The Risk of the Development and Relationship of Kidney Stone Disease and Osteoporosis (Literature review)

Abstract

Urinary stone disease (USD) is a common pathology with the formation of calculi in the kidneys, ureter, and bladder. Besides the family history, hyperparathyroidism, hypo- and hypervitaminosis of vitamin D, hypercalciuria, and hyperoxaluria are the high risk factors for USD development. This is due primarily to the activation of bone resorption with increased hypercalciuria. It is known that in the urine of every person there is a small amount of urea, inorganic salts, uric acid, creatinine and other substances. The main reason for the formation of calculi is a certain metabolic disorder, which leads to the formation of insoluble salts from which stones are formed – urates, phosphates, oxalates, etc. One of the unsolved problems in the metaphylaxis of USD is the treatment and prevention of osteoporosis which is comorbid with it, since calcium and vitamin D preparations are widely used for the prevention and treatment of osteoporosis. Osteoporosis and arterial calcification often coincide in the nature of the manifestation, which indicates an imbalance in the redistribution of calcium with a predominant direction in the vascular the wall. Vitamin K2 deficiency is closely related to the process of vascular calcification. In the cardiovascular system, with the use of vitamin K antagonists or vitamin K deficiency, calcification of the endothelium of blood vessels occurs. The effect of osteocalcin protein on stone formation processes is controversial. For example, some researchers have found that high serum level of Glaprotein is associated with a lower risk of kidney stones. Based on the results of a daily urinalysis study, the EAU Guidelines (2022) updated the recommendations on metaphylactic USD regarding the benefit/harm of additional calcium and vitamin D use in patients with nephrolithiasis depending on the type of crystalluria. The absence of recommendations for the management of patients with combined pathologies (USD, osteoporosis, cardiovascular diseases) prompts a comprehensive assessment of common risk factors, as well as the formation of programs and algorithms for early diagnosis and the development of recommendations for the prevention and avoidance of complications. Based on the literature analysis, it was established that today the issue of choosing the optimal management for diagnosis and treatment of USD and osteoporosis is still very controversial and ambiguous. There is a necessity for detailed study of this problem, the development of a complex differentiated approach to diagnosis and treatment of patients.