nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2011-15-3-11-17nefr-491Research ArticleПЕРЕДОВАЯ СТАТЬЯLEADING ARTICLEРОЛЬ ЛОКАЛЬНЫХ ИНФЕКЦИЙ В ГЕНЕЗЕ МОЧЕКАМЕННОЙ БОЛЕЗНИROLE OF LOCAL INFECTIONS IN DEVELOPMENT OF UROLITHIASISЧУХЛОВИНА. Б.CHUKHLOVINA. B.

Кафедра клинической лабораторной диагностики с курсом молекулярной медицины

ЭМАНУЭЛЬЮ. В.EMANUELYu. V.

Кафедра клинической лабораторной диагностики с курсом молекулярной медицины

НАПАЛКОВАО. В.NAPALKOVAO. V.

Кафедра клинической лабораторной диагностики с курсом молекулярной медицины

ЛАНДАС. Б.LANDAS. V.ЭМАНУЭЛЬВ. Л.EMANUELV. L.

Кафедра клинической лабораторной диагностики с курсом молекулярной медицины

Санкт-Петербургский государственный медицинский университет им. И.П.ПавловаRussian FederationСанкт-Петербургский институт ядерной физикиRussian Federation2011100320111531117Copyright © ЧУХЛОВИН А.Б., ЭМАНУЭЛЬ Ю.В., НАПАЛКОВА О.В., ЛАНДА С.Б., ЭМАНУЭЛЬ В.Л., 20112011ЧУХЛОВИН А.Б., ЭМАНУЭЛЬ Ю.В., НАПАЛКОВА О.В., ЛАНДА С.Б., ЭМАНУЭЛЬ В.Л.CHUKHLOVIN A.B., EMANUEL Y.V., NAPALKOVA O.V., LANDA S.V., EMANUEL V.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/491

Общеизвестно, что мочекаменная болезнь (МКБ) связана с нарушениями солевого обмена, способствующих формированию оксалатных и смешанных конкрементов мочевыводящих путей, в частности - гипероксалурией, гиперкальциурией, дефицитом цитрата в моче. В качестве дополнительных факторов риска повторного камнеобразования рассматриваются нарушения соль-стабилизирующих функций мочевых белков, в особенности, белка Тамма-Хорсфалла - основного белкового компонента нормальной мочи, обладающего уропротективными и антимикробными функциями. Кроме того, в последние годы рассматривается существенная роль локальных инфекций уреазопродуцирующими микроорганизмами (Proteus mirabilis, Corynebacterium urealyticum, Ureaplasma urealyticum и др.) в возникновении аммоний- и кальций-фосфатных камней («инфекционный уролитиаз»). Инвазивные и цитотоксические свойства патогенных штаммов бактерий приводят к повреждению слизистых поверхностей мочевыводящих путей, а продукция уреазы способствует защелачиванию мочи и образованию струвитных конкрементов. В то же время ряд бактерий (например, Oxalobacter formigenes и некоторые другие кишечные микроорганизмы) разрушают оксалаты и, тем самым, являются уропротективными микроорганизмами. Таким образом, отдельные виды микрофлоры, находящиеся под контролем локальных иммунных механизмов, имеют существенное значение как для развития уролитиаза, так и для возможной профилактики его рецидивирования.

Renal stone disease (uriolithiasis) is associated with salt metabolism disorder which promote formation of oxalate and mixed-type urinary concrements, e.g., hyperoxaluria, hypercalciuria, urinary citrate deficiency. Imbalanced salt-stabilizing functions of urinary proteins (in particular, Tamm-Horsfall protein, the major urinary protein with uroprotective and antimicrobial functions) are regarded as supplementary factors of occasional lythogenesis. Moreover, a sufficient role of local infections with urease-producing microorganisms (Proteusmirabilis, Corynebacterium urealyticum, Ureaplasma urealyticum etc.) is currently under consideration, as a reason of ammonium- and calcium phosphate stones ("infectious urolithiasis"). Invasive and cytotoxic properties of pathogenic bacterial strains lead to damage of urogenital mucosal surfaces, whereas urease production promotes urine alcalinization and formation of struvite stones. Meanwhile, some bacteria (e.g., Oxalobacter formigenes and some other intestinal microbes) are able to destroy oxalates, and therefore, are uroprotectants. Therefore, some microbial species being controlled by local immune mechanisms, have a sufficient significance both for development of urolithiasis, and for potential prevention of recurring.

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The authors declare that there are no conflicts of interest present.