Research On Metabolism Treatment Of Patients With Urinary Calculus

Objective:the purpose of the dissertation is to discuss the pathogeny of metabolic disorders in calcium oxalate stones, establish the correct stone disease diagnostic methods, and observe the effect of combined treatment to reduce calcium oxalate stones.Methods:the objective of the study is 115 patients with upper urinary tract calculi who undergo Surgical therapy in hospital from 2014 to 2016. Exam calcium ions, parathyroid hormone, serum creatinine, collected 24h urine, measure 24h urine volume, then shake the collected 24h urine. Take a little urine into the 0.22um microporous filter pore to filter. Diluted to the proportion 1:10 then put into DionexICS-90 ion chromatography. Measure the volume of 24h urinary citrate and oxalate through the appearance of peak time. Analyzing the composition of stone acquired by surgical treatment, and identify the patients’metabolic etiologies then make synthetic therapy according to the metabolic disorders including diet, hydration and drug treatment. Assessing metabolic statement and the upper urinary tract calculi once more, after the patient return to hospital after 3 months,6 months and 12 months respectively.Results:The group of 115 calcium oxalate stones (stone composition analysis results results,71 patients are calcium oxalate monohydrate, which accounts for 61.7% of all patients,44 patients with calcium oxalate monohydrate, occupying 38.3%in all patients.91 patients are in low urine volume (79.13%),88 patients with hyperoxaluria (76.52%).82 patients are in low urinary citrate (72.17%). The number of patients with 3 metabolic abnormalities is 87 (75.65%).The number of patients with 2 metabolic abnormalities is 18 (15.65%).The number of patients with three metabolic abnormalities is 10 (8.70%). Only 2 of them have no metabolic abnormalities (accounting for 1.74%). There are 4 cases of high calcium ions and PTH, while, parathyroid disease was not been found after the undergo further examination. The patients were asked to do regular follow-up which showed no abnormalities. Patients received synthetic therapy have more urinary output during 24h, with less urinary oxalate concentration, and more urinary citrate concentrations, the 24h urinary citrate increased as well, while the changement of 24h urinary oxalate has no sense of statistics. After 6 months, three patients have the crystal-like changes in kidney by ultrasound examination then disappear after synthetic therapy for one month. After 12 months, four patients have the crystal-like changes through ultrasound examination in kidney.1 case has suspected Microlithiasis then disappear after synthetic therapy for one month.Conclusions:1 Accurate diagnosis is necessary before the study of stone recurrence.2 Most of the calcium oxalate stones have a variety of metabolic abnormalities.3 The treatment of stone we taken, in terms of the different pathogenic factors, has yielded preliminary results to prevent recurred.