Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA.
Curr Opin Nephrol Hypertens. 2023 Sep 1;32(5):490-495. doi: 10.1097/MNH.0000000000000903. Epub 2023 Jul 21.
Kidney stone disease is caused by supersaturation of urine with certain metabolites and minerals. The urine composition of stone formers has been measured to prevent stone recurrence, specifically calcium, uric acid, oxalate, ammonia, citrate. However, these minerals and metabolites have proven to be unreliable in predicting stone recurrence. Metabolomics using high throughput technologies in well defined patient cohorts can identify metabolites that may provide insight into the pathogenesis of stones as well as offer possibilities in therapeutics.
Techniques including 1H-NMR, and liquid chromatography paired with tandem mass spectroscopy have identified multiple possible metabolites involved in stone formation. Compared to formers of calcium oxalate stones, healthy controls had higher levels of hippuric acid as well as metabolites involved in caffeine metabolism. Both the gut and urine microbiome may contribute to the altered metabolome of stone formers.
Although metabolomics has offered several potential metabolites that may be protective against or promote stone formation, the mechanisms behind these metabolomic profiles and their clinical significance requires further investigation.
肾结石病是由尿液中某些代谢物和矿物质过饱和引起的。为了预防结石复发，已经测量了结石形成者的尿液成分，特别是钙、尿酸、草酸盐、氨和柠檬酸盐。然而，这些矿物质和代谢物已被证明无法可靠地预测结石复发。在明确的患者队列中使用高通量技术进行代谢组学研究可以识别出可能有助于了解结石发病机制的代谢物，并为治疗提供可能性。
包括 1H-NMR 和液相色谱与串联质谱在内的技术已经鉴定出多种可能参与结石形成的代谢物。与草酸钙结石形成者相比，健康对照组的 hippuric 酸水平以及与咖啡因代谢有关的代谢物水平更高。肠道和尿液微生物组都可能导致结石形成者的代谢组发生改变。
尽管代谢组学已经提供了几种可能具有预防或促进结石形成作用的潜在代谢物，但这些代谢组图谱背后的机制及其临床意义仍需要进一步研究。
