We feel an inherited defect permits some type of excessive retention that leads to an abnormality in the metabolism of phosphate and calcium. Unlike the previous drugs, it only weakly increases excretion of uric acid and would be useless for gout. It has no listed side-effects though we have learned of nausea, heartburn, itching or rash in rare instances. If needed, we increase to 600 mg. For about 70 percent, one of these two dosages suffices.
Adjustment is made as suggested by our subsequent mapping.
Observations suggest a primary defect in phosphate, not calcium metabolism. Calcium with or without magnesium taken with meals has allowed lower dosages of medication because it binds phosphates from food, increases fecal excretion and thereby lessens absorption. Brittle fingernails also suggest an abnormal calcium phosphate deposition at the root, which, similar to concentric tree rings, grow and eventually break or peel when they reach the tip. We found primarily phosphate, some calcium and oxalate, increase in the urine in after initiating treatment in the few patients we tested. Our hypothesis is that an inherited, abnormal renal retention of phosphate and secondarily, calcium, leads to an intracellular excess of both.