RU2359616C1 - Method of differential diagnostics of oxalate-calcium crystallurgy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to nephrology and can be used for differential diagnostics of oxalate-calcium crystallurgy. Ultrasound examination of urinary bladder is onducted twice determining change in echo-suspension character under basal conditions and after carrying out single magnesium oxide load. If echo-suspension disappears, it is diagnosed that suspension was represented by aggregated salts of calcium oxalate, which were dissolved under the impact of magnesium oxide.

EFFECT: obtaining possibility to carry out differential diagnostics of oxalate-calcium crystallurgy during ultrasound examination of urinary bladder.

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Description

The invention relates to medicine, in particular to nephrology, and can be used for differential diagnosis of calcium oxalate crystalluria, detected by ultrasound examination of the bladder in the form of echo suspension.

One of the main clinical manifestations of oxalate nephropathy that distinguishes it from other metabolic diseases of the kidneys is calcium oxalate crystalluria, which develops under conditions of increased crystallization of oxalic acid salts. Calcium oxalate crystals passing through the urinary tract can damage the epithelium and cause an inflammatory reaction (M.S. Ignatova Dysmetabolic nephropathy with calcium oxalate crystalluria / Nephrology: a guide for doctors. - M .: Medicine. - 2000. - P.354- 356).

Among the clinical manifestations of oxalate nephropathy in adult patients, in 63% of cases there is a clinic of chronic non-bacterial cystitis, which manifests itself as a dysuria syndrome, which is described by patients as a burning sensation during urination and an urge to urinate, frequent urination. Microhematuria, lymphocyturia, epithelial cells, crystals of calcium oxalate can be detected in urine sediment in patients (Voronina N.V. Dysmetabolic nephropathy with calcium oxalate crystalluria in adults: clinical, diagnostic, course and treatment issues // Abstract of thesis ... Dr. Medical Sciences. - Khabarovsk, 1996).

An ultrasound examination of the bladder in patients with oxalate nephropathy in the bladder cavity reveals an echo suspension, which can be associated either with an increased content of cellular elements or with aggregated crystals of oxalic acid salt - calcium oxalate (Kapustin S.V., Pimanov S.I. Ultrasound investigation bladder, ureters and kidneys.- Vitebsk: Belmedkniga, 1998.- P.23).

The solution of the question of the structure of the echo suspension in the bladder cavity in patients with dysuria during ultrasound examination is important for determining further tactics for examining the patient.

Diagnosis of the structure of echosuspension detected by ultrasound examination of the bladder in patients with dysuria syndrome includes several methods: laboratory and endoscopic.

Laboratory methods are based on a study of the general analysis of urine and a study of the morphological structure of the urine sediment to detect leukocyturia, calcium oxalate crystalluria, bacteriological to detect bacteriuria, immunological to detect bacterial antigens by polymerase chain reaction. However, these methods are time consuming.

The endoscopic method is based on cystoscopy, which allows you to detect chronic signs of inflammation of the bladder, to identify large crystals of salts or stones in the cavity of the bladder. The disadvantage of this method is invasiveness, conducting it in a urological office, limiting its use in men and children due to soreness and the possibility of trauma to the urethra after endoscopic procedures.

Another method used to examine patients with bladder pathology, X-ray cystography, allows you to identify gross changes in the structure or function of the bladder, but does not allow to differentiate the structure of the echo suspension.

The closest analogue - the prototype is an ultrasonic method in which an echo suspension can be detected at the bottom of the bladder in patients with metabolic disorders. The disadvantage of this method is the inability to differentiate the structure of echosuspension and its composition, which may consist of leukocytes, red blood cells, epithelium or aggregated salt crystals (Kapustin S.V., Pimanov S.I. Ultrasound examination of the bladder, ureters and kidneys. - Vitebsk: Belmedkniga, 1998 .-- p.23).

There are no methods to differentiate the structure of the echo suspension at the bottom of the bladder during ultrasound examination, including in patients with calcium oxalate nephropathy.

The objective of the invention is to provide a method for non-invasive diagnosis of calcium oxalate crystalluria by ultrasound examination of the bladder.

The technical result is the possibility of non-invasive differential diagnosis of calcium oxalate crystalluria during ultrasound examination of the bladder.

The technical result is achieved by the fact that before morning morning urination on an empty stomach at 8.00 an ultrasound examination of the bladder is performed, for example, on an ultrasound machine "Aloka-1700", operating in real time. If echosuspension is detected at the bottom or cavity of the bladder, after emptying the bladder, the patient immediately takes once inside 0.5 g of magnesium oxide, washed down with two glasses of water. The intake of magnesium oxide is fixed. After 2-3 hours, an ultrasound examination of the bladder is repeated and noted: echosuspension is maintained or not. If the echo suspension was caused by aggregated crystals of calcium oxalate, then under the influence of magnesium oxide the echo suspension will disappear. If the echo suspension is due to other salts or cellular elements, then the echo suspension will be determined again.

As you know, magnesium oxide changes the acidity of urine in the alkaline side, improves the solubility of calcium oxalate in urine, and prevents the formation of calcium oxalate stones. Even a single load of magnesium oxide can change the acidity of urine in the alkaline side and reduce the crystallization of these salts in the urine. Magnesium oxide does not affect the dissolution of uric acid and phosphate crystals (Rational pharmacotherapy in urology: a guide for doctors / N.A. Lopatkin et al., Under the general editorship of N.A. Lopatkin, T.S. Perepanova. - M. : Litterra, 2006 .-- P.392).

When developing the method, an ultrasound examination of the filled bladder was carried out as a control before and after loading with magnesium oxide in patients with urate nephropathy, characterized by the release of uric acid crystals and chronic nonspecific bacterial cystitis, in which a cloudy sediment at the bottom of the bladder can be detected. In control subjects, magnesium oxide intake did not change the nature of the echo suspension at the bottom of the bladder. As a control, test results were compared with urinary sediment in a laboratory study. Comparative data are shown in the table.

The advantage of this method: increasing the possibility of screening diagnostics of the development of calcium oxalate crystalluria in patients with oxalate nephropathy with dysuria syndrome, the availability of its implementation, non-invasiveness, which determines the possibility of its use in outpatient practice and allows you to assign adequate treatment.

Example 1

Patient V., 22 g. I was treated with dysuria syndrome. An ultrasound examination of the bladder at the bottom of the bladder reveals a coarse echo suspension and a finely dispersed echo suspension in the bladder cavity; aggregated crystals of calcium oxalate were determined in a urine sediment during a laboratory study. After carrying out a load of 0.5 g of magnesium oxide, the suspension is not determined, in the urine sediment there are no crystals of calcium oxalate. It was concluded that the echo suspension was represented by crystals of calcium oxalate. An additional examination of the patient revealed a change in the function and structure of the kidneys, made it possible to establish a diagnosis of oxalate nephropathy.

Example 2

Patient K., 27 years old, diagnosis: was treated with dysuria syndrome, periodically hematuria. An ultrasound examination of the bladder at the bottom of the bladder and in the cavity reveals a coarse echo suspension, in the general analysis of urine - aggregated crystals of calcium oxalate, a small amount of red blood cells - up to 15-20 in the field of view. After carrying out a load of 0.5 g of magnesium oxide, an echo suspension is not determined, in the urine sediment there are no crystals of calcium oxalate, red blood cells are preserved. It was concluded that the echo suspension was represented by crystals of calcium oxalate.

Example 3

Patient S., 38 years old. Handled with dysuria syndrome. Ultrasound examination of the bladder at its bottom determines a fine suspension, in the sediment of urine - a large number of crystals of uric acid. After carrying out the load with magnesium oxide, according to the ultrasound examination of the bladder, an echo suspension is preserved, uric acid crystals are preserved in the analysis of urine. Diagnosed with urate crystalluria. An additional examination made it possible to establish a diagnosis of urate nephropathy.

Example 4

Patient S., 38 years old. She was treated with chronic dysuria syndrome. An ultrasound examination of the bladder at its bottom determines a cloudy echosuspension, in the sediment of urine - a large number of leukocytes, epithelial cells, single red blood cells. After carrying out the load with magnesium oxide, an echosuspension is preserved according to the data of an ultrasound examination of the bladder, leukocytes, epithelial cells, single red blood cells are preserved in urine tests. The diagnosis of oxalate-calcium crystalluria is excluded. Given the changes in urine tests, a diagnosis of bacterial cystitis has been made.

Claims (1)

A method for differential diagnosis of oxalate-calcium crystalluria, including ultrasound examination of the bladder, characterized in that the patient before the morning urination on an empty stomach conduct an ultrasound examination of the bladder, and if echosuspension is detected after emptying the bladder, the patient takes 0.5 g of magnesium oxide inside with a single drink two glasses of water; after 2-3 hours, an ultrasound examination of the bladder is repeated, and if the echosuspension disappears, oxalate-calcium crystalluria is diagnosed.