Kok D J
Department of Pediatric Urology, Erasmus University Hospital Rotterdam, The Netherlands.
World J Urol. 1997;15(4):219-28. doi: 10.1007/BF01367659.
Can urolithiasis start as an intratubular event? Under severe hyperoxaluric conditions in animal models at least crystal formation can. Recently models have been presented that assess the chances of crystal formation under more normal conditions. These models describe changes in fluid composition as this passes through the nephron, these conditions being simulated in in vitro experiments. It appears that under naturally occurring intratubular conditions calcium-salt crystallization takes place within the time tubular fluid normally spends in the nephron. Precipitation starts with a calcium-phosphate phase under conditions found in the thin lambs. This crystalline phase then (partly) dissolves when collecting duct conditions are used, thereby inducing formation of calcium oxalates. Under these conditions the latter increase in size by way of crystal growth and agglomeration. Large particle formation and cell adhesion can eventually result in particle retention and subsequent stone formation. Viewing urolithiasis as originally an intratubular event has consequences for in vitro experiments and treatments, which are discussed in this paper.
尿路结石会始于肾小管内的某种情况吗？在动物模型中，至少在严重高草酸尿症的情况下，晶体形成是可以的。最近已经提出了一些模型，用于评估在更正常的条件下晶体形成的可能性。这些模型描述了液体成分在通过肾单位时的变化，这些条件在体外实验中得到模拟。似乎在自然发生的肾小管内条件下，钙盐结晶在肾小管液正常在肾单位中停留的时间内发生。在薄段发现的条件下，沉淀从磷酸钙相开始。当使用集合管条件时，这个结晶相（部分）溶解，从而诱导草酸钙的形成。在这些条件下，后者通过晶体生长和聚集而增大尺寸。大颗粒形成和细胞粘附最终可能导致颗粒滞留和随后的结石形成。将尿路结石最初视为肾小管内事件对体外实验和治疗有影响，本文将对此进行讨论。
