1022 Kidney Stone Disease. 



Etiology. According to Klimmer the principal condition 

 for the development of urinary calculi is that the urine con- 

 tains an excess of salts or that slightly soluble or insoluble salts 

 are formed in it, already within the urinary passages. In both 

 cases the eliminated salts are deposited upon any foreign body 

 that may be present in the urinary passages, and the small 

 stone which is formed in this manner gradually enlarges by 

 the continued deposit of salts. It is a question whether the 

 presence of sticky substances, especially of albuminous or 

 gelatinous bodies is required for the formation of stones. The 

 nucleus on which the eliminated salts are deposited is usually 

 furnished by some element derived from the urinary organs 

 (epithelial cells, casts, blood clots, pus- and fibrin shreds, 

 necrotic tissue shreds), it is rarely a foreign body which has 

 entered the urinarv passages from the outside (straw, gravel, 

 etc.). 



The amount of salts present in the urine is materially 

 influenced by the chemical composition of the food and of the 

 drinking water, and therefore in a way also by the conditions 

 of soil. Drinking water which contains much lime or many 

 earthy constituents is of importance; so are food-stuffs that 

 are mixed with earthy substances or which are rich in calcium. 

 It can thus be explained why the disease is more frequent 

 in herbivora in regions where the soil is calcareous (Lang 

 observed on one estate the disease exclusively in those oxen 

 which had lived, at least for a time, on a certain farm). Multiple 

 cases may occur independently of the conditions of soil after 

 inappropriate feeding. Especially feeding with very large 

 quantities of potatoes, the waste of sugar beets, beets, and slop 

 may be followed in cattle by the formation of silicate con- 

 cretions, and a food rich in phosphorus (bran, grains) may give 

 rise to phosphatic calculi (especially in sheep). Theis saw 

 urinary stones in two mares which had for months received 

 }>repared bone meal. 



Inflammatory diseases of the urinary passages, also in 

 complete retention of urine, from whatever cause, may lead 

 to the formation of calculi by causing the formation of slightly 

 soluble or insoluble compounds, owing to the disintegration 

 of the urine; they furnish at the same time a nucleus for the 

 calculus. In this direction bacterial diseases are particularly 

 dangerous. 



The attempt has been made repeatedly to produce urinary calculi artificially. 

 In Studensky's experiments salts were indeed deposited upon foreign bodies that 

 had been introduced into the bladder, but actual calculi were formed only when the 

 bladder was at the same time subject to catarrhal affection. Ebstein and Nicolaier 

 observed the formation of stones after the systematic administration of oxamide. 

 According to these authors this substance is absorbed in the intestines, is then elim- 

 inated in the kidneys and, on coming- in contact with the mucosa of the urinary pas- 

 sages it causes a necrosis of the epithelial cells, so that the albuminous substance is 

 supplied which is said to be required for the formation of calculus. Thomassen also 

 found small stones in the renal pelvis of a small dog which had l)een fed with 

 oxamide for two weeks. 



