Some aspects of the management of bilateral calculus disease of the kidney.

In the diagnosis of bilateral calculus disease of the kidneys, it is important to differentiate between cystine, uric acid, calcium oxalate and phosphate renal lithiasis. Methods for distinguishing one from another are described. Dietary therapy is the method of choice for cystine and uric acid lithiasis. In calcium and phosphate urolithiasis, dietary therapy is a very useful adjunct. It must be regulated by careful studies of its effect on urinary calcium precipitability, a new test for which is described based upon the demonstration of the existence of two forms of calcium in the urine. Irrigation therapy for calcium phosphate and phosphate lithiasis is briefly discussed. Surgical therapy for large renal phosphatic calculi is discussed to show how considerations of renal counterbalance and urinary calcium, magnesium and phosphate excretion through damaged kidney substances influence the surgical plan in each case.