and regrowth rates after ESWL were both influenced by the stone location.
C.
Editorial Comment: This study examines long-term stone regrowth and recurrence rates in patients undergoing ESWL* at the Veterans General Hospital in Taipei, Taiwan. At a followup of about 6 years 26% of patients showed stone regrowth and Hi% had stone recurrence. Since by definition stone growth occurs only in patients with residual stones, the true recurrence rate was 15% in a group of 94 patients undergoing ESWL who were followed for 6 years. Surprisingly, the authors found that the recurrence rate after ESWL was not influenced significantly by stone size or multiplicity but the regrowth rate was affected. This is an important study with considerable long-term information. The study can be compared to that of Henriksson et al, which examines stone recurrence in patients undergoing percutaneous stone extraction. 1 At followup of up to 5 years about a third of the patients were found to have recurrent calcifications on plain film radiography. Mani Menon, M.D. 1. Henriksson, C., Geterud, K., Pettersson, S. and Zachrisson, B. F.: Stone recurrences in kidneys made
stone-free by percutaneous extraction. Scand. J. Urol. Nephrol., 27: 151, 1993.
The Effect of Warfarin on Urine Calcium Oxalate Crystal Growth Inhibition and Urinary Excretion of Calcium and Nephrocalcin E. M. WORCESTER, J. L. SEBASTIAN, J. G. HIATT, A. M. BESHENSKY AND J. A. SADOWSKI, Section of Nephrology
and Medical and Pharmacy Service, Zablocki VA Medical Center and Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, and USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts Calcif. Tissue Int., 53: 242-248, 1993 Urine contains inhibitors of calcium oxalate (CaOx) crystal growth. One such inhibitor is nephrocalcin (NC), a glycoprotein which is made in the kidney and contains several residues of gamma-carboxyglutamic acid (Gla) per molecule. The presence ofGla may be important to its ability to inhibit crystal growth. Several * Dornier Medical Systems, Inc., Marietta, Georgia.
RENAL CALCULI
studies suggest that vitamin K-dependent proteins may also play a role in renal calcium (Ca) handling, and that vitamin D deficiency may lead to excess urinary Ca loss, but the effect of the vitamin K antagonist warfarin on urinary Ca excretion and CaOx growth inhibition in humans is not known. We studied 11 men while they were taking warfarin for a mean of 252 days, and again a mean of 64 days after its discontinuation. Urinary Ca excretion did not differ between those on or off warfarin, or between those on warfarin and normal controls. The ability of the subjects' urine to inhibit CaOx crystal growth did not differ on or off warfarin, or from that of control urine, and the excretion of immunoreactive NC also did not differ between these groups. NC was found to be responsible for approximately 16% of the CaOx growth inhibition seen. These results do not suggest that vitamin K-dependent proteins play a major role in renal Ca excretion in men, or that interference with vitamin K alters NC excretion or inhibitory activity of the urine.
Editorial Comment: A major inhibitor of calcium oxalate crystal growth is nephrocalcin, a glycoprotein containing several residues of y-carboxyglutamic acid. The y-carboxyglutamic acid content of the molecule is important to its function, since nephrocalcin isolated from the urine of stone formers is lacking in y-carboxyglutamic acid residues. y-Carboxylation of target proteins is controlled by a vitamin K dependent carboxylase and, thus, it may be theorized that inhibition of vitamin K may affect renal calcium handling and calcium oxalate crystal growth. These investigators studied 11 men taking the vitamin K antagonist, warfarin, for a mean of 252 days and again 64 days after discontinuing medication. They demonstrated no difference in urinary calcium excretion or calcium oxalate crystal growth inhibition between these men and control patients. Mani Menon, M.D. Citrate and Calcium Effects on Tamm-Horsfall Glycoprotein as a Modifier of Calcium Oxalate Crystal Aggregation B. HESS, L. ZIPPERLE AND P. JAEGER, Policlinic of Medicine, University Hospital, Bern, Switzerland Amer. J. Physiol., part 2, 265: F784-F791, 1993 We measured the effects of Tamm-Horsfall glycoprotein (THP) on calcium oxalate monohydrate (COM) crystal aggregation (Ac) in vitro as well as intrinsic viscosities (Vi) ofTHP at pH 5.7 and 200 mM NaCl and studied the effects of calcium and citrate on these parameters. THP were isolated from 24-h urines of seven male recurrent calcium stone formers (RCSF) and eight age-matched male healthy volunteers (N, normal). At basal conditions, RCSF-THP inhibited~ by 28 ::!:: 10% and normal THP by 60 ::!:: 6% (P = 0.028). In the presence of calcium, increasing THP concentrations from 16 to 28 and 40 mg/1 progressively lowered inhibition by RCSF-THP, but not by N-THP. At 40 mg/1, inhibition by N-THP was 27 ::!:: 9% vs. -43 ::!:: 8% by RCSF-THP (P = 0.001), i.e., all stone former THP promoted Ac. With an additional 3.5 mM of citrate, inhibition of~ was 56 ::!:: 5% by normal and 34 ::!:: 6% by stone former THP (P = 0.021), and all seven stone former THP again inhibited~- Vi of RCSF-THP was higher than that of N at basal conditions (162 ::!:: 21 vs. 93 ::!:: 15 ml/g, P = 0.021) and in the presence of 5 mM calcium (352 ::!:: 54 vs. 118 ::!:: 17 ml/g, P = 0.001), i.e., RCSF-THP were more self-aggregated, but not when citrate was added (185 ::!:: 29 vs. 123 ::!:: 19 ml/g). An inverse correlation between Ac and Vi (r = -0.948, P = 0.0001) was found, i.e., more self-aggregated THP molecules were weaker inhibitors (or even promoters) of Ac. These findings offer a possible new explanation for the role of citrate in calcium oxalate Ac.
Editorial Comment: Tamm-Horsfall protein, which is the most abundant protein in urine from healthy people, is an important modifier of calcium oxalate monohydrate crystallization. Depending on the experimental conditions used, it inhibits or promotes crystallization. The authors measured the effects of Tamm-Horsfall protein on calcium oxalate monohydrate crystal aggregation. The protein isolated from 7 male recurrent calcium stone formers inhibited aggregation by about 40% of control inhibition. By alternating experimental conditions and concentrations of Tamm-Horsfall protein a scenario was created in which the protein from stone formers actually promoted crystal aggregation. Under these experimental conditions TammHorsfall protein from normal subjects continued to inhibit aggregation. Self-aggregated Tamm-Horsfall protein molecules were weaker inhibitors or even promoters of crystal aggregation. With the addition of citrate the Tamm-Horsfall protein in stone formers inhibited crystal aggregation normally. Hess et al have shown previously that Tamm-Horsfall protein from male patients with recurrent calcium oxalate nephrolithiasis exhibits an increased tendency to self-aggregate. 1 This study extends the earlier observations and shows that self-aggregated Tamm-Horsfall protein molecules do not inhibit calcium oxalate monohydrate crystal aggregation. Mani Menon, M.D 1. Hess, B., Nakagawa, Y., Parks, J. H. and Coe, F. L.: Molecular abnormality of Tamm-Horsfall glycoprotein in calcium oxalate nepholithiasis. Amer. J, Physiol., part 2, 260: F569, 1991. .
587
588
RENAL TUMORS, RETROPERITONEUM, URETER, AND URINARY DIVERSION AND RECONSTRUCTION
The Effects of Citrate and Urine on Calcium Oxalate Crystal Aggregation H.-G. TISELIUS, A.-M. FORNANDER AND M.-A. NILSSON, Department of Urology and Clinical Research Centre, University Hospital, Linkoping, Sweden Urol. Res., 21: 363-366, 1993 The rate of crystal sedimentation in a suspension of calcium oxalate monohydrate (COM) crystals was determined spectrophotometrically in the presence and absence of dialysed urine and citrate. A reduced rate of crystal sedimentation after stirring was recorded in suspensions containing citrate in concentrations between 0.33 and 1.67 mmol/1. The sedimentation rate was reduced in the presence of a 0.3-3.3% concentration of dialysed urine, with increased inhibition of crystal sedimentation when the concentration of urine was increased. A comparison of the inhibition of COM crystal sedimentation in whole urine and in dialysed urine from normal subjects and stone-formers disclosed significantly higher values (P <0.05) in the dialysed urine. The results support previous observations that physiological concentrations of citrate might efficiently inhibit the aggregation of COM crystals. Furthermore even low concentrations of both whole urine and dialysed urine are apparently very efficient inhibitors of COM crystal aggregation.
Editorial Comment: These authors demonstrate that physiological concentrations of citrate inhibit calcium oxalate monohydrate crystal sedimentation or aggregation. Combining this information with that derived from the article by Hess et al, citrate appears to have a direct inhibitory effect on crystal aggregation and an indirect effect by increasing the inhibitory potential of Tamm-Horsfall protein. Mani Menon, M.D. Evidence of a Link Between Erythrocyte Band 3 Phosphorylation and Anion Transport in Patients with 'Idiopathic' Calcium Oxalate Nephrolithiasis B. BAGGIO, L. BORDIN, G. GAMBARO, A. PICCOLI, G. MARZARo AND G. CLARI, Institutes of Internal Medicine and
Biological Chemistry, University of Padova, School of Medicine, Padova, Italy Miner. Electr. Metab., 19: 17-20, 1993 This study was carried out to verify the hypothesis of a link between faster endogenous phosphorylation of band 3 protein, the anion carrier, and anomalous oxalate transmembrane self-exchange found in erythrocyte from calcium oxalate renal stone formers. Agents able to modify 32P-labelling of band 3 protein induced a concurrent modification in oxalate transmembrane flux. Cyclic AMP- and phospholipid-sensitive Ca 2 + -independent protein kinases seem to be critical modulators of band 3 function. These observations demonstrate a close link between the band 3 phosphorylation state and its anion transport function, and provide new insights into the pathogenetic mechanisms of the cellular anomalies observed in calciumoxalate renal stone disease.
Editorial Comment: Patients with idiopathic calcium oxalate nephrolithiasis exhibit higher oxalate and urate transmembrane self-exchange rates and faster endogenous phosphorylation of band 3 protein, which is the anion carrier. It has been suggested that increased phosphorylation of band 3 is linked to increased transmembrane oxalate transport. This study shows that agents that modify phosphorylation of band 3 induce a concurrent modification in oxalate transmembrane flux, whereas agents that mediate phosphorylation of bands 4.1 and 4.9 do not induce a similar change. Mani Menon, M.D.
RENAL TUMORS, RETROPERITONEUM, URETER, AND URINARY DIVERSION AND RECONSTRUCTION Localized Renal Cell Carcinoma Treated by Radical Nephrectomy. Influence of Pathologic Data and the Importance of DNA Ploidy Pattern on Disease Outcome G. RAVIV, I. LEIBOVICH, Y. MoR, D. NASS, 0. MEDALIA, B. GOLDWASSER AND 0. NATIV, Departments of Urology and Pathology, The Chaim Sheba Medical Center, Tel Hashomer and Department of Cell Biology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Cancer, 72:2207-2212, 1993 Background. The course of patients with renal cell carcinoma may be considerably different. Approximately 50% with presumed localized disease have metastases after nephrectomy. Pathologic stage at diagnosis, histologic grade, and histologic type have been considered the most important predictors of prognosis. Nevertheless, subsets of patients within a specified stage and grade may have considerable differences in disease progression and survival.