ROLE OF LOCAL INFECTIONS IN DEVELOPMENT OF UROLITHIASIS

Abstract

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.