Recent advances in the pathophysiology of nephrolithiasis.

Recent advances in the pathophysiology of nephrolithiasis.
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DOI:
10.1038/ki.2008.626
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发表时间:
2009-03
影响因子:
19.6
通讯作者:
Sakhaee, Khashayar
Sakhaee, Khashayar
中科院分区:
医学1区
文献类型:
--
作者:
Sakhaee, Khashayar

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近10年来,尿酸钙结石的发病机制研究取得了重大进展。这些进展使我们进一步了解了尿酸肾结石和代谢综合征之间的发病联系,草酸钙结石形成中的草酸盐形成基因的作用,Slc 26 a6-null小鼠中的草酸盐转运,Randall斑块作为草酸钙肾结石前体的潜在发病作用,以及肾小管晶体保留的作用。随着这些进展,我们可能会有针对性地开发新的药物,包括(1)胰岛素增敏剂;(2)益生菌疗法与O。产甲酸杆菌、重组酶或工程菌;(3)涉及通过增加阴离子转运蛋白活性(Slc 26 a6)、管腔活性非吸收剂或草酸盐结合剂上调肠管腔草酸盐分泌的治疗;和(4)预防Randall斑块和/或肾小管晶体粘连形成的药物。
Over the past 10 years, major progress has been made in the pathogenesis of uric acid and calcium stones. These advances have led to our further understanding of a pathogenetic link between uric acid nephrolithiasis and the metabolic syndrome, the role of Oxalobacter formigenes in calcium oxalate stone formation, oxalate transport in Slc26a6-null mice, the potential pathogenetic role of Randall’s plaque as a precursor for calcium oxalate nephrolithiasis, and the role of renal tubular crystal retention. With these advances, we may target the development of novel drugs including (1) insulin sensitizers; (2) probiotic therapy with O. formigenes, recombinant enzymes, or engineered bacteria; (3) treatments that involve the upregulation of intestinal luminal oxalate secretion by increasing anion transporter activity (Slc26a6), luminally active nonabsorbed agents, or oxalate binders; and (4) drugs that prevent the formation of Randall’s plaque and/or renal tubular crystal adhesions.
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