Therapy of uric acid nephrolithiasis in the practice of therapist and family physician
V.S. Saenko
Sechenov University, Moscow
An increase in the prevalence of urolithiasis increases the relevance of its prevention, diagnosis, and treatment. It is important to understand the mechanisms of formation of various types of urinary tract stones and to carry out their differential diagnosis. For the prescription of metaphylactic or litholytic treatment for patients with uric acid type of stone formation, it is important to know a chemical composition of the stone, an assessment of metabolism in order to determine the concomitant disorders. It is necessary to separate the concepts of urate and uric acid nephrolithiasis, to understand what factors affect stone formation, to have a clear idea of what types of stones are formed during purine metabolism disorder, since the treatment tactics depend on it. A major role in the dissolution of uric acid stone and the prevention of relapse is played by the correction of the water consumption schedule by increasing the daily urine flow, the volume of water consumed. At the same time, there is a dilution of the concentration of stone-forming substances and an increase in the pH levels of urine and urinary citrate, which is the most powerful inhibitor of stone formation. Patients are recommended to follow a diet, use hydrocarbonate mineral waters. For drug litholytic therapy, Blemaren® citrate mixture preparation is used under the control of pH-metry. The clinical efficacy of an individually developed conservative pharmacotherapy in the uric acid form of urolithiasis is 84–98%, and conducting of an adequate individualized metaphylactic treatment can reduce the frequency of relapses.
Key words: purine metabolism disorder, uric acid urolithiasis, metaphylaxis of urolithiasis, pH-metry, citrate therapy, Blemaren®.
For citation: Saenko V.S. Therapy of uric acid nephrolithiasis in the practice of therapist and family physician // RMJ. Medical Review. 2018. № 11. P. 45–48.
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7. Taylor E.N., Curhan G.C. Body size and 24-hour urine composition // Am J Kidney Dis. 2006. Vol. 48. P. 905–915.
8. Daudon M., Lacour B., Jungers P. Influence of body size on urinary stone composition in men and women // Urol Res. 2006. Vol. 34. P. 193–199.
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10. Саенко В.С., Газимиев М.А., Песегов С.В. Место минеральных вод в метафилактике мочекаменной болезни. Урология. 2016. № 5. С. 87–94 [Saenko V.S., Gazimiev M.A., Pesegov S.V. Mesto mineral’nyh vod v metafilaktike mochekamennoj bolezni. Urologiya. 2016. № 5. S. 87–94 (in Russian)].
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