The calculi formation prophylaxis in recurrent bilateral nephrolithiasis
THE AIM. To evaluate the interrelation between recurrent calculi formation in patients with bilateral nephrolithiasis and the dysfunction in homeostasis system for the pathogenetic correction by fibrinolysis activators and citrate mixtures. PATIENTS AND METHODS. In this study 436 patients with various clinical forms of nephrolithiasis, depending on clinical course, out of whom 110 (25,5%) had one sided renal calculi, 56 (12,8%) were treated regarding urether calculi, 270 (62,0%) had bilateral recurrent renal and urether calculi. The mean age of the patients with nephrolithiasis was 48,6 ± 1,3, in the case of bilateral calculi the mean age of women radically differed from that of men, and if the men's the mean age was 55,7 ± 2,7, women's it was 46,1± 2,2. All patents had clinical and special investigations, which let us evaluate the state of hemocoagulation, blood (BFA) and urine (UFA) fibrolitic activity. RESULTS. The conducted study states that hemocoagulation data shows a pronounced increase of the blood coagulating activity in patients with recurrent bilateral nephrolithiasis in comparison with the groups with solitary, firstly revealed concretions of the urinary tract. The more apparent depression of fibrinolysis was noted in the postoperative period. The study of UFA after the operation showed the acute decrease of this index on the 3, 7 and 14 day. For the prophylaxis of the calculi recurrence was used a method, based on the use of citrate mixtures and fibrinolisis activators, which help the lysis of the fibrin in the urinary tract. The results of the BFA investigation in patients receiving the citrates and nicotinic acid showed the increase in its levels by the end of first week after the operation. CONCLUSION. The depression of BFA and UFA during nephrolithiasis pose hazard to the recurrence of the renal concretions. Left in the pelvis and calyx of the kidney the fibrin clots condense and adsorb on their surface the salt crystals, which become a nucleus of recurring concretions. In an effort of metaprophylaxis of recurring nephrolithiasis indicated the means and remedies which increase fibrinolitic behavior of urine and blood.