Conservative method for treating the cases of urolithiasis and preventing recurrent calculus formation

FIELD: medicine.

SUBSTANCE: method involves adjusting blood and urine acid-base balance under urine pH control within a day. Sequential oscillatory variation of urine pH is set within physiological limits from 4.5 to 8.0.

EFFECT: enhanced effectiveness in adjusting metabolism processes participating in calculi formation.

 

One of the main criteria that determine the type formed of kidney stones, is the acidity (pH) of the urine. At acidic pH values (4,5-5,7) easy praecipitium uric acid with the formation of urate stones (Pytel Y.A.,1995, RAS, S. et al., 1977). Sedimentation of salts of oxalic acid mono - and dihydrate calcium oxalate occurs in intervals urine pH of 5.8 to 6.5 (Single YG, jurak V.S., 1984). Calcium-oxalate crystals in 30% are formed only at pH 6.25 (Ahlstrand Ch., 1984). Alkaline urine has a negative effect on the solubility of phosphate salts (Lopatkin N.A., 1998, Berg S., 1986). However, there is a direct correlation between changes KHS blood (chronic compensated metabolic acidosis) and views emerging calculus (Tatevosyan A.S., 1997).

In healthy people the daily fluctuation of the pH of urine is in the maximum physiological range from 4.5 to 8.0, while maintaining the stability of all enzymes urine. A distinctive feature of patients with renal stone disease (PKB) is a persistent consistency urine pH in a narrow range -<1,0 called itazura (Tatevosyan A.S., 2000), in which proishodivshuyu the activity of certain enzymes that stimulate crystallization of the corresponding salts (Single YG, jurak V.S., 1984).

There is a method of treatment of urate nephrolithiasis by applying a nitrate the pharmacological preparations (Blamart, Uralic, Makulit, Solimar etc)that alter urine pH (Medmaravis, 2000). The recommendations provide that the number and frequency of taking the drug should be determined by the limits of the urine pH from 6.2 to 6.8. This approach does not take into account the fact that a long stay urine pH in the proposed narrow souldrinker the interval (a 6.2 to 6.8) contributes to the replacement activity of some enzymes on the other, that is, the dissolution of one and parallel to the deposition of other salts. That is why a half-century use of citrate mixtures did not fully dissolve stones larger than 10 mm in a single patient, thereby reducing the interest of using citrate drugs in the practice of urology.

The prototype is described Sergienko NF (Urology and Nephrology, 1999, No. 2, p.34-36 ) citrate therapy in the treatment of urate nephrolithiasis, carried out as a baseline when the stones cups kidney (10-12 mm) or stone fragments after remote or contact lithotripsy. A good result as the authors considered the dissolution of stones up to 10 mm, was observed in 42% of people, or a decrease of more than 1/3 of original volume of stone larger than 10 mm, obtained in 37% of patients.

The method is based on the fact that, by eliminating soulbrew and achieving maximum fluctuation range of pH of urine, wound up activity with testwuide enzymes that is, in the conditions of daily physiological fluctuation in pH of urine (4,5-8,0) none of the enzymes urine does not have time to be activated and, therefore, there is no possibility of any reaction precipitation of salts, and is that drug-food (including citrate and mixtures) correction of acid-base status of blood and urine tests carried out with such intensity, at which the diurnal fluctuations in pH of urine are in the range from 4.5 to 8.0, i.e. to have the maximum physiological values. However, in the course of alkalizers therapy is the correction of chronic metabolic acidosis, which after 4-5 months of treatment is completely leveled.

The technical proposal is a reliable cure, excluding highly traumatic surgical intervention, ensuring the prevention of stone formation in the presence of this risk, preserving the quality of life of the patient.

The method is as follows. In the morning you check the pH of urine and when it is 4,5-5,5 spend alkalizers therapy in this volume, wherein pH of the urine rises to the highest possible value of 7.5 to 8.0, after which the medication stop and examine the dynamics of lowering the pH of urine, until it reaches the original value (4,5-5,5), and then again called achut drugs alkalizing the urine until its pH is again reached a high level of 7.5 to 8.0.

If the original soulbury is in the range 5.5 to 6.5 also have alkalizing therapy before raising the pH of urine, equal to 7.5 to 8.0, followed by the termination of the medication until the pH value of the urine will not decrease to the initial level (5.5 to 6.5), which designate acidic drug-food load, so that urine pH dropped to 4.5 to 5.0. In the future, the treatment cycle is repeated upon reaching litaize. Indicators KHS blood test not more often than 1 time per month, normalization reflects their positive dynamics of flow of the underlying disease - renal stone disease.

The method is tested on 52 patients.

Example 1. B-Oh R, 48 years old, and a/b No. 5679. The last 10 years notes periodic discharge of small stones. In 1997 he performed remote lithotripsy stone 3 of the left ureter. In 2001 when ray and ultrasound examination revealed shashechnye stones 10-15 mm of both kidneys (left 2, right 1). KHS blood pH of 7.35, RNO2=28, Rho2=75, BE=-6,5. The daily level of fluctuations in the pH of the urine revealed soulbrew 5,0-5,5.

The treatment is complete the proposed method. On the morning of the first portion of urine in 700accounted for 5.0. For Breakfast the patient drank 300 ml of yogurt. 1000urine pH was 6.0. Drank 1 cha is ing spoon citrate drug Uralic - , Then in the 1200a control measurement of urine pH has established its level is equal to 7.0. The patient as a supplementary ration for dinner proposed boiled pumpkin, grapefruit and tea with lemon. 1500urine pH was 8,0 after which the patient was transferred to an arbitrary mode. To 23 hours control measurement of the pH of the urine has identified its lowest value of 5.0, and given the need for bedtime decided to abandon food forms of alkalization and assign 2 teaspoons citrate mixture. The next morning in the 700urine pH was equal to 6.0, i.e. not yet reached its minimum value, which determined the further waiting. 1200urine pH was lowered to 5.0 patient took 1 teaspoon of baking soda (Na HCO2and after 2 hours urine pH was raised to 7.5.

After 6 months at follow-up stones VMP is not detected. Recurrent stone formation currently missing. In addition, showed complete normalization KHS blood: pH=7,4, RNO2=35, Rho2=90, BE =-1,5.

Medico-social effect of the proposed treatment is that it allows litolitic therapy to patients renal stone disease especially in those cases where surgical treatment is not shown to reduce the frequency of recurrent stone formation particularly in patients undergoing surgical treatment to reduce the stay n the hospital sheet and improve metabolic processes, contributing to the formation of stones.

Method of conservative treatment of urolithiasis and prevention of recurrent stone formation, including the correction of acid-base status of blood and urine, characterized in that therapy is carried out under the control of the pH of urine during the day, ask a coherent, oscillatory change of the amount of urine pH in the physiological range from 4.5 to 8.0.



 

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FIELD: medicine.

SUBSTANCE: method involves adjusting blood and urine acid-base balance under urine pH control within a day. Sequential oscillatory variation of urine pH is set within physiological limits from 4.5 to 8.0.

EFFECT: enhanced effectiveness in adjusting metabolism processes participating in calculi formation.

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FIELD: medicine.

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