Evan Andrew P, Coe Fredric L, Connors Bret A, Handa Rajash K, Lingeman James E, Worcester Elaine M
Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana; International Kidney Stone Institute, Methodist Hospital, Indianapolis, Indiana; and.
Nephrology Section, University of Chicago, Chicago, Illinois.
Am J Physiol Renal Physiol. 2015 Apr 15;308(8):F938-49. doi: 10.1152/ajprenal.00655.2014. Epub 2015 Feb 4.
Human stone calcium phosphate (CaP) content correlates with higher urine CaP supersaturation (SS) and urine pH as well as with the number of shock wave lithotripsy (SWL) treatments. SWL does damage medullary collecting ducts and vasa recta, sites for urine pH regulation. We tested the hypothesis that SWL raises urine pH and therefore Cap SS, resulting in CaP nucleation and tubular plugging. The left kidney (T) of nine farm pigs was treated with SWL, and metabolic studies were performed using bilateral ureteral catheters for up to 70 days post-SWL. Some animals were given an NH4Cl load to sort out effects on urine pH of CD injury vs. increased HCO3 (-) delivery. Histopathological studies were performed at the end of the functional studies. The mean pH of the T kidneys exceeded that of the control (C) kidneys by 0.18 units in 14 experiments on 9 pigs. Increased HCO3 (-) delivery to CD is at least partly responsible for the pH difference because NH4Cl acidosis abolished it. The T kidneys excreted more Na, K, HCO3 (-), water, Ca, Mg, and Cl than C kidneys. A single nephron site that could produce losses of all of these is the thick ascending limb. Extensive injury was noted in medullary thick ascending limbs and collecting ducts. Linear bands showing nephron loss and fibrosis were found in the cortex and extended into the medulla. Thus SWL produces tubule cell injury easily observed histopathologically that leads to functional disturbances across a wide range of electrolyte metabolism including higher than control urine pH.
人体结石中的磷酸钙（CaP）含量与较高的尿CaP过饱和度（SS）、尿液pH值以及冲击波碎石术（SWL）治疗次数相关。SWL会损伤髓质集合管和直小血管，而这些部位是调节尿液pH值的场所。我们检验了这样一个假设：SWL会提高尿液pH值，进而提高CaP SS，导致CaP成核和肾小管堵塞。对9头农场猪的左肾（T）进行SWL治疗，并在SWL治疗后长达70天的时间里，使用双侧输尿管导管进行代谢研究。给一些动物给予氯化铵负荷，以区分集合管损伤与增加的HCO3 (-)输送对尿液pH值的影响。在功能研究结束时进行组织病理学研究。在对9头猪进行的14次实验中，T肾的平均pH值比对照（C）肾高出0.18个单位。向集合管增加HCO3 (-)输送至少部分是造成pH值差异的原因，因为氯化铵酸中毒消除了这种差异。T肾比C肾排泄更多的钠、钾、HCO3 (-)、水、钙、镁和氯。一个能导致所有这些物质流失的单个肾单位部位是髓袢升支粗段。在髓质髓袢升支粗段和集合管中发现了广泛的损伤。在皮质中发现了显示肾单位丢失和纤维化的线性带，并延伸至髓质。因此，SWL会产生易于通过组织病理学观察到的肾小管细胞损伤，这会导致包括高于对照尿液pH值在内的广泛电解质代谢功能紊乱。
