RU2064184C1 - Method for differential diagnosing type of calculus formation in patients suffering from nephrolythiasis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves examining diurnal urine of a patient by applying agregatometry method by means of sequential addition of inductors like uric, phosphoric and oxalic acids, analyzing curve recorded in adding one or other inductor and determining crystal sizes. When recording one-phase curve having no angle of decrease, monomineral type of calculus formation is considered to take place. When two- or three-phased curve is observed, mixed type of calculus formation is considered to take place. The crystal sizes being found to be between 4.0 and 6.0, urate calculi are diagnosed, the case of 8.0-10.0 crystal sizes brings the diagnosis of phosphates, the case of 12.0-16.0 crystal sizes brings the diagnosis of oxalates. EFFECT: enhanced effectiveness of diagnosis.

Description

 The invention relates to medicine, namely to urology.

 Kidney stone disease is a common disease and is associated with a violation of water-salt metabolism, which occurs, as a rule, due to prolonged use of products containing a large amount of mineral salts and stagnation of urine in the urinary tract in diseases accompanied by a violation of its outflow. These factors contribute to the precipitation of urine crystals of salts, which are usually in it in a dissolved state. Urinary stones form from them. So, urate is formed from uric acid salts, phosphates from phosphate salts, and calcium oxalate oxalates.

 Conservative treatment and prevention of stone formation depend on the composition of the stones. In this regard, accurate diagnosis of the type of stone formation is of paramount importance.

 Known methods for diagnosing the type of stone formation in patients with kidney stone disease by x-ray examination (A.Ya. Pytel, "X-ray diagnosis of diseases of the urinary system", N. Moscow, 1966, S. 350-368), ultrasound (N.V. Pilipenko " Ultrasound diagnosis of diseases of the urinary system ", Moscow, 1990, pp. 28-29). However, these methods are not informative, because do not allow to differentiate the type of stone formation, which makes it difficult to conduct adequate treatment.

 A known method for determining the type of stone formation, which consists in the emission of crystallization processes on an experimental model of urine from stone-forming salts of lithogenic substances (V. S. Dziurak "Proteolysis and the concentration of hydrogen ions of urine in the pathogenesis and treatment of kidney stone disease", Dissertation of the doctor of medical science, Kiev, 1988, 1988 , p. 339).

 The essence of the method lies in the fact that visually in the Goryachev’s chamber, crystals are counted and their quantity and size are judged on one or another type of metabolic disturbance and, accordingly, the type of stone formation.

 However, the known method is experimental. It does not have sufficient accuracy, because visually it is not always possible to determine the presence of crystals that may not be visible under a microscope. The method does not allow to differentiate the type of metabolic disturbance in mixed types of stone formation.

 As a prototype, a method of differential diagnostics of the type of stone formation was adopted by determining the content of lithogenic substances in daily urine (B. V. Tarasenko, "Pathogenetic substantiation of the differentiated treatment of patients with nephrolithiasis and metaphylaxis of stone formation relapses", Dissertation of the doctor of medical sciences, Tashkent, 1991, p. 427 )

 The essence of the method lies in the fact that in the daily urine the presence of uric, phosphoric or oxalic acids is determined by spectrometric method. At a concentration of one or another acid above the norm, uric acid, phosphoric acid or oxalic acid type of stone formation are judged.

 However, the method does not allow to judge the type of stone formation in its mixed forms, while they make up 60-70 of the total number of patients in Russia.

 The objective of the invention is to provide a highly effective accurate method for differential diagnosis of stone formation type in patients with kidney stone disease, both in monomineral and mixed forms of the disease.

 The essence of the invention lies in the fact that in the method of differential diagnosis of types of stone formation in patients with kidney stone disease, including the study of daily urine of a patient, urine is examined by aggregatometry by sequentially adding urinary, phosphoric and oxalic acid inductors to it, analyzing the curve and determining the size of the crystals, and when registering a single-phase curve without a recession angle, a monomineral type of stone formation is judged, and when a two or three-phase curve with a recession angle is judged on a mixed type of stone formation Hovhan, wherein, when the size of the crystals of 4.0-6.0 microns diagnostsiruyut urate stones 8,0-10,00 um phosphate, and 12.0 at 16.0 microns oxalate.

 Using the invention allows to obtain the following technical result.

 The method makes it possible to accurately determine the type of violation of the water-salt metabolism in the patient’s body and the type of stone formation, both monomineral and mixed.

 For the first time, it was possible to determine the chemical composition of stones without first removing them from the body.

The reliability of the results is 98.8
The method does not require preliminary preparation of patients, it can be carried out on an outpatient basis.

 The study can be performed even on a small amount of urine (5 ml).

 Based on the determination of the type of stone formation by aggregatometry, a scientifically based metaphylaxis of recurrent stone formation can be carried out.

Aggregation urine test conducted for the first time
The method is as follows.

 The patient's daily urine is defended and in a volume of 5 ml they will be placed in a special cuvette located in a passing light stream on an aggregometer. The apparatus is equipped with a thermostatic unit and automatic recording on the aggregatogram of processes occurring in a biochemical environment during mechanical stirring.

 Then, 2-3 drops of an inducer: uric, phosphoric and oxalic acids are successively added to urine in the urine. Depending on the presence or absence of one or another type of metabolic disturbance and, accordingly, stone formation, a reaction to a specific solution occurs and these processes are recorded on an aggregometer in the form of a curve. If there is an oxalate type of stone formation, then the reaction will be with the addition of an oxalic acid inducer, uric acid uric acid inducer, phosphate phosphoric acid inducer. With a mixed type of stone formation, the curve is recorded when two inductors are added.

 The authors found that each type of stone formation is characterized by a specific crystal size: uric acid (urate) 4-5 microns, phosphate (phosphates) 8-10 microns, oxalate (oxalates) 14-18 microns.

 Moreover, for the monomineral type of stone formation, a single-phase curve without a recession angle is characteristic, for a mixed type, a two or three-phase curve with a recession angle is present.

 Example 1. Patient K., 39 years old, was admitted to the urology clinic of the University named after S.P. Botkin with a preliminary diagnosis established by ultrasound: kidney stone disease of the right kidney.

 The patient collected daily urine, in a volume of 5 ml was placed in a cuvette aggregator. 2-3 drops of uric, phosphoric and oxalic acid inducer were added successively in each drop. When phosphoric acid was added, a single-phase curve was recorded without a recession angle. The crystal size is 8.96 microns. Diagnosis: monomineral phosphate stone.

 The obtained data coincided with the result of X-ray diffraction analysis of stone fragments after lithotripsy.

 Example 2. Patient R., 45 years old, was admitted to a urological clinic with a preliminary diagnosis established by ultrasound: a stone of the right kidney.

 5 ml of the patient's daily urine was placed in a cuvette of the aggregator. When a uric acid inducer was added, a single-phase curve was recorded with no angle of decline. The crystal size is 4.14 microns. Monomineral urate stone was diagnosed.

 Example 3. Patient S., 37 years old, was admitted to a urological clinic with complaints of pain in the lumbar region. X-ray examination showed the presence of stones in the left kidney.

 5 ml of the patient’s daily urine was placed in the cuvette of the aggregometer, then uric, phosphoric and oxalic acid inductors were added sequentially. When oxalic acid was added, a single-phase curve was recorded without an angle of decline. Crystal size: 14.72 microns.

 Diagnosis: monomineral oxalate stones.

 Example 4. Patient S., 60 years old, was admitted to the urological clinic of the hospital named after S.P. Botkin complaining of aching pain in the right lumbar region. An X-ray examination revealed a stone of the right kidney. The patient's daily urine in a volume of 5 ml was examined on an aggregometer. With the addition of oxalic and uric acid inductors, a two-phase curve having an angle of decline was recorded. Crystal sizes: 15.2 and 41.86 microns.

 Diagnosis: urate-oxalate stone of the right kidney. The diagnosis was confirmed after the stone fragments were removed by X-ray analysis.

Claims (1)

A method for differential diagnosis of types of stone formation in patients with kidney stone disease, including the study of the patient’s daily urine, characterized in that the urine is examined by aggregation method by successively adding inductors to it: uric, phosphoric and oxalic acids, the recorded curve is analyzed and the crystal size is determined and, when registering, single-phase a curve without a recession angle diagnoses a monomineral type of stone formation, and with a two-or three-phase curve with a recession angle
a mixed type of stone formation, and with a crystal size of 4.0-6.0 microns, urate stones, 8.0-10.0 phosphate, 12.0-16.0 oxalate are determined.