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Kamica moczowa

2003 Oct; 44 (4): 4754-4781

Ocena zależności pomiędzy poziomem szczawianów w moczu a występowaniem jelitowej bakterii Oxalobacter formigenes u chorych na kamicę szczawianowo-wapniową

Urinary oxalate levels and the enteric bacterium Oxalobacter formigenes in patients with calcium oxalate urolithiasis

Department of Urology, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, 28 Yongon Dong, Jongno Ku, Seoul 110-744, Republic of Korea

W doniesieniu zawarto wyniki prospektywnego badania oceniającego związek pomiędzy kolonizacją przewodu pokarmowego bakterią Oxalobacter formigenes a poziomem szczawianów w moczu u chorych dotkniętych kamicą szczawianowo-wapniową. Analizie poddano 103 chorych w wieku od 21 do 73 lat (średni wiek 47 lat). Ocenie laboratoryjnej poddano próbki moczu i świeżego kału. Ocenę ilościową O. formigenes oparto na systemie PCR z wykorzystaniem egzogennego, konkurencyjnego szablonu DNA. Dodatkowo oceniano objętość wydalanego moczu i poziomy: kreatyniny, szczawianów, magnezu, fosforanów, cytrynianów, kwasu moczowego oraz pH. Drobnoustrój wykryto u 45,6% (n=47) chorych na kamicę szczawianowo-wapniową przy zastosowaniu techniki PCR. U chorych na kamicę z ujemnym testem na obecność Oxalobacter formigenes średni poziom szczawianów w moczu wynosił 0,36 mmoL/24 godz., w porównaniu z 0,29 mmoL/24 godz. u chorych z testem dodatnim (p < 0,05). średnia ilość jednostek formujących kolonie drobnoustrojów przypadających na 1g kału wynosiła 1,1 x 107 u wszystkich badanych. Poziom szczawianów w moczu z dobowej zbiórki znacznie obniżał się wraz ze wzrostem poziomu jednostek formujących kolonie O. formigenes (p = 0,021). Wyniki badania stanowią rzetelną podstawę koncepcji o istotności Oxalobacter formigenes w utrzymaniu homeostazy. Brak obecności bakterii w przewodzie pokarmowym może stać się istotnym czynnikiem ryzyka rozwoju kamicy szczawianowo-wapniowej.


2003 Oct; 44 (4): 467-474

Prospektywna ocena skuteczności selektywnego leczenia i czynników ryzyka wznowy u chorych na nawrotową kamicę szczawianowo-wapniową

Prospective study on the efficacy of a selective treatment and risk factors for relapse in recurrent calcium oxalate stone patients

Department of Urology, University of Bonn, Sigmund-Freud-Str 25, D-53105 Bonn, Germany. roswitha.siener@ukb.uni-bonn.de

Do 2-letniego badania włączono 134 chorych poddanych obserwacji co najmniej raz na 6 miesięcy. W zależności od wyników analizy materiału pochodzącego z 24-godzinnej zbiórki moczu oraz danych laboratoryjnych i wywiadu żywieniowego, chorym proponowano indywidualne zlecenia farmakologiczne i dietetyczne. Podczas pełnego okresu obserwacji nawrót kamicy stwierdzono u 57 (43%) chorych. U chorych, u których nie stwierdzono nawrotu kamicy, ustalono, że znamienny spadek skalkulowanego ryzyka rozwoju złogów jest wprost proporcjonalny do znamiennego wzrostu objętości moczu, pH moczu, wydalania potasu i cytrynianów. Chorzy z nawrotem kamicy wykazywali wzrost wydalania szczawianów z moczem. Analiza metodą wieloczynnikowej regresji logistycznej wykazała, że leczenie metodą ESWL oraz mnoga i rozsiana kamica kielichowa w wywiadzie stanowią nie zależne czynniki prognostyczne ryzyka wystąpienia wznowy. Wnioski wypływające z tego ciekawego opracowania wskazują na zrozumienie konieczności zalecania chorym na kamicę szczawianowo-wapniową spożywania odpowiedniej ilości płynów oraz stosowanie adekwatnego leczenia polegającego na alkalizacji moczu. Najważniejszym czynnikiem ryzyka nawrotu kamicy jest wzrost wydalania szczawianów.



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