_INCIDENCES OF FORMS OF URINARY LITHIASIS尿路结石形态的对比发生率（PPT54）课件.ppt

STONE DISEASE ( Brief Overview ) COMPARATIVE INCIDENCES OF FORMS OF URINARY LITHIASIS Stone analysis in Percentage Form of Lithiasis India USA Japan UK Pure Calcium Oxalate 86.1 33 17.4 39.4 Mixed Calcium Oxalate and 4.9 34 50.8 20.2Phosphate Magnesium Ammonium 2.7 15 17.4 15.4Phosphate (Struvite ) Uric Acid 1.2 8.0 4.4 8.0 Cystine 0.4 3.0 1.0 2.8 Cause of Stone Disease Supersaturation of urine is the key to stone formation Intermittent supersaturation - Dehydration Crystal aggregation Anatomic Abnormailities – PUJ , MSK Bacterial Infection Defects in transport of Calcium and Oxalate by Renal epithelia Inhibitors Promoters of Stone Formation in Urine INHIBITORS Inhibits crystal Growth - Citrate – complexes with Ca Magnesium – complexes with oxalates Pyrphosphate - complexes with Ca Zinc Inhibits crystal Aggregation Glycosaminoglycans Nephrocalcin Tamm- Horsfall Protein PROMOTERS Bacterial Infection Matrix Anatomic Abnormalities – PUJ obst., MSK Altered Ca and oxalate transport in renal epithelia Prolonged immobilisation Increased uric acid levels I.e taking increased purine subs– promotes crystalisation of Ca and oxalate ?? Nanobacteria – seen in 97% of renal stones SOME DISEASES ASSOCIATED WITH HYPERCALCAEMIA HYPERCALCIURIA Hyperparathyroidism Leukemia Sarcoidosis Lymphoma Multiple myeloma Myxedema Hyperthyroidism Adrenal Insufficiency Metastatic Malig. Neoplasms Vit. D Intoxication TYPES OF KIDNEY / URETER STONES OXALATE (CALCIUM OXALATE) PHOSPHATE URIC ACID URATE CYSTINE Uncommon Stones XANTHINE STONES – (Autosomal Recessive . Def of Xanthine Oxidase leading to Xanthinuria) DIHYDROXYADENINE STONE – ( Def. of enzyme adenine phospo ribosyl transferase ) SlLICATE STONES – Rare in humans ( excess intake of Antacid with Mg Trisilicate. Mostly in cattle due to ingestion of Sand ) MATRIX - Infection by Proteus - Radiolucent (all calculi have some amt ( 3%) of matrix but matrix calculus has 65% Matrix content in calculi