RESUMEN
A new outlook on etiology and pathogenesis of nephrolithiasis regards renal tubular acidosis (RTA) as the basic pathogenetic factor of nephrolithiasis. These conclusions were made basing on the findings on blood and urine glycolysis enzymes, lactic acid, acid-base metabolism, titrated acids, ammonium. RTA stages responsible for the variety of the forming concrement and two groups of nephrolithiasis etiological factors (acting on epithelial cell of the nephron and involved in urinary processes) are distinguished.
Asunto(s)
Cálculos Renales/etiología , Equilibrio Ácido-Base , Acidosis Tubular Renal/complicaciones , Acidosis Tubular Renal/metabolismo , Femenino , Humanos , Concentración de Iones de Hidrógeno , Cálculos Renales/metabolismo , Masculino , Nefronas/metabolismo , Cálculos Ureterales/etiología , Cálculos Ureterales/metabolismoRESUMEN
Rheorenographic findings, activities of 4 major glycolytic enzymes and 3 Krebs cycle ones in serum and blood, urinary fibrinolytic activity were analyzed in 117 patients with coral nephrolithiasis (the pelvis was drained after calculus removal) in 114 patients with non-coral calculi (the pelvis was sutured) before and 7, 14 days after surgery. Rheography revealed a significant decrease in arterial vascular tone and blood filling and an impairment in venous return in the diseased kidney. In the patients with nephrolithiasis, the enzymatic activity showed 3.5-10.5- and 4.5-11.5-fold increase (p less than 0.001) in the Krebs cycle and glycolysis, respectively, suggesting activation of not only oxidative phosphorylation, but anaerobic glycolysis. Tubular metabolic acidosis occurred, which made the enzymes enter blood and urine from the epithelial cells. On days 7-14 of postoperation, rheographic parameters, enzymatic and fibrinolytic activities of the urine remained virtually unchanged as compared to the values observed in the preoperative period. Moreover, the patients with a sutured pelvis showed highly accelerated glycolysis during the surgery against prior to the procedure. Urinary mitochondrial enzyme release increased, which reflected an enhancement of degenerative changes in nephron cells. Urinary fibrinolytic activity remained lower. In the patients with a drained pelvis, all the parameters in question became better.
Asunto(s)
Homeostasis/fisiología , Cálculos Renales/fisiopatología , Adulto , Enfermedad Crónica , Femenino , Humanos , Riñón/fisiopatología , Riñón/cirugía , Cálculos Renales/cirugía , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Pielonefritis/fisiopatología , Pielonefritis/cirugía , Urodinámica/fisiologíaRESUMEN
Computerized dynamic gamma scintigraphy with indirect radionuclide angiography was carried out in 29 patients with a single kidney. It was found that patients with a single kidney show already at the stage of "intact" organ persistent disorders of intrarenal hemodynamic processes as well as chronic urostasis. This variant of radionuclide examination may be used in the prophylactic management of this category of patients.