| Chapter 1 The analysis of the results of 1694 adult and 74 children patients'result of upper urinary stone ananlysisObjective Upper urinary stone is popular disease in Urology. But the studies of stone composition,rate and the difference between sex and age are very few, moreover there is not datas of children. The different composition of stone yields the underlying reasones of stone formation. The stone composition,rate and the difference between sex and age were computed with the datas of patients with upper urinary stone.To get data of the stone composition, rate,difference between different group and to evaluate the underlying reasions of stone formation. To offer objective datas for reinforcing the examination,treatment of the related patients and study of prophylaxis.Methods The datas of 1694 adult and 74 children patients in hospital were collected between May 2007 and August 2009.The classification and rate were computed according to the composition of stone.And compared the rate of different classification between sex and age. The method of stone analysis were chemical analysis and near infrared spectrum.Results The male is more than female both in adult and children. The rate of pure calcium oxalate stone,pure cystine stone, pure urate stone, infection stone, the mixed cystine and calcium stone, mixed infection and calcium stone, mixed calcium oxalate and calcium phosphate, other calcium without infection stone was 0.4%(7), 0.1%(2),0.6%(11),9.4%(160),0.2%(3),12.2%(206),58.6%(993),18.4%(312)in 1694 adult patients respectively. The rate of containing infection composition stone,containing cystine composition and containing calcium was 21.6%(366/1694), 0.3%(5/1694),89.9%(1521/1694)by summation.The rate of pure calcium oxalate stone,pure cystine stone, pure urate stone, infection stone, the mixed cystine and calcium stone, mixed infection and calcium stone, mixed calcium oxalate and calcium phosphate, other calcium without infection stone was 0.4%(4),0.2%(2),0.5%(5),7.1%(70),0.3%(3),8.9%(88),63.7%(631), 19.0%(188)in 991 male patients respectively.The rate of pure calcium oxalate stone, pure urate stone, infection stone, mixed infection and calcium stone, mixed calcium oxalate and calcium phosphate, other calcium without infection stone was 0.4%(3),0.9%(6),12.8%(90),16.8%(118), 1.5%(362)and 17.6%(124).The rate of stone containing infection composition was 15.9%(158/991)in male and 29.6%(208/703)in female.There was marked different between them by chi square test(χ2=45.201, P<0.001).The rate of mixed calcium oxalate and calcium phosphate stone was 63.7%(631/991)in male and 51.5%(362/703)in female.There was marked different between them by chi square test(χ2=25.150, P<0.001).The rate of pure calcium oxalate stone,pure cystine stone, infection stone, the mixed cystine and calcium stone, mixed infection and calcium stone, mixed calcium oxalate and calcium phosphate, other calcium without infection stone was 2.7%(2), 8.1%(6),4.1%(3),14.9%(11),2.7%(2),29.7%(22),37.8%(28)in 74 children respectively. The rate of containing infection composition stone,containing cystine composition and containing calcium was 6.8%(5/74),23%(17/74),87.8%(65/74)by summation.The rate of pure calcium oxalate stone,pure cystine stone, infection stone, the mixed cystine and calcium stone, mixed infection and calcium stone, mixed calcium oxalate and calcium phosphate, other calcium without infection stone was 1.9%(1), 3.8%(2),3.8%(2),17.3%(9),1.9%(1),32.7%(17),38.5%(20)in 52 male children respectively.The rate of pure calcium oxalate stone,pure cystine stone, infection stone, the mixed cystine and calcium stone, mixed infection and calcium stone, mixed calcium oxalate and calcium phosphate, other calcium without infection stone was 4.5%(1), 18.2%(4),4.5%(1),9.1%(2),4.5%(1),22.7%(5),36.4%(8).The rate of stone containing cystine composition was 23%(17/74) in children and 0.3%(5/1694) in adult(χ2=296.731, P<0.001).There was marked different between them by chi square test.The rate of stone containing infection composition was 6.8%(5/74) in children and 21.6%(366/1694)in adult(χ2=9.429, P=0.002<0.01).There was different between them by chi square test.The rate of mixed calcium oxalate and calcium phosphate stone was 29.7%(22) in children and 51.5%(362/703) in adult(χ2=24.201, P<0.001).There was marked different between them by chi square test.Conclusions The The males is more than females of upper urinary lithiasis. The stone containing calcium composition was the most popular type of stone and the rate of mixed calcium oxalate and calcium phosphate stone was the highest of them. The rate of stone containing infectiong composition was second high and contain cystine composition was low. The rate of stone containing infectiong composition in female was higher than male adults and the rate of mixed calcium oxalate and calcium phosphate stone was lower.Infer that the metabolism abnormality related with stone formation influenced most adults and especially for male.Also infer that urinary infection was a reason for the stone formation and especially for female. The most popular type of stone in children was containing calcium compostion, and the second was containing cystine.Compared with adult,the rate of stone containing cystine compostion in children was higer,the rate of mixed calcium oxalate and calcium phosphate stone and containing infection compositon was lower. Infer, the metabolis abnormality also play an important role the stone formation in children,and hereditary factor was more dangerous factor of stone formation for children than adults.Chapter 2 The application and the meaning of the examination of metabolism abnormality related with stone formation for patients with complicated renal stone of mixed calcium oxalate and calcium phosphateObjective Most renal stones are composed of mixed calcium oxalate and calcium phosphate. It is relatively diffcult of treating and preventing recurrence of the patients with complicated this type of stone. The study of the formation reason for this stone is few in domestic. Through 24-hour urine analysis and the examination of distal renal tubular acidosis, to evaluate whether the patient combined the metabolism abnormality related with this stone formation and to evaluate the reasons this stone formation is the main purpose of this study. And then get the datas for more perfect strategy of preventing the recurrence of the the stone.Methods From January 2008 to June 2009,184 patients with complicated renal stone of mixed calcium oxalate and calcium phosphate accepted recheck. The items of recheck including imperative ones:the analysis and instant pH of second sanguinis sample, the renal function evaluation, the detection of blood biochemical indicator, arterial blood gas analysis,24-hour urine analysis and the optional ones:the burden test of Ammonium Chloride or Calcium Chloride and detection of blood PTH.Results The rate of hypercalcinuria, hypomagnesiuria, high phosphorus urine,hyperuricosuria, hypocitraturia,hyperoxaluria and low urine volume was 10.3%(19),27.2%(50),11.4%(21),11.4%(21),83.7%(154),20.7%(38) and 11.4%(21) respectively in 184 patients thrugh 24-huor analysis.The rate of hypercalcinuria, hypomagnesiuria, high phosphorus urine, hyperuricosuria, hypocitraturia hyperoxaluria and low urine volume was 3.9%(4), 33%(34),10.7%(11),12.6%(13),83.5%(86),22.3%(23) and 11.7%(12)respectively in 103 malesThe rate of hypercalcinuria, hypomagnesiuria, high phosphorus urine, hyperuricosuria, hypocitraturia and low urine volume was 18.5%(15),19.8%(16), 12.3%(10),25.9%(21),84%(68),18.5%(15) and 11.1%(9)respectively in 81 females.The rate of hypocitraturia and hyperoxaluria is similar of males and females by the chi square test (χ2=0.007, P=0.934>0.05;χ2=0.402, P=0.526>0.05), but the rate of hypercalcinuria is different by the chi square test (χ2=10.488, P=0.001< 0.01).The rate of dRTA was 20.1%(37/184),3.3%(6/184) was suffering overt dRTA and 3.3%(6/184) was incomplete dRTA by the burden test of Ammonium Chloride. 97.3%(36/37) appeared hypocitraturia of the patients with dRTA.Conclusions The metabolism abnormality related with this stone formation played a important role of the renal stone formation of complicate mixed calcium oxalate and calcium phosphate. The rate of hypocitraturia was 80% highly and the rate of hyperoxaluria, hypomagnesiuria,hyperuricosuria was around 20% respectively. Hypercalcinuria made a little contribution. dRTA(especiallly of idRTA) may influence 20% patients and it is also the reason of hypocitraturia.10% of the patients intake fluid not enough. The rate of hypocitraturia and hyperoxaluria was similar between male and female. The rate of hypercalcinuria of female is higher than male but the reason is unkown. It is useful for detecting the hypocitraturia, dRTA and other metabolism abnormality though examination of metabolism.And then help to prevent the recurrence of the stone by the in time measure.Chapter 3 The application and the meaning of the examination of metabolism abnormality related with stone formation for cured patients with infection renal stonesObjective Infection renal stones is the more popular in the urology. It is confirmed that the urinary infection is the important role of the stone formation. The combined metabolism abnormality of these stone formation was paid close attention recently. Through 24-hour urine analysis and the examination of distal renal tubular acidosis, to evaluate whether the patient combined the metabolism abnormality related with infection renal stone formation and to estimate it's role of these stone formation is the main purpose of this study. And then get the datas for more perfect strategy of preventing the recurrence of the the stone.Methods From January 2008 to June 2009,53 patients with renal infection stones accepted recheck. The items of recheck including imperative ones:the analysis and instant pH of second sanguinis sample, the renal function evaluation, the detection of blood biochemical indicator, arterial blood gas analysis,24-hour urine analysis and the optional ones:the burden test of Ammonium Chloride or Calcium Chloride and detection of blood PTH.Results The rate of hypercalcinuria, hypomagnesiuria, high phosphorus urine,hyperuricosuria, hypocitraturia,hyperoxaluria was 13.2%(7),24.5%(13), 18.9%(10),17%(9),83%(44) and 24.5%(13) respectively with 53 patients thrugh 24-huor analysis. There was not low urine volume patients. The rate of dRTA was 28.3%(15/53),4 patients was suffering fromeovert dRTA and 11 were suffering from incomplete dRTAConclusions The ones of cured renal infection stones combined relative high metabolism abnormality without the influence of urinary infection. The main abnormalities were hypocitraturia, hyperoxaluria and distal renal tubular acidosis,especially is the insidious idRTA. Metabolism abnormality plays an important role of renal infection stones formation. Besides urinary system infection, it is infered that the metabolism abnormality is related with the stone formation and recurrence. Cue us to better the strategy of preventing the recurrence of the infection stone. For the cured patient, treating the metabolism abnormality should become the main content of preventing the recurrence of stone and different from controlling urinary infection as main content of patients with residual stone. Chapter 4 The application and the meaning of the examination of metabolism abnormality related with stone formation for patients with medullary sponge kidneyObjective Medullary sponge kidney(MSK)is regarded as a inborn disease.The anatomical developing abnormality of the collecting duct is looked as the main reason of renal calculi and renal calcification for a long time. The combined abnormality of tubule functional and metabolism of MSK was paid close attention recently. Through 24-hour urine analysis and the examination of distal renal tubular acidosis, to evaluate whether the patient combined the metabolism abnormality relate with stone formation and to estimate it's role of stone formation. And then get the datas for more perfect strategy of treatment and prevention of the second renal calculi.Methods From June 2008 to June 2009,13 patients with MSK accepted recheck. The items of recheck including the analysis and instant pH of second sanguinis sample, the renal function evaluation, the detection of blood biochemical indicator, arterial blood gas analysis,24-hour urine analysis, the burden test of Ammonium Chloride or Calcium Chloride and so on.Results The rate of hypercalcinuria, hypomagnesiuria, high phosphorus urine,hyperuricosuria, hypocitraturia,hyperoxaluria was 23.1%(3),30.8%(4), 7.7%(1),7.7%(1),61.5%(8) and 30.8%(4) relatively with 13 patients thrugh 24-huor analysis. There was not low urine volume patients. The rate of dRTA was 46.2%(6/13),3 patient was suffering overt dRTA and 3 were incomplete dRTA.The 6 patients with dRTA were all combined hypocitraturiaConclusions The patients with medullary sponge kidney combine relative high rate of dRTA, hypocitraturia, hypomagnesiuria and hypercalcinuria. Estimate they are related with the formation of second of the patients of MSK, especially of dRTA,it is maybe related with the pathological changes of renal tubules and collecting ducts. The 24-hour urine analysis and the examination of dRTA should be taken as conventional items for MSK especially of children.it is useful for detecting the metabolic abnormality, then help to decrease and/or prevent the formation of renal calculi and renal calcification by in time measures. |
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