Clinical value of crystalluria and quantitative morphoconstitutional analysis of urinary calculi
Clinical value of crystalluria and quantitative morphoconstitutional analysis of urinary calculi
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DOI：
10.1159/000080261
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发表时间：
2004-10-01
影响因子：
--
通讯作者：
Jungers, Paul
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文献类型：
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作者：
Daudon, Michel;Jungers, Paul
尿路结石的形态分析，即形态检查结合傅里叶变换红外光谱（FTIR），对于诊断罕见但严重的遗传性或获得性结石疾病，如胱氨酸、2,8-二羟基腺嘌呤、黄嘌呤、鸟粪石、尿酸铵或含药物结石以及原发性高尿酸血症具有决定性意义。在缺乏早期诊断和适当管理的情况下，这些疾病可能导致肾功能的进行性丧失。在常见形式的草酸钙（CaOx）结石中，主要的一水钙（whewellite）主要与高血钙有关，而主要的二水钙（weddellite）主要与高钙尿有关，这种区别对指导代谢评估和预防措施很有意义。晶体尿检查，也基于形态学和FTIR，是一种有价值的诊断方法，当没有可用的结石分析。存在特定的晶体（胱氨酸，2,8-二羟基腺嘌呤，鸟粪石，尿酸铵）是诊断本身。在所有类型的肾结石中，连续结晶尿测定是评估结石形成风险和评估预防措施有效性的一种简单、廉价和可靠的方法。根据我们的经验，测定尿晶体体积是治疗移植后胱氨酸尿或原发性高草酸尿患者的有用工具。综上所述，鉴于其在肾结石的诊断和治疗中的价值，应更多地使用结石的精确形态学和FTIR分析以及系列结晶尿测定。版权所有(C) 2004 S. Karger AG，巴塞尔。
Morphoconstitutional analysis of urinary calculi, i.e. morphologic examination combined with Fourier transform infrared spectroscopy (FTIR), is of decisive interest for the diagnosis of rare but severe inherited or acquired stone diseases such as cystine, 2,8-dihydroxyadenine, xanthine, struvite, ammonium urate or drug-containing calculi as well as primary hyperoxalurias. In the absence of early diagnosis and proper management, these diseases may lead to progressive loss of renal function. Among common forms of calcium oxalate (CaOx) stones, predominant CaOx monohydrate (whewellite) is mainly associated with hyperoxaluric conditions whereas predominant CaOx dihydrate (weddellite) is mainly associated with hypercalciuria, and this distinction is of interest to orient metabolic evaluation and preventive measures. Crystalluria examination, also based on morphology and FTIR, is a valuable diagnostic method when no stone is available for analysis. Presence of specific crystals (cystine, 2,8-dihydroxyadenine, struvite, ammonium urate) is diagnostic by itself. In all types of nephrolithiasis, serial crystalluria determination appears as a simple, cheap and reliable method to evaluate the risk of stone formation and assess the effectiveness of preventive measures. Determination of urinary crystal volume was in our experience a useful tool in the management of patients with cystinuria or primary hyperoxaluria in the post-transplantation period. In conclusion, both accurate morphologic and FTIR analysis of stones and serial crystalluria determination should be more largely used, in view of their value in the diagnosis and management of renal stone formers. Copyright (C) 2004 S. Karger AG, Basel.