Effect of epoetin zeta for correction of renal anemia in hemodialysis patients with thalassemia minor.

Two patients with thalassemia minor and end-stage renal failure on hemodialysis were treated with epoetin zeta (Silapo, Retacrit; STADA, Germany), a medicinal product that was developed and registered as biosimilar to epoetin alfa. Dosing was titrated individually for two patients to achieve a stable hemoglobin (Hb) concentration of 10.5-12.0 g/dL. One patient was treated intravenously with epoetin zeta; the other patient was treated subcutaneously. After 12 weeks of therapy both patients achieved Hb levels within the target range, confirming the effi cacy of epoetin zeta in patients with thalassemia minor.

Treatment of immune nephropathies with high doses of immunoglobulins.

UNLABELLED: The present study presents the results from the application of high doses of gamma-globulin in the treatment of immune (idiopathic and satellite) glomerulopathies. MATERIALS AND METHODS: Twenty patients were treated. Of these 12 were with primary chronic glomerulonephritis, 7--with lupus nephritis and 1--with renal amyloidosis. All diagnoses were verified through a renal puncture biopsy. The following therapeutic scheme was used--85 mg/kg/body weight of gamma-globulin was applied intravenously three times a day every other day till reaching a total course dose of 250 mg/kg/body weight. All patients presented with nephrotic syndrome following conventional treatment with corticosteroids, anticoagulants and anti-aggregants. The blood cell count, the serum creatinine, creatinine clearance, 24 h diuresis and level of proteinuria were monitored. RESULTS AND DISCUSSION: 14 of the patients showed a complete clinical and laboratory remission. Four of them got an incomplete remission with a proteinuria of 2 g/24 h. No positive effect from the treatment was observed in 2 of the patients. All patients with lupus nephritis were influenced positively to a certain extent by the treatment applied. No serious side effects leading to therapy interruption were observed. CONCLUSIONS: 1. The treatment with high doses of immunoglobulin is a good alternative to the pulse immunosuppressive treatment of patients with idiopathic and lupus nephritides, manifested with a nephrotic syndrome and unaffected by a previous conventional immunosuppressive and anticoagulant therapy. 2. The results from the treatment with high doses of immunoglobulin are more pronounced in patients with lupus nephritides, which in turn raises the possibility for an earlier reduction of corticosteroid therapy and avoidance of its side effects. 3. Immunoglobulin therapy is an alternative in the management of nephrotic symptoms in cases with chronic renal failure where an immunosuppressive treatment is irrelevant.

Assessment of serum osteocalcine level in pre-dialysis patients with chronic renal failure.

UNLABELLED: The application of serum osteocalcine as a marker of osseous synthesis in patients with renal osteodystrophy is still disputable because of its predominantly renal excretion. The aim of the present study was to investigate the level of serum osteocalcine in pre-dialysis patients with chronic renal failure (CRF). MATERIAL AND METHODS: 47 patients aged 22-60 years (26 males and 22 females) with chronic renal failure were studied. 23 of them were stage I CRF patients (creatinine up to 353.6 mumol/l) and 24 were stage II and III CRF patients (creatinine up to 800 mumol/l). 35 healthy subjects (15 males and 20 females) were used as controls. Serum osteocalcine was measured by a radioimmunologic assay (ELSA-OSTEO-CIS, France). Serum creatinine, calcium, phosphorus and alkaline phosphatase were detected on a biochemical analyzer "Optima" (Kone Instruments, Finland) using the standard techniques recommended by IFCC. RESULTS: Serum osteocalcine was significantly elevated in patients with stage I CRF (45.61 +/- 7.75 ng/ml), compared to the control group (14.61 +/- 1.02, p < 0.001; u = 3.96). A significant increase was also found in patients with stage II and III CRF (120.48 +/- 15.96 ng/ml, p < 0.001; u = 4.22). No significant difference in osteocalcine level was found between male and female patients (83.77 +/- 15.09 vs. 94.52 +/- 16.88). 32 (68%) patients of the entire sample had osteocalcine above the reference values. These included 11 out of 23 patients with stage I CRF (47%) and 21 out of 24 patients with stage II and III CRF (87%). A moderately positive correlation was established between osteocalcine level and the duration of CRF (0.57), as well as between serum creatinine (0.39) and phosphorus (0.34). A moderately negative correlation was discovered between creatinine clearance (-0.42) and total serum calcium (-0.37). CONCLUSIONS: Serum osteocalcine could be used as a marker for bone synthesis in pre-dialysis patients with CRF. Our results indicate that more than 50% of the patients show evidence for renal osteodystrophy.

Influence of age, sex and body weight on renal osteodystrophy in predialysis patients with chronic renal failure.

UNLABELLED: The aim of the present investigation was to examine the influence of age, sex and body weight on osseous changes in pre-dialysis patients with chronic renal failure (CRF). 87 patients (44 males and 43 females) aged 18-60 years with CRF were studied. The levels of serum creatinine, total and ionized calcium, phosphorus, alkaline phosphatase, intact parathormone and serum osteocalcine were followed up. Body weight is presented as BMI. 47 of the patients were subjected to double X-ray absorptiometry of lumbar vertebra (Lunar) and 40 patients were examined by computed tomography osteometry. RESULTS: No reliable differences in the levels of biochemical parameters in male and female patients with the same degree of CRF were established. A tendency towards an increase in the level of intact parathormone and serum osteocalcine in women with both initial and advanced CRF was recorded. The BMI in patients with advanced CRF was lower as compared to those with initial CRF. Different stages of osseous changes were observed in 29 males (74.35%) and in 25 females (60.97%). A tendency for a higher frequency and severity of osseous changes in men aged up to 40 years was observed. After this age males and females were equally affected. A high positive correlation (r = 0.50) between BMI and the percentage of the normal Bone Mineral Density/Bone Mineral Content in females with CRF stage II and III was noticed. CONCLUSIONS: No significant difference in the frequency and severity of osseous changes in male and female uremic patients was observed. Bone changes were more frequent and pronounced in males up to 40 years of age, while this tendency reversed after the menopause. The higher body weight was beneficial for the osseous changes only in females with advanced CRF, while in all other patients no correlation with densitometric parameters was noticed.

Low protein diet and ketosteril in predialysis patients with renal failure.

UNLABELLED: After a short review of the contemporary understanding of amino acid supplementation to low protein diets in patients with uremia we present the results of administration of ketosteril in 20 low-protein-diet patients on such a diet. MATERIAL AND METHODS: Twenty patients (10 men and 10 women) with stable II and III stage chronic renal failure were assigned to a low protein diet (protein up to 40 g/day). Ketosteril (6 tablets a day) were added to the diet. Some of the basic markers of protein metabolism and nitrogen balance were followed. RESULTS: No evidence of deteriorated protein synthesis was found in the therapy thus administered. Serum urea and creatinine values did not change and even tended to decrease. Glomerular filtration was found to increase insignificantly more markedly in the patients with renal failure in the early stages. CONCLUSIONS: A low protein diet with increased content of essential amino acids and their keto-analogues does not deteriorate the nitrogen balance of patients with chronic renal failure. By adding essential amino acids and keto-analogues a normal protein metabolism is maintained in spite of the reduce intake of protein substances with the diet. Supplementation of the diet of chronic renal failure patients with essential amino acids and keto-analogues allows a considerable reduction of the protein intake to be achieved which brings about reduction of glomerular hyperfiltration which actually retards the progression of renal failure and improves its short-term prognosis.

Cyclosporin A in the treatment of patients with nephrotic syndrome.

OBJECTIVE: To present our experience in the treatment of conventional therapy refractory nephrotic syndrome with cyclosporin A. MATERIAL AND METHODS: The study sample included 22 patients (12 men, 10 women, aged 40.43 +/- 5.93 years). Twenty one patients were diagnosed histologically: 11 were with different histologic variants of chronic gtlomerulonephritis, 7 with lupus nephritis and 3 with renal amyloidosis. Sandimmun Neoral-Sandoz was given orally in a dose of 2-5 mg/kg/24 hours; mean duration of the course of treatment 41.4 +/- 12.4 days. In the course of treatment we followed quantitatively 24-hour proteinuria, diuresis, hematologic parameters, serum creatinine, transaminases, the fat profile, and creatinine clearance. RESULTS: The patients were allocated into 3 groups according to their response to treatment--in 5 patients (22.73%) it achieved complete clinical and laboratory remission, in 8 (36.36%)--partial remission and in 9 (40.91%) it failed. The 24-hour diuresis in the patients with complete and partial remission increased significantly during the third week of treatment (from 1212.5 +/- 114.7 to 2700 +/- 394.61, p < 0.05, t = 3.62). Proteinuria was reduced from 3.47 +/- 0.54 to 1.86 +/- 0.36 g/d (p < 0.05, t = 2.48) at the end of treatment. No substantial change in the antihypertensive therapy was necessary in any of the patients. There was no decline of the renal and liver functions. Neither allergic reactions nor serious side effects that may have caused discontinuation of treatment were observed. Complete or partial clinical and laboratory remission was achieved in 59.09% (13 patients) (confidence interval = 39.2%-78.9%, odds ratio = 0.95). Cyclosporin A therapy is an appropriate alternative in the treatment of refractory nephrotic syndrome in some of the immunologic glomerulopathies. The types of glomerulopathy that are best affected are minimal-change glomerulonephritis, some of the mesangioproliferative glomerulonephritis cases and some forms of lupus nephritis. No effect whatsoever was found in cases with renal amyloidosis.

Epoetin-beta (Recormon-Roche) in the treatment of renal anemia in patients with chronic renal failure.

UNLABELLED: In the study a clinical assessment is made of the results of treatment of patients with renal anemia by epoetin-beta. MATERIAL AND METHODS: Thirty two patients (22 women, 10 men) with chronic renal failure and anemia, ranging from 18 to 77 years of age (mean age 46.29 +/- 5.84), were recruited for the study. All patients underwent treatment with epoetin-beta (Recormon, Boehringer-La Roche). The criterion for inclusion in the study was presence of severe anemia (HGB < 90 g/l). Extrarenal causes for the anemia were excluded in all patients. The main treatment objective was to increase hemoglobin to 100-120 g/l. All patients received concomitant iron supplementation at constant control of the iron status. The predialysis patients were administered iron perorally (200 mg/day) while the patients on chronic hemodialysis were given iron parenterally (intravenously) (Venofer, 100 mg/day). RESULTS: Anemia was significantly corrected. Hemoglobin level rose significantly from 77.15 +/- 2.32 g/l before treatment to 110.71 +/- 6.25 g/l at the end of month three. It remained less than 100 g/l for the time of study only in one patient. Neo-Recormon had a considerable positive effect on the overall condition of patients. No significant changes were found in the rate of progression of renal failure nor were there any marked side effects and intolerability to the drug observed. CONCLUSIONS: Anemia was significantly corrected in the renal anemia patients treated with epoetin beta. In predialysis patients iron supplementation can be effectively administered orally. If given in high doses (more than 4000 IU/kg), epoetin-beta can cause rapid increase of the hematologic parameters, especially in the initial phase of treatment; this affects adversely arterial pressure which necessitates changes in the antihypertensive therapy. Erythropoietin therapy reduces and even eliminates the need of transfusion in patients with chronic renal anemia.

Our experience in the combined pathogenetic treatment of chronic glomerulonephritis.

UNLABELLED: The most common combined pathogenetic treatment regimens for the treatment of chronic glomerulonephritis are the object of the present study. It is not quite uncommon in everyday clinical practice for the physician to encounter patients with similar pathohistologic patterns who respond differently to a standard therapeutic schedule. METHODS: Having in mind the complexity of the problem we analyzed our ten-year experience with the combined pathogenetic treatment of 150 patients, aged 17 to 52, with histologically proven chronic glomerulonephritis. The diagnosis was made on the basis of light microscopy, immunofluorescent and, where available, electron microscopy studies of kidney biopsies using clinical and laboratory criteria. In most cases the combined pathogenetic treatment included standard dosage regimens consisting of corticosteroids--Prednisolone in a dose of 1.0-1.5 mg/kg, cytotoxic agents--Cyclophosphamide 1.0-1.5 mg/kg, anticoagulants--heparin (Calciparin) given for one month and antiplatelet drugs--Dipyridamole 300 mg/day. When the preceding regimen was unsuccessful the patients were given pulse therapy with Methylprednisolone 10-15 mg/kg on three successive days or Cyclophosphamide 10 mg/kg in a single dose. Those who failed to respond to the standard pathogenetic and pulse therapy were treated with Cyclosporin (Sandimmun-Sandoz) in a daily dose of 2-5 mg/kg. Complete remission occurred in forty-two patients (63.6%) with mesangial proliferative glomerulonephritis and 18 patients (60%) with membranous glomerulonephritis. The remaining patients were non-responders. RESULTS: The highest percentage of patients with complete remission was observed among those with minimal-change glomerulonephritis--20 patients (95.2%) and the lowest--among those with mesangiocapillary glomerulonephritis--5 patients (27.7%), focal segmental glomerular sclerosis and hyalinosis and sclerosing glomerulonephritis--11.1% and 16.7%, respectively. CONCLUSIONS: The authors think that at present the combined pathogenetic treatment of chronic glomerulonephritis has no alternative and can slow the progression of the renal injury as well as influence favorably the short- and long-term prognosis of the patient with glomerulonephritis.

On the disturbances in carbohydrate metabolism in pre-dialysis patients with chronic renal failure.

UNLABELLED: We describe some of the aspects of impaired carbohydrate metabolism in predialysis uremic patients. METHODS: A total of seventy-five nondiabetic patients with chronic renal failure (CRF) were enrolled in the present study. The level of glycosylated hemoglobin was measured in 51 patients using kits from Merck and an oral glucose challenge test was performed in 20 according to a standard protocol. The levels of immunoreactive insulin and growth hormone (GH) were measured in all predialysis patients using original kits and an automatic minigamma counter (Abbott, USA). The results were compared with those from 30 healthy controls. RESULTS: In patients with first degree CRF the level of glycosylated hemoglobin was 5.9 +/- 05%. In patients with second and third degree CRF there was a trend towards higher glycosylated hemoglobin levels--6.3 +/- 0.6% (P > 0.05; u = 1.1) as compared with the controls--5.5 +/- 0.4%. The analysis of the results from the oral glucose challenge test revealed impaired glucose tolerance in 12 predialysis patients with CRF with blood glucose levels of 9.1 +/- 1.6 mmol/l at the second hour following the ingestion of glucose. Nine of those had second or third degree CRF. The baseline levels of plasma immunoreactive insulin showed a tendency towards increase in the patients with uremia as compared with the controls (7.2 +/- 1.1 IU/ml versus 6.4 +/- 0.7 IU/ml) whereas no significant difference was found at the 1st, 2nd or 3rd hour following the ingestion of glucose as compared with the healthy controls. Five of our patients had significantly elevated basal insulin levels. With regard to GH levels, we found similar baseline values in our study patients and the controls. At the 1st hour following the glucose challenge the GH values showed a tendency towards increase in the uremic patients--6.1 +/- 1.1 ng/ml. In 4 of our study patients we found significantly elevated GH levels at the 1st hour following the ingestion of glucose (6.6 +/- 0.7 ng/ml). CONCLUSIONS: 1. No significant disturbances in carbohydrate metabolism were found in patients with mild (initial) CRF. 2. In patients with moderate and advanced CRF we found changes consistent with impaired carbohydrate metabolism and a tendency towards an increase in the basal immunoreactive insulin levels. 3. Growth hormone levels showed a different pattern of change in predialysis patients and those changes cannot be explained by the changes in carbohydrate metabolism.

Cyclic adenosine monophosphate (cAMP) levels in predialysis patients with chronic renal failure.

We studied the changes in the urinary cAMP level in fifty-five predialysis patients (30 men and 25 women) with chronic renal failure (CRF). The excretion of cAMP in 20 patients with first-degree CRF (serum creatinine levels below 356.6 mmol/I) and 15 patients with second or third degree CRF (serum creatinine below 800 mmol/I) was compared with that of 20 age-matched controls using the original I-125 RIA (radioimmunoassay) kit of Incstar Corporation, USA. The urinary cAMP was within normal limits in first-degree CRF patients (mean +/- Sx = 2,617 +/- 268.2 nmol/l) whose serum calcium level was slightly decreased. When calculated per 100 ml of glomerular filtration rate, their urinary cAMP level was significantly elevated--101.17 +/- 0.39--as compared with that of the controls--2.5 +/- 0.2. The urinary cAMP excretion was significantly higher in second and third degree CRF patients--mean 3,755 +/- 435.2 nmol/l, p < 0.05. This increase correlated with hypocalcemia whereas the serum alkaline phosphatase levels remained normal. 20% of the patients with second or third degree CRF had normal urinary cAMP excretion. In our opinion, urinary cAMP levels can reliably be employed as a sensitive and specific indicator of the onset of mild secondary hyperparathyroidism in predialysis patients with CRF.

Clinical electron microscopic correlations in patients with glomerulonephritis.

The purpose of the present study was to perform an electron microscopic investigation of patients with chronic glomerulonephritis and to find correlations between the type of glomerular disorder and the features of the clinical course of the disease. 26 patients--16 female and 10 male aged 17-62 years (mean age, 34.5 years) were investigated. All patients were clinically diagnosed as having chronic glomerulonephritis with a disease duration ranging from 3 months to 2 years. The main clinical and laboratory parameters studied were presence of edemas, hypertension, proteinuria, hyperlipidemia, haematuria and renal failure confirmed by the creatinine clearance. A puncture renal biopsy was performed by classical methods under ultrasound guidance using a Vim-Silverman needle. An electron microscope Philips CM-12 was used in the study. We found in all patients a significant correlation between the degree of proteinuria and the marked deformation and edema of the podocyte pedicles. In making the integral histological diagnosis of chronic glomerulonephritis it is necessary to determine more precisely the mesangial involvement and the changes in the membrane by means of an electron microscopic study. This will be conducive to a reduction in the number of mistakes in diagnosing some primary chronic glomerulonephrites.

External respiration in patients with chronic renal failure in a predialysis state.

The purpose of this study was to make functional assessment of the external respiration in patients with chronic renal failure (CRF) in a predialysis state and to find some early indicators for uremic lung impairment. Twenty two patients (13 men, 9 women, aged 30 to 65) with different renal diseases were investigated. According to the stage of progression of CRF we allocated the patients to two groups-14 patients with stage I CRF (serum creatinine up to 353.6 mumol/I), and 8 patients with stage II CRF (serum creatinine from 353.6 to 707.2 mumol/I). The comprehensive functional study included slow spirometry, forced expiration, bodyplethysmography, and investigation of the diffusion, blood-gas and acid-base parameters. The respiratory muscle strength was measured by means of a modified device first used by Black LE and Hyatt RE. Ventilatory parameters in stage I CRF patients were found to be either normal or slightly changed while the parameters of the respiratory muscle strength worsened earlier than the ventilatory parameters. In the patients with stage II CRF the pronounced ventilatory and diffusion disorders was found to occur much more frequently.

Study of the effect of recombinant erythropoietin on renal anaemia in predialysis patients with chronic renal failure.

Recombinant erythropoietin was given to six renal anaemia patients (2 male and 4 female, aged 38-66 years) with chronic renal failure in the predialysis state. Eprex (Cilag, Switzerland) was used in the treatment. The preparation was administered subcutaneously, thrice weekly for 6 months, at a mean dose of 50 U/kg. The aim of the therapy was to keep haemoglobin in the target range of 100 and 120 milligrams. No allergic reactions or other forms of intolerance to the preparation were noticed. The mean baseline haemoglobin level prior to treatment (75.5 +/- 4.06 milligrams) increased to 96.3 +/- 6.9 milligrams at three months and 106.0 +/- 7.1 milligrams at six months (P < 0.01). The baseline MCHC increased from 313.6 +/- 2.7 milligrams to 324.3 +/- 4.29 milligrams (P < 0.05) during the third month of treatment. Hematocrit also increased significantly-from 0.23 +/- 0.01 to 0.31 +/- 0.01 (P < 0.01) during the third and to 0.36 +/- 0.02 (P < 0.001) during the sixth month of treatment. The erythrocyte counts from 2.73 +/- 0.2 x 10(12)/l reached 3.69 +/- 0.24 x 10(12)/l (P < 0.01) at three months and 4.01 +/- 0.27 x 10(12)/l (P < 0.001) at six months. Reticulocyte counts increased from 1.93 +/- 0.37/1000 to 4.06 +/- 0.6/1000 after one month of treatment (P < 0.02) reaching the highest values during the second week of treatment. After the fourth week, reticulocyte number fluctuated slightly but not significantly above the baseline. The serum iron decreased from 12.0 +/- 0.36 mumol/l to 10.5 +/- 1.0 mumol/l (P < 0.05) and 9.93 +/- 0.9 mumol/l (P < 0.02) at three and six months, respectively. The results revealed a non-significant reduction of serum ferritin and transferrin in the course of treatment. We also found a strong positive correlation between the dose of Eprex applied and the haemoglobin, hematocrit and the erythrocyte values in the treated patients.

Glomerular hyperfiltration and serum beta 2-microglobulin used as early markers in diagnosis of autosomal dominant polycystic kidney disease.

This study was undertaken to investigate the dynamics of glomerular filtration and serum beta 2-microglobulin in patients with confirmed autosomal dominant polycystic kidney disease (ADPKD) without chronic renal failure (CRF). Twenty five patients (11 women and 14 men, age range 15 to 56 years) with echographically and computer-tomographically proven ADPKD were entered into the study. Glomerular filtration was followed using the 24 hour creatinine clearance and beta 2-microglobulin serum level was measured radioimmunologically using an ABBOTT laboratories kit. 12 patients had a significantly reduced glomerular filtration: 1.01 +/- 0.05 ml/s compared with 2.12 +/- 0.15 ml/l in the control group (P < 0.001). This group of patients also had a significantly increased level of the serum beta 2-microglobulin: 3.54 +/- 0.47 micrograms/l versus 1.42 +/- 0.28 micrograms/l in healthy controls (P < 0.001). Seven of the patients showed normal glomerular filtration and significantly increased beta 2-microglobulin: 2.65 +/- 0.46 micrograms/l (P < 0.05). The glomerular filtration in six of the patients was found to be significantly increased (hyperfiltration) 2.65 +/- 0.04 ml/s (P < 0.001) while their serum beta 2-microglobulin level tended to rise (2.25 +/- 0.3 micrograms/l). We believe that glomerular hyperfiltration combined with the increased level of the serum beta 2-microglobulin can be used as an early marker of ADPKD.

Ionized calcium in patients with chronic renal failure.

Parameters of various renal disorders were studied in 31 patients (17 men and 14 women) who all were in the stage of chronic renal failure (CRF). These parameters included total serum creatinine, ionized calcium, serum creatinine, creatinine clearance and acid-base balance. The results were compared with a control group of 30 healthy subjects. In the patients with first stage CRF, the total serum calcium did not significantly decrease (mean = 2.19 +/- 0.12 mmol/l) and ionized calcium was within reference value limits (mean = 1.28 +/- 0.02 mmol/l). The percentage of ionized calcium in total serum calcium was higher for these patients (mean = 58.43%) than for the control group (mean = 52.25%). For patients with first and second stage CRF, the total serum was significantly lower (mean = 1.92 +/- 0.03 mmol/l) than for the healthy controls (p < 0.001) as well as for patients with first stage CRF (p < 0.05). The ionized calcium in these patients was not significantly lower (mean = 1.14 +/- 0.01 mmol/l); however, its percentage was higher than that of serum calcium (mean = 59.38%). There was a slight negative correlation between the levels of ionized calcium and serum creatinine in patients with first stage CRF (r = -0.30) and a significant correlation in patients with second and third stage CRF.

[The hemolytic-uremic syndrome during contraceptive prevention with Rigevidon]. / Khemolitichno-uremichen sindrom po vreme na kontratseptivna profilaktika s Rigevidon.

A case of a 20-year-old woman who developed a hemolytic-uremic syndrome while using the contraceptive drug Rigevidon is reported. Clinically the disease was manifested by acute renal failure, thrombocytopenic purpura and hemolytic anemia. The treatment with antiaggregants, anticoagulants, hemodialysis and plasmapheresis was without effect. The diagnosis was proved by the postmortem examination. The risks of the use of oral contraceptives and the need of new and better methods for contraception are discussed.

[Urinary magnesium excretion in nephrolithiasis]. / Magnezieva urinna ekskretsiia pri bubrechnokamenna bolest.

Magnesium urine excretion and its correlation with calcium urine excretion were studied in 152 patients with nephrolithiasis by atomic-absorption spectrophotometry. In 14.5% of the patients with unilateral nephrolithiasis and in the 25.6% of the patients with bilateral nephrolithiasis the magnesium urine excretion was lowered. Following calcium loading the magnesiumuria in healthy persons was reliably and positively influenced while in the patients with nephrolithiasis with initial lowered magnesium excretion there was an insignificant increase. The ration MgU/CaU is of special importance for the evaluation of the lithogenic risk. The determination of the Ca-Mg interrelation is obligatory for every patient with nephrolithiasis because of its great practical importance for the treatment of these patients.