Sikora Przemysław, Bieniaś Beata, Majewski Marek, Borzecka Halina, Wawrzyszuk Mirosława, Zajaczkowska Małgorzata
Klinika Nefrologii Dzieciecej, Akademii Medycznej im Feliksa Skubiszewskiego w Lublinie.
Przegl Lek. 2006;63 Suppl 3:134-6.
Citrate is thought to be one of the most important inhibitor of calcium salts crystallization in the urine. Therefore, an assessment of urinary citrate excretion is an integral element of metabolic evaluation in urolithiasis. The reported incidence of urolithiasis associated with hypocitraturia varies from 10% to 63%. The purpose of the study was to assess urinary citrate excretion in children with calcium urolithiasis living in region of Lublin. The study comprised 60 children (34 boys and 26 girls) aged 4.3-18 years. In 36 of them, calcium oxalate urolithiasis was diagnosed by spectrophotometry. In the remaining children, an assessment of stone composition was impossible. However, in all children, stones were radiopaque. Hypercalciuria (HC) and mild hyperoxaluria (HOx) were diagnosed in 23 and 16 children, respectively. In the remaining 21 children urolihiasis was classified as idiopathic. The controls were 35 healthy age- and gender-matched children. Urinary citrate excretions were assessed by enzymatic method in 24-hour urine specimens and expressed as citrate/creatinine ratios (Cit/Cr). Decreased Cit/Cr were observed in 9 (15%) children with calcium urolithiasis. However, there was no significant difference between the mean Cit/ Cr in children with calcium urolithiasis and controls (410 +/- 207 mg/g vs 385 +/- 144 mg/g). There was also no significant difference between the mean Cit/ Cr in children with HC and controls. Similarly, the mean Cit/Cr did not differ significantly between children with HOx and controls. However, the lowest mean Cit/Cr was revealed in children with HOx (306 +/- 161 mg/g).
In most children with calcium urolithiasis urinary citrate excretion was normal. However, in some children with urolithiasis, detection of hypocitraturia allows to explain pathogenesis of stone formation and to carry on a causative prophylaxis.
柠檬酸盐被认为是尿液中钙盐结晶最重要的抑制剂之一。因此，评估尿柠檬酸盐排泄是尿路结石代谢评估的一个重要组成部分。报道的与低枸橼酸盐尿症相关的尿路结石发病率在10%至63%之间。本研究的目的是评估居住在卢布林地区的儿童钙结石患者的尿柠檬酸盐排泄情况。该研究包括60名年龄在4.3 - 18岁的儿童（34名男孩和26名女孩）。其中36名通过分光光度法诊断为草酸钙结石。其余儿童无法评估结石成分。然而，所有儿童的结石在X线下均显影。分别在23名和16名儿童中诊断出高钙尿症（HC）和轻度高草酸尿症（HOx）。其余21名儿童的尿路结石被归类为特发性。对照组为35名年龄和性别匹配的健康儿童。通过酶法对24小时尿液标本中的尿柠檬酸盐排泄进行评估，并以柠檬酸盐/肌酐比值（Cit/Cr）表示。9名（15%）钙结石儿童的Cit/Cr降低。然而，钙结石儿童与对照组的平均Cit/Cr之间无显著差异（410±207mg/g对385±144mg/g）。HC儿童与对照组的平均Cit/Cr之间也无显著差异。同样，HOx儿童与对照组的平均Cit/Cr也无显著差异。然而，HOx儿童的平均Cit/Cr最低（306±161mg/g）。
大多数儿童钙结石患者的尿柠檬酸盐排泄正常。然而，在一些尿路结石儿童中，检测到低枸橼酸盐尿症有助于解释结石形成的发病机制并进行病因预防。
