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Kamica moczowa

2003 Oct; 44 (4): 4754-4781

Ocena zależno¶ci pomiędzy poziomem szczawianów w moczu a występowaniem jelitowej bakterii Oxalobacter formigenes u chorych na kamicę szczawianowo-wapniow±

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 oceniaj±cego zwi±zek pomiędzy kolonizacj± przewodu pokarmowego bakteri± Oxalobacter formigenes a poziomem szczawianów w moczu u chorych dotkniętych kamic± szczawianowo-wapniow±. Analizie poddano 103 chorych w wieku od 21 do 73 lat (¶redni wiek 47 lat). Ocenie laboratoryjnej poddano próbki moczu i ¶wieżego kału. Ocenę ilo¶ciow± O. formigenes oparto na systemie PCR z wykorzystaniem egzogennego, konkurencyjnego szablonu DNA. Dodatkowo oceniano objęto¶ć wydalanego moczu i poziomy: kreatyniny, szczawianów, magnezu, fosforanów, cytrynianów, kwasu moczowego oraz pH. Drobnoustrój wykryto u 45,6% (n=47) chorych na kamicę szczawianowo-wapniow± przy zastosowaniu techniki PCR. U chorych na kamicę z ujemnym testem na obecno¶ć Oxalobacter formigenes ¶redni 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). ¶rednia ilo¶ć jednostek formuj±cych kolonie drobnoustrojów przypadaj±cych 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 formuj±cych kolonie O. formigenes (p = 0,021). Wyniki badania stanowi± rzeteln± podstawę koncepcji o istotno¶ci Oxalobacter formigenes w utrzymaniu homeostazy. Brak obecno¶ci bakterii w przewodzie pokarmowym może stać się istotnym czynnikiem ryzyka rozwoju kamicy szczawianowo-wapniowej.


2003 Oct; 44 (4): 467-474

Prospektywna ocena skuteczno¶ci selektywnego leczenia i czynników ryzyka wznowy u chorych na nawrotow± kamicę szczawianowo-wapniow±

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 wł±czono 134 chorych poddanych obserwacji co najmniej raz na 6 miesięcy. W zależno¶ci od wyników analizy materiału pochodz±cego 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 objęto¶ci moczu, pH moczu, wydalania potasu i cytrynianów. Chorzy z nawrotem kamicy wykazywali wzrost wydalania szczawianów z moczem. Analiza metod± wieloczynnikowej regresji logistycznej wykazała, że leczenie metod± ESWL oraz mnoga i rozsiana kamica kielichowa w wywiadzie stanowi± nie zależne czynniki prognostyczne ryzyka wyst±pienia wznowy. Wnioski wypływaj±ce z tego ciekawego opracowania wskazuj± na zrozumienie konieczno¶ci zalecania chorym na kamicę szczawianowo-wapniow± spożywania odpowiedniej ilo¶ci płynów oraz stosowanie adekwatnego leczenia polegaj±cego na alkalizacji moczu. Najważniejszym czynnikiem ryzyka nawrotu kamicy jest wzrost wydalania szczawianów.



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