PECULIARITIES OF DIAGNOSING AND TREATING URINE STONE DISEASE ASSOCIATED WITH THE METABOLIC SYNDROME
DOI:
https://doi.org/10.11603/1811-2471.2022.v.i4.13492Keywords:
urolithiasis, metabolic syndrome, quercetin, obesity, hyperuricemia, diabetes, metaphylaxis, uric acidAbstract
SUMMARY. Nephrolithiasis is a globally spread disease that most often develops in patients of working age. It stems from endogenous and exogenous factors, depends on heredity, and has signs of stone formation in the kidneys and urinary tract, with a severe course and a tendency to relapse.
One of the most common pathologies associated with nephrolithiasis is metabolic syndrome (MS).
An actual problem in urology is the diagnosis and treatment of urolithiasis (KSD), comorbid with MS, the use of drugs that can inhibit the excretion of stone-forming compounds and activate crystallization inhibitors to implement the nephrolithiasis metaphylactic algorithm.
The aim – based on the scientific literature data, to analyze the possibilities of diagnosis and treatment of KSD associated with MS.
Obesity raises stone formation risks due to excessive consumption of nutrients which increases the movement of lithogenic substances of calcium, oxalate, and uric acid. A decrease in the acidic pH of urine causes a disorder of ammonia synthesis, which is associated with insulin resistance. Hyperuricemia is associated with excessively low urine acidity and increases the number of recurrences of stone formation and is one of the features of MS. Violation of purine metabolism in uric acid KSD can be considered a sign of insulin resistance. A correlation was established between hyperuricemia and the level of blood pressure, hyperglycemia, waist circumference, and body mass index. It has been proven that lowering the level of uric acid reduces the development of cardiovascular disease complications. The administration of angiotensin-converting enzyme inhibitors and sartans is relevant in connection with changes in the homeostatic functions of the kidneys in MS. Stimulation of plasminogen by urokinase induces the synthesis of plasmin, which decomposes uromucoid, reducing recurrences of stone formation. Litholytic therapy should be prescribed after examining the indicators of metabolic processes in patients with KSD. Allopurinol is prescribed when hyperuricemia and hyperuricuria are detected. Quercetin is the most promising drug for the metaphylaxis of MS-associated KSD.
Conclusions. Obesity and hyperuricemia are associated with excessively low urine acidity and an increase in the number of stone recurrences. Patients with MS-associated KSD are offered a comprehensive examination and treatment with traditional therapy with urocolytic, urostatistical means and drugs that affect metabolic processes. Quertin based on plant bioflavonoids is a promising drug for the treatment of MS-associated KSD.
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