Fatores litog?nicos em pacientes com lit?ase urin?ria de Fortaleza, Cear?

• Main Author: Silva, S?lvia Fernandes Ribeiro da
• Other Authors: CPF:26277573349
• Format: Others
• Language: Portuguese
• Published: Universidade Federal do Rio Grande do Norte 2014
• Subjects: Lit?ase; C?lculo urin?rio; Fatores de risco; Oxalato de c?lcio; Lithiasis; Urinary stone; Risk factors; Calcium oxalate; CNPQ::CIENCIAS DA SAUDE
• Online Access: http://repositorio.ufrn.br:8080/jspui/handle/123456789/13204

Made available in DSpace on 2014-12-17T14:13:36Z (GMT). No. of bitstreams: 1 SilviaRS_TESE.pdf: 1377136 bytes, checksum: 8255e0cbf50a79a12b6f6b0f3965241e (MD5) Previous issue date: 2010-10-08 === Lithiasis is considered a public health issue due to its high prevalence and rates of recurrence. Objective: To identify risk factors for lithiasis in kidney stone patients from Fortaleza, Brazil. In the first stage of the study, the medical records of 197 patients with urinary lithiasis covering the period 1996 2006 were analyzed with regard to clinical and metabolic data. In the second stage, 340 kidney stones were submitted to morphological examination under 10x magnification. According to the external morphology and the cut surface, the stones were classified as pure or mixed, and major and minor components were identified. In addition, the stone fragments of 25 patients treated with lithotripsy were submitted to morphological analysis. In the third stage, a subsample of 50 stones was used in a double-blind comparison of morphological and chemical findings. Results were expressed as concordant, partly concordant (discordant for minor components) or discordant (discordant for major components). The average age of first symptoms was 35.8?13.3 years, with no significant difference between the genders. The male/female ratio was 1:1.7. Recurrence was reported in 53.3% of cases. The main metabolic changes observed were hypernatriuria (80.7%), hypercalciuria (48.7%), low urine volume (43.7%), hyperoxaluria (30.5%) and hyperuricosuria (17.3%). Pure stones represented 34.7% of the total sample of 340 stones. The most common route of elimination was spontaneous for pure stones (49.1%) and surgical for mixed stones (50.5%). Pure stones consisted most frequently of calcium oxalate (OxCa) (59.3%) and uric acid (UA) (23.7%), the former prevalent in women, the latter prevalent in men. The most frequently observed component in mixed stones was OxCa (67.1%), followed by carbapatite (11.2%) and struvite (7.9%). The main components were OxCa and UA for men, and carbapatite and struvite for women. Nearly half (48%) the 25 analyzed fragments were pure, consisting of calcium oxalate dihydrate (COD) (56%), calcium oxalate monohydrate (COM) (48%), phosphate (32%) and UA (20%). Four patients (16%) had infectious stones. In the chemical analysis of the subsample of 50 stones, the most 64 frequently observed major components were calcium (70%), oxalate (66%), ammonium (56%), urate (28%) and carbonate (24%). In the morphological analysis, the main components were calcium and magnesium phosphate (32%), COM (24%), UA (20%), COD (18%) and cystine (6%). Morphological and chemical findings were totally concordant for 38% of the stones, partly concordant in 52% and discordant in 10%. Conclusion: The risk factors for lithiasis in kidney stone patients from Fortaleza (Brazil) were hyperoxaluria, hypercalciuria with or without hypernatriuria, hyperuricosuria and low urine volume === A lit?ase urin?ria ? um problema de sa?de p?blica pela elevada preval?ncia e recorr?ncia. Objetivo: O objetivo do presente estudo foi determinar os fatores litog?nicos em pacientes com lit?ase urin?ria de Fortaleza, Cear?. O estudo foi dividido em tr?s fases: na primeira, realizouse estudo documental de prontu?rios de 197 pacientes com lit?ase urin?ria atendidos entre 1996 e 2006, para a an?lise de dados cl?nicos e avalia??o metab?lica. Na segunda fase foi realizada uma avalia??o morfol?gica de 340 c?lculos urin?rios, classificando-os como puro ou misto e os componentes em majorit?rios ou minorit?rios. Foi tamb?m avaliado fragmentos de c?lculos de 25 pacientes tratados com litotripsia. Na terceira fase utilizou-se uma amostra de 50 c?lculos para um estudo duplo-cego comparando a an?lise morfol?gica e a an?lise qu?mica. Os resultados foram considerados como concordantes, parcialmente concordantes (componentes minorit?rios discordantes) ou discordantes (componentes majorit?rios discordantes). A m?dia de idade dos 197 pacientes no primeiro sintoma foi 35,8 ? 13,3 anos, n?o houve diferen?a entre os g?neros. A rela??o homem:mulher foi de 1:1,7, 53,3% eram recorrentes. As principais altera??es metab?licas foram hipernatri?ria (80,7%), hipercalci?ria (48,7%), volume urin?rio baixo (43,7%), hiperoxal?ria (30,5%) e hiperuricos?ria (17,3%). Entre os 340 c?lculos analisados, 34,7% foram puros. A via de elimina??o mais comum dos c?lculos puros foi a espont?nea (49,1%) e a dos mistos foi a cir?rgica (50,5%). Os c?lculos mais freq?entes foram o oxalato de c?lcio (OxCa=59,3%) e ?cido ?rico (AU=23,7%), sendo o primeiro mais comum nas mulheres e o segundo nos homens. Entre os c?lculos mistos, o OxCa foi o principal componente (67,1%), seguido da carbapatita (11,2%) e estruvita (7,9%). Os principais componentes nos homens foram o OxCa e AU, enquanto que nas mulheres foram a carbapatita e estruvita. Entre os 25 fragmentos de c?lculos analisados, 48% foram puros. Os componentes encontrados foram: OxCa dihidratado-COD (56%), OxCa monohidratado-COM (48%), fosfato (32%), AU (20%). Quatro pacientes (16%) apresentaram c?lculo de infec??o. Na an?lise qu?mica dos 50 c?lculos urin?rios os principais componentes majorit?rios foram c?lcio (70%), xvi oxalato (66%), am?nio (56%), urato (28%) e carbonato (24%), enquanto que na morfol?gica foram fosfato de c?lcio e magnesiano (32%), COM (24%), AU (20%), COD (18%) e cistina (6%). Concord?ncia total foi observada em 38%, parcial em 52% e discord?ncia em 10%. Conclus?o: Os fatores de risco litog?nicos na regi?o de Fortaleza foram hiperoxal?ria, hipercalci?ria com ou sem hipernatri?ria, hiperuricos?ria e volume urin?rio reduzido