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THE NUTRITIONAL SIGNIFICANCE OF PRIMARY BLADDER STONES 1
Author(s) -
Andersen D. A.
Publication year - 1962
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1962.tb06506.x
Subject(s) - calcium oxalate , bladder stones , incidence (geometry) , medicine , population , bladder stone , vitamin , zoology , calcium , biology , urinary system , environmental health , physics , optics
SUMMARY1 Observations are presented on a series of 256 primary bladder stones treated at Ahmednagar, India, between 1939 and 1957. More detailed investigations carried out under the auspices of the Indian Council of Medical Research between 1957 and 1960 are described.The stones are found to occur predominantly in males (97 per cent.) and most commonly between the ages of 1 and 10, with a peak incidence at 5 years. Histological studies carried out in thirty cases showed no evidence of specific vitamin A changes in the bladder epithelium, and any etiological relationship between vitamin A and the occurrence of primary bladder stones is, on this and other grounds, discounted. Studies of the chemical composition of thirty stones showed that the commonest constituent was calcium oxalate. The nuclei of four stones examined contained more calcium oxalate and less phosphates and urates than the stone as a whole. This fact, if confirmed, suggests a renal origin of the stones. The population group affected is the poor farmer, farm labourer, or village artisan, whose diet is almost entirely vegetarian, and based on hard millet of which 23 to 24 oz. a day are eaten by an adult. This gives an adequate total calorie value and a fairly high protein intake, but there is little or no animal protein and very low fats and oils.2 The situation in Europe 100 years ago is presented, and it is found that primary stones in the bladder were common, both in children and adults. They were found most frequently in England in Norfolk, which was a poor agricultural area, where the food at that time showed a marked resemblance to the diet described. The incidence of primary bladder stones was found to diminish in the second half of last century, and reached vanishing point in England between 1920 and 1930, and in Scandinavia between 1910 and 1920. There was simultaneously in Scandinavia a great increase in the recorded occurrence of renal stones and a preliminary observation is presented regarding this.A working hypothesis that primary bladder stones are basically caused by a diet consisting almost exclusively of one cereal is presented, and other possible astiological factors are considered.3 A brief review of recent experimental work is given which indicates that there is a theoretical possibility of stone formation in the renal tract due to an imbalance, whether excess or shortage, of the individual amino acids associated with a deficiency, whether primary or secondary, in a constituent of the vitamin B group, possibly B 6 , concerned in intermediate metabolism.