COMBINED TREATMENT FOR DENDRITIC NEPHROLITHIASIS. CLINICAL CASE

We present a case of successful combined treatment for dendritic stone (K-IY according to classification of Scientific Research Institute of Urology) in the left kidney of a patient with comorbid pathology (diabetes mellitus II type, CHI risk I, lumbar osteochondrosis). Feature of this case is that during operative transcutaneous endoscopic intervention we removed ≈80% of an easily available pelvic part of a stone, and to avoid excessive trauma of parenchymatous tissue for the purpose of the maximum preservation of renal function, we left intact hard to reach calyceal fragments of a concrement. Considering data of рН metric 3-day monitoring which revealed constantly sharp sour reaction of urine (<5.8–6.0), within the 5-month postoperative follow-up, the patient accepted health supplement ‘OMS-citrate’ according to the administered scheme which provides implementation of the maximum scope рН urine and individual dosage selection depending on the personified extent of metabolism disorder.

The offered approach in citrate ‘mixtures’ administration deprives of a possibility for salts settling out, interfaced to the corresponding enzymes, as there are no conditions for incrustation of an external layer of a stone, as with a normal amplitude рН urine from 5.0 to 8.0 (>0 U), activity of all enzymes are reduced as their activation requires long (10–15 day) stay of рН urine in narrow limits (<0.8–1.2 units an isoaciduria). Citrate therapy in the setting of the stent of internal drainage, had been carried out, within 4 months the remained stone fragments completely released all renal collecting system, and on the stent after its extraction in 5 months there were no signs of salt incrustation. X-ray-radiological examinations in 1.5 years after the operation showed no signs of lithiasis recurrence, at the same time function of kidneys did not worsen (remained), and the urodynamics was restored. Besides, on the background of the carried-out treatment fornephrolithiasis, positive dynamics of the accompanying comorbid pathology (diabetes and atherosclerotic disease) was observed.

1. Urology: National Guidelines. М., GEOTAR-Media, 2009. 1024 p. (In Russ.).

2. Tatevosyan A.S. Etiological and pathogenetic bases of nephrolithiasis. Sovetskaya Kuban. 1997. 150 p. (In Russ.).

3. Golovanov S.A, Sivkov A.V., Prosyannikov M.Y. Urine acidity, metabolic risk factors and urolith formation. XYIII congress of Russian Urologic Society, Ekaterinburg, 2018. 113-114. (In Russ.).

4. Alyaev Y.G., Kuzmicheva G.M., Rudenko V.I. Modern aspects of citrate therapy in patients with urolithiasis. Medical caste. 2004;4:20-24. (In Russ.).

5. Glibochko P.V., Alyaev Y.G., Rapoport L.M. Modern conservative (citrate) therapy for urate calculus in ureters. Urology. 2014;5:10-18. (In Russ.).

6. Saenko V.S., Gazimiev M.A., Pesegov S.V., Alyaev Y.G. Metaphylaxis of urolithiasis. Part I. Growth factors of urolithiasis incidence. Modern view on lithiasis mechanism. Urology. 2018;4:161-169. (In Russ.).

7. Alexeenko S.N., Tatevosyan A.S., Kazarov R.G. Main alkalizing composition for aligning of acidalkaline balance in human organism, potentiation of energetic metabolism and antioxidant system. Patent of invention № 2676714. Registered in State Registry RF 10.01.2019 (In Russ.).

8. Kolpakov I.S. Conservative treatment for urolithiasis. M., MIA. 2009.148 p. (In Russ.).

9. Kolpakov I.S. Urolithiasis. Moscow, Academy. 2006. 222 p. (In Russ.).

10. Kadirov Z.A., Istrativ V.G., Suleimanov S.I. Urolithiasis. M., Binom. 2013. 184p. (In Russ.).

11. Alexeenko S.N., Medvedev V.L. Tatevosyan A.S. How to estimate severity of uric urolithiasis. Patent of invention №2517221. Registered in State Registry RF 2014. (In Russ.).

12. Prosyannikov M.Y., Anokhin N.V., Golovanov S.A. Urolithiasis and cardiovascular diseases: statistic link only or pathogenetic mechanisms community. Experimental and clinical urology. 2018;3:34-41. (In Russ.).

13. Tatevosyan A.S. Conservative treatment for urolithiasis and recurrence prevention. Patent of invention №2253366. Registered in State Registry RF 2005 (In Russ.).