Alvarez Arroyo M V, Traba M L, Rapado A
Laboratorio de la Unidad Metabólica, Fundación Jiménez Díaz, Madrid, Spain.
Urol Int. 1992;48(3):342-6.
A small group of patients with nephrolithiasis who forms mixed (calcium oxalate and uric acid) calculi presents particular problems in their clinical management. In 3,158 stones analyzed in our laboratory, we found 158 mixed calculi in 86 of the patients. In this work, the clinical and biochemical results obtained from 27 patients with mixed stones were compared with those from 27 control patients with calcium oxalate renal lithiasis. A significant difference was found in oxalate and citrate urinary elimination (mean +/- SD) in mixed stone formers versus pure calcium oxalate stone formers: oxaluria (mg/24 h: 38 +/- 15 vs. 28 +/- 12; p less than 0.01) and citraturia (mg/24 h: 214 +/- 139 vs. 437 +/- 303; p less than 0.01). Citraturia was decreased in a high proportion (77%) in mixed stone formers, and only a reduced percentage of them (23%) presented normal values, although in the low limit of normality. As treatment and prophylactic measure, we proposed oral administration of citrates in mixed stone patients because citrate inhibits spontaneous nucleation of calcium salts and crystal growth, and it also increases the urinary pH with a consequent increase in uric acid solubility.
一小部分形成混合性（草酸钙和尿酸）结石的肾结石患者在临床管理中存在特殊问题。在我们实验室分析的3158颗结石中，我们在86名患者中发现了158颗混合性结石。在这项研究中，将27名混合性结石患者的临床和生化结果与27名草酸钙肾结石对照患者的结果进行了比较。发现混合性结石形成者与单纯草酸钙结石形成者的草酸和柠檬酸盐尿排泄（平均值±标准差）存在显著差异：草酸尿（毫克/24小时：38±15对28±12；p<0.01）和柠檬酸盐尿（毫克/24小时：214±139对437±303；p<0.01）。混合性结石形成者中柠檬酸盐尿减少的比例很高（77%），只有一小部分（23%）呈现正常数值，尽管处于正常范围的下限。作为治疗和预防措施，我们建议对混合性结石患者口服柠檬酸盐，因为柠檬酸盐可抑制钙盐的自发成核和晶体生长，还可提高尿液pH值，从而增加尿酸溶解度。
