{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:40:07Z","timestamp":1786372807142,"version":"build-2736575974"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Incomplete distal renal tubular acidosis is a well known cause of calcareous nephrolithiasis but the prevalence is unknown, mostly due to lack of accepted diagnostic tests and criteria. The ammonium chloride test is considered as gold standard for the diagnosis of incomplete distal renal tubular acidosis, but the furosemide\/fludrocortisone test was recently proposed as an alternative. Because of the lack of rigorous comparative studies, the validity of the furosemide\/fludrocortisone test in stone formers remains unknown. In addition, the performance of conventional, nonprovocative parameters in predicting incomplete distal renal tubular acidosis has not been studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>We conducted a prospective study in an unselected cohort of 170 stone formers that underwent sequential ammonium chloride and furosemide\/fludrocortisone testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Using the ammonium chloride test as gold standard, the prevalence of incomplete distal renal tubular acidosis was 8%. Sensitivity and specificity of the furosemide\/fludrocortisone test were 77% and 85%, respectively, yielding a positive predictive value of 30% and a negative predictive value of 98%. Testing of several nonprovocative clinical parameters in the prediction of incomplete distal renal tubular acidosis revealed fasting morning urinary pH and plasma potassium as the most discriminative parameters. The combination of a fasting morning urinary threshold pH &lt;5.3 with a plasma potassium threshold &gt;3.8 mEq\/L yielded a negative predictive value of 98% with a sensitivity of 85% and a specificity of 77% for the diagnosis of incomplete distal renal tubular acidosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The furosemide\/fludrocortisone test can be used for incomplete distal renal tubular acidosis screening in stone formers, but an abnormal furosemide\/fludrocortisone test result needs confirmation by ammonium chloride testing. Our data furthermore indicate that incomplete distal renal tubular acidosis can reliably be excluded in stone formers by use of nonprovocative clinical parameters.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.01320217","type":"journal-article","created":{"date-parts":[[2017,8,3]],"date-time":"2017-08-03T20:20:14Z","timestamp":1501791614000},"page":"1507-1517","source":"Crossref","is-referenced-by-count":45,"title":["Furosemide\/Fludrocortisone Test and Clinical Parameters to Diagnose Incomplete Distal Renal Tubular Acidosis in Kidney Stone Formers"],"prefix":"10.2215","volume":"12","clinical-trial-number":[{"clinical-trial-number":"nct01690039","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Nasser A.","family":"Dhayat","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W.","family":"Gradwell","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganesh","family":"Pathare","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland;"},{"name":"Swiss National Centre of Competence in Research TransCure, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Anderegg","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland;"},{"name":"Swiss National Centre of Competence in Research TransCure, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Schneider","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Luethi","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cedric","family":"Mattmann","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orson W.","family":"Moe","sequence":"additional","affiliation":[{"name":"Departments of Internal Medicine and Physiology, and the Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Vogt","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel G.","family":"Fuster","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland;"},{"name":"Swiss National Centre of Competence in Research TransCure, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2017,8,3]]},"reference":[{"key":"B1-20230813","first-page":"259","article-title":"The excretion of acid in renal disease.","volume":"28","author":"Wrong","year":"1959","journal-title":"Q J Med"},{"key":"B2-20230813","doi-asserted-by":"crossref","first-page":"838","DOI":"10.4103\/1319-2442.113916","article-title":"Metabolic evaluation in first-time renal stone formers in North India: A single center study.","volume":"24","author":"Joshi","year":"2013","journal-title":"Saudi J Kidney Dis Transpl"},{"key":"B3-20230813","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1159\/000282457","article-title":"Incidence and clinical features of renal tubular acidosis-1 in urolithiasis.","volume":"50","author":"Ito","year":"1993","journal-title":"Urol Int"},{"key":"B4-20230813","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1111\/j.1464-410X.1989.tb05249.x","article-title":"Screening renal stone formers for distal renal tubular acidosis.","volume":"63","author":"Osther","year":"1989","journal-title":"Br J Urol"},{"key":"B5-20230813","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1097\/00005792-199111000-00001","article-title":"Comparison of patients with idiopathic calcium phosphate and calcium oxalate stones.","volume":"70","author":"Gault","year":"1991","journal-title":"Medicine (Baltimore)"},{"key":"B6-20230813","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1159\/000180502","article-title":"Incomplete renal tubular acidosis: Some clinical and physiological features.","volume":"15","author":"Tannen","year":"1975","journal-title":"Nephron"},{"key":"B7-20230813","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1159\/000181761","article-title":"Incidence and clinical importance of renal tubular defects in recurrent renal stone formers.","volume":"25","author":"Backman","year":"1980","journal-title":"Nephron"},{"key":"B8-20230813","first-page":"688","article-title":"Urinary risk factors for recurrent calcium stone formation in Thai stone formers.","volume":"90","author":"Stitchantrakul","year":"2007","journal-title":"J Med Assoc Thai"},{"key":"B9-20230813","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/BF01496659","article-title":"Ambulatory diagnostic evaluation of 389 recurrent renal stone formers. 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