Coe Fredric L, Evan Andrew P, Lingeman James E, Worcester Elaine M
Renal Section MC5100, University of Chicago School of Medicine, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
Urol Res. 2010 Aug;38(4):239-47. doi: 10.1007/s00240-010-0296-z. Epub 2010 Jul 13.
Data concerning nine forms of human stone disease, along with observations on normal people give new insights into formation of interstitial apatite plaque and intra-tubular crystal deposits. In general, across multiple disease states, one can reproduce the same relationships between plaque abundance as is seen among patients within individual disease states, so that the link between plaque and high urine calcium excretion, and low urine volume and pH seems increasingly secure. From this, one can propose a specific model of plaque formation, susceptible to experimental test. In many diseases, formation of inner medullary collecting duct and Bellini duct deposits is compatible with simple crystallization driven by urine supersaturations; this is expected in that these segments contain tubule fluid quite close in composition to final urine. But in ileostomy, small bowel disease and obesity bypass patients, crystals found in deposits are not those expected: apatite and urates in deposits, despite formation of highly acidic urine. Also, this discrepancy suggests the possibility of divergence between bulk urine pH and pH of focal collecting ducts, a new kind of possibility that is susceptible to experimental test.
关于九种人类结石疾病的数据，以及对正常人的观察结果，为间质磷灰石斑块和肾小管内晶体沉积物的形成提供了新的见解。一般来说，在多种疾病状态下，可以重现与个体疾病状态患者中所见的斑块丰度之间相同的关系，因此斑块与高尿钙排泄、低尿量和pH值之间的联系似乎越来越可靠。据此，可以提出一个斑块形成的具体模型，易于进行实验验证。在许多疾病中，内髓集合管和乳头管沉积物的形成与尿液过饱和驱动的简单结晶相符；这是可以预期的，因为这些节段所含的小管液成分与最终尿液非常接近。但在回肠造口术、小肠疾病和肥胖旁路手术患者中，沉积物中发现的晶体并非预期的晶体：尽管形成了高度酸性的尿液，但沉积物中的磷灰石和尿酸盐却存在。此外，这种差异表明总体尿液pH值与局部集合管pH值之间可能存在差异，这是一种新的可能性，易于进行实验验证。
