Влияние остеопороза и факторов его возникновения на профилактику рецидива мочекаменной болезни

Abstract

The aim of postoperative examination, treatment and follow-up of patients with urinary stone disease is a prevention of recurrence. A choice of method of prevention is based on the results of postoperative examination with consideration of etiological factors of urinary stone disease. An analysis of influence of osteoporosis and its causative factors on the recurrence of urinary stone disease is presented in the article. to clarify the influence of osteoporosis and its causative factors on excretion of calcium, uric acid and recurrence of urinary stone disease. A total of 86 patients after surgical treatment of urinary stone disease were included in the study. A physicochemical analysis of stones and their fragments, excretion of calcium and uric acid were done postoperatively. The risk factors for osteoporosis were identified using specific questionnaire. Bone mineral density (BMD) was assessed by X-ray densitometry. After X-ray phasic analysis of the stones and studying of the daily excretion of calcium and uric acid, 10 and 7 patients were prescribed to thiazide diuretics and allopurinol, respectively. In 69 patients (80.2%) there were no indications to the treatment and all of them were included in control surveillance group. Calcium oxalate stones were predominated in patients who were under surveillance (=0,0254). A prevalence of risk factors for osteoporosis was similar in all groups (=0,2156), as well as rate of decrease in BMD (=0,64). In patients taking thiazide diuretics, a significant decrease in daily calcium excretion was found (=0,0054) without significant changes in excretion of uric acid and diuresis volume. Among patients receiving allopurinol there was a significant decrease in daily uric acid excretion (=0,021), without significant changes in excretion of calcium and diuresis volume. There were no significant changes of these values in the control group. A recurrence of urinary stone disease in treatment group was detected in 4 patients with a decrease of BMD after 381+/-61 days, while in control group there were 5 recurrences in patients with decreased BMD and I recurrence in patient with normal BMD after 836+/-64 days. Treatment aimed at prevention of recurrence of urinary stone disease allows to correct detected metabolic disturbances. However, such factor as the decrease in BMD can influence on the rate and frequency of recurrence of urinary stone disease. A clarifying of risk factors for osteoporosis and diagnosis of osteoporosis allow to give reliable recommendations for its treatment and to decrease risk of recurrence of urinary stone disease.