S.I. Bilai, M.A. Dovbysh, O.M. Mishchenko, I.M. Dovbysh

The state of purine exchange in patients with uratic nephrolithiasis comorbide with metabolic syndrome

SUMMARY

Urolithiasis is one of the most common and frequent diseases in the world, developing most often in people of working age. In the development of urate nephrolithiasis (UN), an important role is played by a violation of purine metabolism in the form of hyperuricemia and hyperuricuria. Nowadays, hyperuricemia is often associated with metabolic syndrome (MS) and cardiovascular disease (68.8%). A direct correlation was established between the level of uric acid and the components of MS.

Objective: to study changes in purine metabolism in patients with comorbid urateurolithiasis with metabolic syndrome during complex therapy.

Object and research methods. The study involved 117 people. The indicators obtained from donors were taken as normal. All patients are divided into two groups: the main group, in which 79 people were diagnosed with urate nephrolithiasis (UN) comorbid with metabolic syndrome (MS). The control group included 38 patients in whom UN was detected. Patients in the control group were prescribed traditional therapy: the anticholinergic drug ribal, the non-steroidal anti-inflammatory drug dexalgin in therapeutic dosages, urolite U in granules depending on the pH of the urine (6,2-6,8), allopurinol.

Patients of the main group on UN comorbid with MS, depending on the nature of therapy, were divided into the 1st main subgroup (42 patients) and the 2nd main subgroup (37 people). Along with traditional therapy, patients of the 1st main subgroup were prescribed drugs that correct metabolic disorders depending on their presence and severity: lipid-lowering and antidiabetic drugs, allopurinol, liprazide. In the 2nd main subgroup, patients with UN comorbid with MS were prescribed traditional therapy: the anticholinergic drug riabal, the non-steroidal anti-inflammatory drug dexalgin in therapeutic dosages, urolite U in granules depending on the pH of the urine (6,2-6,8), allopurinol.

All patients underwent general clinical tests of blood and urine, urine according to Nechiporenko, bacteriological examination of urine, uric acid in the blood and daily urine, creatinine, urea, bilirubin, blood electrolytes, glomerular filtration rate, overview and intravenous urography, urinary tract ultrasound, kidney dopplerography, radioisotope renography. The study of indicators was carried out before treatment, after 7 and 14 days, after 1,5-2 months and after 3-6 months. The diagnosis of MS was based on the detection of central obesity type in patients with UN and additional criteria that indicate the presence of MS (hyperglycemia, arterial hypertension, dyslipidemia).

The results of the study showed that in patients with UN the state of uric acid (UA) metabolism, as a stone-forming substance in the blood and urine, and the functional ability of the kidneys were significantly worsened compared to normal. When UN was associated with the signs of MS, these indicators were significantly worse in comparison with the norm and in comparison with patients with UN, which indicated a pathogenetic relationship between purine metabolism disorders and MS manifestations.

In patients with UN in the control group, the level of uric acid in the blood and urine significantly increased before treatment compared with the group of healthy individuals. However, the level of uric acid in the blood of patients of the main group was significantly higher than in patients with UN. Nitrogen-excretory function in patients of the control group at the beginning of treatment was significantly reduced, as evidenced by an increase in the level of urea, creatinine in the blood and a decrease in glomerular filtration rate relative to normal and more than in patients with UN comorbid with MS.

In patients of the 1st main subgroup, a decrease in uric acid in urine was observed on day 7 in comparison with the previous term. On day 14, the level of uric acid in the blood significantly decreased and after 1,5-2 months in the blood and urine was significantly less than with the traditional treatment of patients of the 2nd subgroup. At the end of the observation, after 3-6 months, a significant decrease in the level of uric acid in the blood remained relative to the values of the previous terms and relative to the indicator of the 2nd subgroup. In urine, this indicator was significantly lower than in the 2nd main subgroup with conventional therapy and relative to the norm.

The blood urea level in patients of the 1st main subgroup at the beginning of treatment was significantly higher than normal values and did not differ from the indicator of patients of the 2nd main subgroup. Starting from day 7, the urea level significantly decreased and after 14 days until the end of the observation it did not differ from the norm and was less than in patients of the 2nd main subgroup with conventional therapy.

Blood creatinine on the 7th day of the study in patients of the 1st main subgroup with UN comorbid with MS significantly exceeded the value of the 2nd subgroup with conventional therapy. After 1,5-2 months and until the end of the observation, the creatinine level in the 1st main subgroup decreased and was less than in patients of the 2nd subgroup.

The glomerular filtration rate after 7 and 14 days remained almost unchanged in patients of both groups. After 1,5-2 months, the level of this indicator in patients of the 1st subgroup increased and after 3-6 months significantly exceeded it in patients of the 2nd main subgroup.

Thus, the violation of uric acid in blood and urine and the level of creatinine, blood urea, glomerular filtration rate in patients with UN comorbid with MS of the 1st main subgroup improved with the use of drugs that correct the manifestations of the components of MS, in contrast to treatment only with traditional means.

Conclusions.

1. In patients with urateurolithiasis comorbid with metabolic syndrome, the level of uric acid in the blood and urine before treatment is significantly higher than in patients with urate nephrolithiasis and is normally and pathogenetically related to the components of the metabolic syndrome.

2. With urateurolithiasis comorbid with metabolic syndrome, the functional state of the kidneys according to the level of blood creatinine and blood urea and glomerular filtration rate is significantly worse than in patients with urate nephrolithiasis.

3. In patients with comorbid UN with MS, due to agents that correct metabolic disorders, after 3-6 months there was an improvement in purine metabolism and kidney function, which is explained by a significant decrease in the level of UA in blood and urine, the level of urea and blood creatinine and an increase in glomerular filtration rate compared to conventional therapy.