OXALIC ACID METABOLISM DISORDERS IN PATIENTS WITH OXALATE NEPHROLITHIASIS AND WAYS OF CORRECTION

Urolithiasis is one of the most common pathologies of the urinary system and ranks second in the structure of urological diseases after urinary tract infections. In the analysis of the chemical composition of the concretions it is found that the majority (up to 70-80% of cases) of them contain salts of oxalic acid and calcium. Numerous metabolic disorders are caused by the release of lysosomal enzymes - ribonuclease, acidic and alkaline phosphatase. The aim of the study was to define the peculiari-ties of disorders of oxalic acid metabolism in patients with oxalate nephrolithiasis, to improve the methods of their correction and to develop effective schemes of metaphylactics of oxalate nephrolithiasis. Hypo- and hypervitaminosis A lead to mitochondrial damage, increased activity of enzymes that change in membrane permeability and violation of their torment polysaccharide component causing degenerative changes and intense desquamation of epithelial cell membranes adjustment, release oxalic acid in blood plasma, and consequently cause oxasaluria. 120 patients with oxalate nephrolithiasis aged 20 to 65 years were examined. The control group consisted of 25 healthy individuals who were representative to the patients in the main sample by age and gender. All patients after extracorporeal lithotripsy and spontaneous stone removal underwent complex traditional therapy according to the protocols of the Ministry of Health of Ukraine, with the addition of modern metaphylactic measures in the treatment of oxalate nephrolithiasis. Patients were prescribed herbal diuretics to stimulate diuresis (combined phytopreparation, 100 ml of solution containing: 100 ml of an aqueous extract (2: 1) obtained from a mixture of medicinal plants: horsetail of a field stalk (Equisetumarvense) 570 mg, bulb of a red plant (Spergulariar 330 mg, bald leaves (Peumusboldus) 280 mg, prickly pear (cactus) fig flower (Opuntiaficus-indica) 170 mg, narrow-leaved flower railway (Sideritisangusti-folia) 170 mg, rosemary pharmacy leaves (Rosmarinusofficinalis) 170 mg, palmchat (170) mg, pharmacy leaf lemon balm (MelissOfficiflis) 170 mg; extractant water. ). In patients with mixed stones (oxalate + urate) on the background of hyperoxaluria, hyperuricemia and hyperuricosuria was prescribed citrate mixtures (Blemaren, Uralite) according to the scheme with control of urine pH. Depending on the regimen, patients were divided into 3 groups. The concentration of glycolate in the urine of patients after complex treatment in group III amounted to 620,2 ± 49,2 μmol / l, practically reached the level of healthy. In groups I and II, the level of glycolate in urine was much lower and did not reach physiological norms, but there was a tendency to increase. The inclusion of the antioxidant agent - arginine and the complex of vitamins in therapy leads to a de-crease in the level of oxaluria to the upper limits of norm in group III of patients in urine 456,91 ± 37,70 to 319,81 ± 26,36 μmol / l and blood from 26,94 ± 1.52 to 22.46 ± 1.54 μmol / l (p <0.05). There was a decrease if calcium levels in blood and urine in patients of groups I and II, good results were achieved in group III patients due to the use of arginine antioxidant in combined therapy. As a result of the proposed metaphylactic tactics, an increase in the concentration of citrate in the urine and blood is achieved. The results of metaphylactic therapy for 3 years showed that the number of relapses of oxalate nephro-lithiasis was lowest in patients of group III (11.2%), compared to results of groups I and II where the recur-rence rates were 28.0% and 22.0%.