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Gastroenterologie
a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2015; 69(6): 561– 569. doi:10.14735/amgh2015561.

Urolitiáza u pacientů s idiopatickými střevními záněty

Vladimír Teplan Orcid.org  1,2,3, Milan Lukáš Orcid.org  4

+ Pracoviště

Souhrn

Zánětlivá onemocnění střeva jsou typicky doprovázena průjmy a malabsorpcí, což představuje predisponující faktory pro tvorbu ledvinných kamenů. Prevalence urolitiázy činí kolem 1,5–5 %, ale u nemocných po resekci střeva 3,7–16 %. Enterická hyperoxalurie je častou komplikací zánětlivých onemocnění střeva, ileální resekce a Roux-En-Y – gastického bypassu a je známou příčinou nefrolitiázy a nefrokalcinózy. Nadbytek oxalátů je primárně vylučován ledvinami. Zvýšené močové vylučování oxalátů vede k zvýšené saturaci moči Ca oxaláty, agregaci krystalů a vzniku urolitiázy či nefrokalcinózy. Prevence oxalátové litiázy zahrnuje vedle zvýšeného příjmu tekutin perorální podávání citrátu, magnézia, suplementu Ca, nutričně bilanční nízkooxalátové nízkotučné diety a též biologické ovlivnění střevní flóry (Oxalobacter formigenes, Bifidobacterium lactis apod.). Nové léčebné postupy u nemocných se zánětlivými onemocněními střeva zásadním způsobem změnily průběh onemocnění. Zda však tato příznivá změna ovlivní prevalenci a rizikové faktory pro tvorbu močových kamenů, není dosud známo.

Klíčová slova

hyperoxalurie, prevence, střevní flora, urolitiáza, urolitiáza, zánětlivá onemocnění střev

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