[Percutaneous nephrolithotomy in a patient after liver transplantation].

The work is devoted to the description of percutaneous nephrolithotomy in a patient who previously underwent liver transplantation. In case of immunodeficiency of any etiology, one-stage non-severe kidney injury is less dangerous compared to infectious and inflammatory complications, which naturally have more severe course compared to in those with intact immune system. Based on these considerations, the patient underwent percutaneous nephrolithotomy, which allowed to remove the stone of 2.5 cm in size without any complications. The choice of surgical treatment and management tactics for this category of patients are described in detail in the article.

[Cardiorenal syndrome in urological practice].

A lecture on the pathogenesis and treatment of cardiorenal syndrome, which is a combination of various variants of renal and heart failure, is presented in the article. Currently, there are five types of this syndrome. All of them are discussed in detail from the view of relevance for urological practice. In patients of the urological profile, II type, to a lesser extent III and V types of cardiorenal syndrome are most common. Moreover, type II, which is the simultaneous coexistence of chronic heart failure and chronic renal failure due to different (unrelated causal relationships) conditions, can significantly influence on the choice of surgical tactics. This question requires further research. Type III of cardiorenal syndrome, which is a cardiac complication of a prolonged acute phase of acute renal failure, in most cases can be prevented through drug treatment and timely renal replacement therapy. Type V cardiorenal syndrome, which represents a combined damage to the heart and kidneys within the same condition, apparently, occurs in urological practice in the most severe patients with metabolic syndrome, which allows to combine uric acid stones and other variants of gouty nephropathy into one nosology, naturally leading to progressive renal failure, ischemic heart disease and chronic heart failure. In the section on treatment tactics, it is mentioned that there are no standard approaches to the treatment of cardiorenal syndrome in the literature. The restrictions in the choice and dosing regimen of cardiotropic drugs due to renal failure are considered in detail. The importance of timely hemodialysis is especially emphasized. In conclusion, the authors suggest that the development of cardiorenal syndrome is due to the effect of potentiation with a significantly higher rate of progression of both renal and heart failure compared to isolated forms of both conditions.

[Characteristics of pathogenesis and manifestations of nephrolithiasis in patients with chronic cardiovascular diseases].

AIM: To study the pathogenetic and clinical features of nephrolithiasis in patients with concomitant chronic cardiovascular diseases (CVD), particularly the chemical composition of renal stones, the frequency of relapses, as well as the daily dynamics of the urine specific gravity and acidity level as the main factors of stone formation. MATERIALS AND METHODS: A total of 270 patients were treated in the Department of the urology No. 1 of the "Main Military Clinical Hospital named after N. N. Burdenko" of the Ministry of Defense of the Russian Federation during the period from 2008 to 2018. The main group included 184 patients suffering from nephrolithiasis, of which 72 had hypertension in combination with coronary heart disease, and in other 112 patients chronic heart failure (CHF of stage I, IIA and IIB in 55, 37 and 20 patients, respectively) was previously diagnosed. Data on the CVD were obtained from medical records; if necessary, patients were referred to an internist and/or cardiologist. The CHF was staged in accordance with the Strazhesco-Vasilenko (1935) classification. In the control group there were 86 patients with urolithiasis without any cardiovascular disorders. A retrospective analysis of the stone composition was performed using a NICOLET iS10 spectral analyzer. The urine specific gravity and acidity (pH) was determined using a semi-automatic analyzer CLINITEK Status Plus three times a day (both during hospital stay and 3 months after discharge). Statistical analysis was done using the SPSS program v.19. The absolute values (M+/-m) were calculated, as well as Min, ME, Mo, Max. Relative values, including Fischer criterion, were evaluated, taking into account the Bonferroni correction. Differences were significant if p-value was < 0.05. RESULTS: There was no difference between groups in age (32; 64; 83). In both groups men were predominated (~ 75-78%). According to chemical analysis, stone composition in the control group was as following: oxalates (76.6%), uric acid (9.3%), phosphates (8.1%); mixed stones (6.7%). Independent of stage of CHF, respective figures were 51.4, 23.6, 8.3 and 16%, respectively. The follow-up of patients for 5 years showed that patients were admitted to the urological hospital with a stone recurrence on average 1.8 times, compared to 3 and 3.8 times with concomitant CVD and CHF, respectively. The most concentrated (specific gravity of 1035) and the most acidic (pH =5.5-5) urine in patients with CHF was found in the evening. CONCLUSION: Chronic CVD has a significant impact on the clinical manifestations of urinary stone disease. The most pronounced changes are associated with CHF. Features of nephrolithiasis in patients with a CVD include the predominance of uric acid and urate stones, more frequent recurrences, shift in the peak of acidity and urine specific gravity from morning to evening hours.

[The features of pathogenesis of urolithiasis in patients with diabetes mellitus type 2].

INTRODUCTION: In recent years, a large number of studies has been published that proved a very significant role of diabetes mellitus type 2 for development of urolithiasis. The aim of our work was to conduct a comparative study of biochemical parameters of blood and urine as well as chemical composition of urinary stones in urolithiasis patients in the general population and in patients with diabetes mellitus type 2. MATERIALS AND METHODS: The work was divided into 2 stages. During the first stage an analysis of chemical composition of urinary stones in the general population (n=5669) and in patients with diabetes mellitus type 2 was carried out (n=350). During the second stage an analysis of biochemical parameters of blood and urine in urolithiasis patients in the general population (n=101) and in patients with diabetes mellitus type 2 was conducted (n=350). RESULTS: In the general population calcium oxalate stones was predominated (56.8%), while phosphate (24.9%) and urate (17.4%) stones were less frequent. In a subgroup of patients with diabetes mellitus type 2 uric acid stones were predominated (74.3%), significantly exceeding calcium oxalate (15.1%) and calcium phosphate (10.6%) stones. In the general population of patients with urolithiasis, hypercalciuria, hyperuricosuria, hyperuricemia and hypomagnesiuria was detected in 60.4%, 42.6%, 26.7% and 43.5% of cases, respectively. In patients with concomitant diabetes mellitus type 2, hypercalciuria, hyperuricosuria, hyperuricemia was observed in 9.4%, 26.7% and 42.5%, respectively. In 60.3% of patients with diabetes mellitus type 2 marked acidity of the morning urine was detected (pH<6.0). CONCLUSION: Correction of metabolic disorders in patients with urinary stone disease and diabetes mellitus type 2 should be aimed at increasing of urine pH and reducing the level of uric acid in the blood and urine.

Nephrolithiasis against type 2 diabetes mellitus: on the effect of hypoglycemic therapy on lithogenesis.

AIM: To study the effects of oral hypoglycemic agents that can affect the probability of recurrence of nephrolithiasis. MATERIALS AND METHODS: The article is based on the results of examination and treatment of 315 patients suffering from recurrent nephroli-thiasis and medically compensated type 2 diabetes mellitus treated at the N.A. Lopatkin Institute of Urology and Interventional Radio-logy - the branch of the SMRC of Radiology, Ministry of Health of Russia and D.D. Pletnev City Hospital Moscow Healthcare -Department in 2012-2017. The patients were divided into three groups according to the applied tool antidiabetic: metformin, glibenclamide, canagliflozin. The control group consisted of patients receiving insulin therapy. RESULTS: The propensity of Metformin to reduce the pH of urine, which has a negative impact in the conditions of urate nephrolithiasis, which is most common in the population of patients with type 2 diabetes mellitus. Glibenclamide, on the contrary, somewhat latches urine. But changes in the reaction of urine under the influence of the drug do not go beyond normal values and are not clinically significant. Canagliflozin increases diuresis due to medication induced glycosuria and stimulates renal excretion of uric acid and its salts. However canagliflozin does not cause significant shifts in the pH of urine that may somewhat negates the increased risk of recurrence of urate stone formation in the background of the uricosuric effect of the drug. CONCLUSION: Drug therapy of type 2 diabetes mellitus significantly affects the properties of urine from patients with nephrolithiasis.

[EMPIRICAL ANTIBACTERIAL PROPHYLAXIS IN EMERGENCY SURGERY].

The main principles of selecting antibacterial drugs for prophylactic therapy of patients prior to surgery of gastrointestinal tract, vessels, skin, and soft tissues are considered. Special attention is devoted to antibacterial prophylaxis in co-morbid patients, in particular those with chronic renal insufficiency, chronic liver disorder, decompensated diabetes mellitus, and allergy to beta-lactam antibiotics. All proposed schemes are optimized with respect to three criteria: clinical effectiveness, economic feasibility, and epidemiologic safety (stopping the selection of poly-resistant microbial families).