Mehmet Mesut PİŞKİN, Giray KARALEZLİ, Mehmet KILINÇ

Üriner sistem kalsiyum taş hastalığına bağlı kemik kütlesi değişiklikleri

Amaç: Üriner sistem taş hastalığı ülkemizde sık görülen bir patolojidir. Kalsiyum taşları bu hastalık grubunun en büyük kısmını oluşturur. Hiperkalsiüri, taş hastalarında en sık görülen metabolik bozukluktur ve bu hastalarda kalsiyum metabolizması bozularak kemik kütlesini etkileyebilmektedir. Bu çalışmada kalsiyum taş hastalığı bulunan hastalardaki kemikler kütlesindeki değişikliklerin araştırılması amaçlandı. Yöntem: Çalışmaya kalsiyum taş hastalığı tanısı ile takip edilen yaşları 20-50 arasında değişen (ortalama yaş 39.8) 41 erkek olgu alındı. Taş hastalığı hikayesi bulunmayan 20-50 yaşları arasında değişen (ortalama yaş 39.9) 40 erkek olgu ise kontrol grubu olarak alındı. Her iki grubun kemik kütle ölçümleri femur boynu ve lumbal vertebra düzeyinde dual-enerji-x-ray absorpsiyometri yöntemi ile yapıldı. Olgulara diyet kısıtlanması yapılmadan 24 saatlik idrar metabolik değerlendirmesi, kan biyokimyası testleri yapıldı. Bulgular: Çalışma grubu ile kontrol grubunun yaş dağılımları ve vücut kütle indeksleri arasında anlamlı fark saptanmadı (P=0.097). Taş hastalığı bulunan olgulardan 20’si (% 48) hiperkalsiürik idi. Kemik mineral dansiteleri çalışma grubundaki 17 olguda (% 41), kontrol grubunda ise yalnızca bir olguda (% 2.5) düşük idi, gruplar arasında anlamlı fark vardı (P

Bone mass alterations due to urinary system calcium stone disease

Objective: Urinary stone disease is a common pathology in our country. Calcium nephrolithiasis is the most frequently observed type among these patients. Hypercalciuria is the most common metabolic disorder and the bone mass might be altered with the disturbed calcium metabolism in these patients. In this study the bone mass alterations in patients with calcium stone disease was aimed. Methods: 41 male patient with calcium stone disease, aged between 20–50 (mean age 39.76) were studied, and 40 males without stone disease aged between 20–50 (mean age 39.85) formed the control group. The bone mass evaluation was performed with the Dual-Energy-X ray Absorptiometry on the level of femur neck and the lumbar region. Blood biochemistry and 24 hour urinary samples were evaluated without and diet restriction. Results: There were no difference in comparison of the age and the body mass index between the study group and the control group (P=0967). In the study group 20 patients (48 %) were hypercalciuric. The bone mineral density was below the normal ranges in 17 patients (41 %) in study group, but only one (2.5 %) in the control group, it was statistically significant (P<0.05). Osteoporosis and osteopenia was significantly higher in the study group (P<0.001, P<0.001). There was correlation between osteoporosis and recurrence (r=0.717, P<0.01). Conclusion: Stone disease is a risk for osteoporosis. The bone mass should be evaluated in especially in recurrent cases, and the patients, precautions regarding protection of the bone mass should be taken and the patient should be informed.

PDF

___

1. Caudarella R, Vescini F, BuVa A. Osteoporosis and Urolithiasis. Urol Int 2004;72 (suppl 1):17–9.
2. Uribarri J, Man S, Carroll JH. The first kidney stone. Ann Intern Med 1989;111:1006–9.
3. Pak CY. Etiology and treatment of urolithiasis. Am J Kidney Dis 1991;18:624–37.
4. Weisinger JR, Bellorini-Font E, Sylva V. An ambulatory methabolic study of calcium nephrolithiasis in Venezuela. In:Schewille PO, Smith LH, Robertson WG, VahlensicekW (eds). Urolithiasis and related clinical research. New York, 1985 p. 275–8.
5. Locker FG. Hormonal regulation of calcium homeostasis. Nurs Clin North Am 1996;31:797–803.
6. Stoller ML, Bolton DM. Urinary stone disease. In: Tanagho EA, Mc Aninch JW (eds) Smith’s General Urology, 15th ed. New York Lange Medical Books/McGraw-Hill, 2001, p 291-321.
7. Premaor MO, Furlanetto TW. Vitamin D deficiency in adults: to better understand a new presentation of an old disease. Arq Bras Endocrinol Metabol. 2006;50:25–37.
8. Kazantzis G. Cadmium, osteoporosis and calcium metabolism. Biometals 2004;17:493–8.
9. Francis RM. Male osteoporosis. Rheumatol 2000;39:1055–7.
10. Pacifici R, Rothstein M, Rifas L. Increased monocyte interleukin-1 activity and decreased vertebal bone density in patient with fasting idiopathic hypercalciuria. J Clin Endocrinol Metab 1990;71:138–45.
11. Fuss M, Gillet C, Simon J, Vandewalle JC. Bone mineral density in hipercalciuric calcium stone disease and in primary hyperparathyroidism. Eur Urol 1983;9:32-4.
12. Batailie P, Achard JM, Fournier A. Diet, vitamin D and vertebral mineral density in hypercalciuric calcium stone formers. Kidney Int 1991;39:1193–1205.
13. Weisinger JR. Bone loss in hipercalciuria; Cause or Conseqence? Am J Kidney Dis 1999;33:x1vi-x1viii.
14. Akıncı M, Esen T, Tellaloğlu S. Urinary stone disease in Turkey: An updated epidemiological study. Eur Urol 1991;20:200–3.
15. Pak CY. Medical management of nephrolithiasis. J Urol 1982;128:1157-64.
16. Alhava EM, Juuti M, Karljalainen P. Bone mineral density in patients with urolithiasis: A preliminary report. Scand J Urol Nephrol 1979;10:154–6.
17. Pietschmann F, Breslau NA, Pak CYC. Reduced vertebral bone density in hipercalciuric nephrolithiasis. J Bone Miner Res 1992;7:1383–8.
18. Trinchieri A, Nespoli R, Ostini F. A study of dietary calcium and other nutrients in idiopathic renal calcium stone formers with low bone mineral content. J Urol 1998;159:654–7.
19. Jaeger P, Lippuner K, Casez JP. Low bone mass in idiopathic renal stone formers; Magnitude and significance. J Bone Miner Res 1994;9:1525–32.
20. Weisinger JR. New insights into the pathogenesis of idiopathic hypercalciuria: The role of bone. Kidney Int 1996;49:1507-18.
21. Tasca A, Cacciola A, Ferrarese P, Ioverno E, Visonà E, Bernardi C, et al. Bone alterations in patients with idiopathic hypercalciuria and calcium nephrolithiasis. Urology 2002;59:865–9.
22. Amanzadeh J, Gitomer WL, Zerwekh JE, Preisig PA, Moe OW, Pak CY, et al. Effect of high protein diet on stone-forming propensity and bone loss in rats. Kidney Int 2003;64:2142-9.
23. Reddy ST, Wang CY, Sakhaee K, Brinkley L, Pak CY. Effect of low-carbohydrate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolism. Am J Kidney Dis 2002;40:265-74.
24. Giannini S, Nobile M, Sartori L, Calo L, Tasca A, Dalle Carbonare L, et al. Bone density and skeletal metabolism are altered in idiopathic hypercalciuria. Clin Nephrol 1998;50:94-100.
25. Curhan GC, Willet WC, Rimm EB, Stampfer MJ. A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med 1993;328:833-8.