Nefrolitiasi
Urolithiasis, or urolithiasis is one of the most common urological disorders. The incidence rate for 1997 was 426.7 cases per 100 000 inhabitants. The prevalence of urolithiasis, morbidity and mortality caused by the current problem. In recent years, the incidence of urolithiasis has a tendency to increase, because of increasing life expectancy, changes in people's diet. While the people are most men of working age than women.
Causes of bladder stones nephrolithiasis Uric acid is a type of kidney stones associated with the violation of purine metabolism and the accumulation of greater amounts of uric acid, due to increased consumption of foods rich in protein, in the context of declining physical activity. People who are overweight are more likely to stone formation of uric acid. However, not only on-nutrition, but prolonged fasting leads to increased concentration of uric acid in the blood.
Of particular note is the ability of alcohol to block the release of uric acid by the kidneys, causing an increase in its concentration in urine.
High levels of uric acid in urine can be caused by caffeine. Although caffeine increases urine production, showing the same uric acid at the same time, increases the basal metabolic rate, increasing the formation of uric acid. If the amount of caffeine consumed per day is equal to 1 to 1.5 g and more, some of it is converted into uric acid.
One of the reasons for the increase of uric acid in urine are cancer and blood diseases, especially during therapy with cytostatics or radiation. This is due to the fact that over nukleoproteinovogo strong catabolism of tumor cells, as well as excessive tissue destruction in the process of cytostatic and radiation therapy. In addition, uric acid can accumulate in taking certain drugs: diuretics, antibiotics, corticosteroid hormones. In patients with impaired purine often found a direct correlation between high levels of uric acid in blood plasma and hyperglycemia. In the body
Uric acid is formed by nucleotides nucleotides own food proteins from tissues and the synthesis of the body. The basic form of existence of the latter in the body is lithe monosodium, whose formation is linked to the metabolism of adenine and guanine, two purine bases, consisting of a nucleic acid that forms a nucleoprotein protein. Through the complex transition changes purine bases hypoxanthine and xanthine in which further influenced by xanthine converted into uric acid in urine excreted by the kidneys and can form stones. The symptoms of nephrolithiasis
Clinical symptoms in urate nephrolithiasis mochekamennnoy disease is typical and shows the classic triad of renal colic
* is one of the symptoms main that may be of variable intensity, with increasing temperature, often, this results in connection with the abuse on the eve of alcohol, consumption of large quantities of food to meat, exercise,
* Gross hematuria - blood in urine;
* Discharge of concretions, the presence of sand in the sediment of the urine of yellow-brown;
The diagnosis of nephrolithiasis
The diagnosis of uric acid stones, in violation of purine metabolism is usually not complicated, but, unlike other types of urolithiasis has some differences - not detected by X-ray because it does not absorb X-rays radiographic study begins with an overview urography to confirm rentgennegativnosti contrast or weak stone, which indicates that the impurity a small amount of oxalate. In these situations, you can find concretions: retrograde urography (kidney catheterization with the introduction of contrast, to reveal a filling defect); pnevmopielografiyu (retrograde introduction of oxygen, to view the stone, since the oxygen X-ray is not delayed); pnevmoperetoneum (visualization of kidney stone and the background of the surrounding air) over recent years more and more applied rentgenovsuyu computer tomography, which allows you to view rentgennegativny stone and set it apart from cancer of the pelvis;
method Ultrasonic cheap and effective that is used for both surveys to find the stones in the kidney, upper ureter (with extensions), predpuzyrnogo ureter during bladder filling, and the dynamic examination during therapy litoliticheskoy.
In laboratory studies revealed elevated serum uric acid in normal content ranging from 0.147 to 0.358 mg / dL, but may vary depending on age and sex. The urinalysis is usually determined by the salt of uric acid, acidic urine (pH below 6.4). Leukocyturia and red blood cells common to all forms of nephrolithiasis. The treatment of urate nephrolithiasis
Treatment of urate nephrolithiasis in violation of purine metabolism is complex, aims to reduce uric acid in the extracellular space. To this end, drugs, action urikostaticheskoe okazyvayushee (allopurinol 300 mg. A day under the control of uric acid in blood serum) and the combined action (100 mg benzbromarone. A day under the control of uric acid in serum).
Recommended food restricted diet rich in protein. These include: meat, oily fish, liver, kidneys, brain, mushrooms, meat, fish, mushroom soup, beans, peas, lentils, liqueur, red wine, dark beer, cocoa, chocolate, tea and strong coffee, pickles, meat , pickles, raspberries, figs, mineral water, alkaline (Borjomi).
not recommended for use: spinach, celery, peppers, radishes, cauliflower.
Without limitation, the use of dairy products, eggs, vegetables, rice and oatmeal, wheat and rye bread products, cereals and pasta.
After normalization of the metabolism of purines, while maintaining the flow of urine in the upper urinary tract can be prepared citrate appointment (blemaren, magurlit regime Ural-Y under the control of urine pH), which litoliticheskoe action. The treatment is performed under ultrasound guidance, which reflects the effectiveness of therapy litoliticheskoy. Prescribing vitamins B1 and B6, drugs improve blood circulation (Trental), if necessary spend protivovospaliteluyu therapy. It should be noted
that patients with urate nephrolithiasis in violation of purine metabolism should be the follow-up, for the correction of supportive therapy as soon as a recurrence of the disease.
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