Daudon M, Lacour B, Jungers P, Drüeke T, Reveillaud R J, Chevalier A, Bader C A
INSERM U 90, Départment de Néphrologie, Hôpital Necker, Paris, France.
J Urol. 1992 Apr;147(4):977-80. doi: 10.1016/s0022-5347(17)37438-4.
Renal stones from 30 chronic hemodialysis patients were subjected to morphological study by means of microscopic examination and to constitutional analysis with infrared spectrophotometry. In 29 patients calculi could be classified into 3 main types: 1) protein stones made of pure proteins or with a protein core and less than 30% calcium oxalate (9 cases, or 30%)--they were observed predominantly in patients with primary glomerular disease, 2) oxalo-protein stones with a core of calcium oxalate and a total stone content of more than 30% calcium oxalate (15 cases, or 50%)--they appeared to be related to metabolic factors, such as high urinary oxalate and low urinary citrate concentration, and to iatrogenic factors, namely vitamin D3 and calcium salt supplementation, and 3) aluminum-magnesium urate stones, probably induced by aluminum overload (6 cases, or 20%). Thus, our study indicates that a significant proportion (70%) of stones formed by hemodialysis patients may be due to metabolic and iatrogenic factors. Our data suggest that accurate analysis of such stones provides useful information on pathogenetic factors and consequently may give clues to their prophylaxis.
对30例慢性血液透析患者的肾结石进行了形态学研究，采用显微镜检查，并通过红外分光光度法进行成分分析。在29例患者中，结石可分为3种主要类型：1）纯蛋白质构成或有蛋白质核心且草酸钙含量低于30%的蛋白质结石（9例，占30%）——主要见于原发性肾小球疾病患者；2）以草酸钙为核心且结石总成分中草酸钙含量超过30%的草酸 - 蛋白质结石（15例，占50%）——似乎与代谢因素有关，如高尿草酸和低尿枸橼酸盐浓度，以及医源性因素，即补充维生素D3和钙盐；3）铝 - 镁尿酸盐结石，可能由铝过载引起（6例，占20%）。因此，我们的研究表明，血液透析患者形成的结石中有很大比例（70%）可能归因于代谢和医源性因素。我们的数据表明，对此类结石进行准确分析可提供有关致病因素的有用信息，从而可能为结石的预防提供线索。
