title: [Modern diagnostic and management aspects of citrate therapy for uric acid nephrolithiasis].
abstract: BACKGROUND
  Iso-aciduria - long-term existence of urine pH within a narrow range (pH <0.8-1.2 units.) - activates certain enzymes for which these pH levels are favorable. Then, this activation induces precipitation of crystals corresponding to these enzymes.
  
  
  OBJECTIVE
  To enable citrate therapy without a risk of altering the stone chemical composition and to identify indicators reflecting the degree of metabolic disorders in patients with uric acid nephrolithiasis.
  
  
  METHODS
  Citrate therapy was provided with a mixture comprising "Potassium citrate monohydrate" and "Tri-sodium citrate di-hydrate" in a ratio of 2: 1. The study group included 64 patients, who had ultrasound-detected calyx stones and hyperechoic inclusions from 2 to 4 mm without acoustic shadow, located in the papillary region of the renal pyramids. Statistical analysis was performed by cross tabulations (pairing).
  
  
  RESULTS
  The results of the statistical analysis have proven the legitimacy and feasibility of the proposed method of classifying patients into homogeneous groups according to the disease severity.
  
  
  CONCLUSIONS
  Long-term citrate therapy should be carried out in such a way as to achieve maximum range of urine pH (from 5.4 to 7.8 units), which will allow to avoid deposition of other crystals upon the existing stone and identify indicators reflecting the degree of metabolic disorders in patients with uric acid nephrolithiasis.
  
  
  CONCLUSIONS
  Long-term citrate therapy should be carried out in such a way as to achieve maximum range of urine pH (from 5.4 to 7.8 units), thus avoiding deposition of other crystals upon the existing stone.
authors.affiliation: Department of Urology, Kuban State Medical University, Krasnodar.
authors.forename: S N
authors.initials: SN
authors.lastname: Alekseenko
authors.affiliation: Department of Urology, Kuban State Medical University, Krasnodar.
authors.forename: A S
authors.initials: AS
authors.lastname: Tatevosyan
authors.affiliation: Department of Urology, Kuban State Medical University, Krasnodar.
authors.forename: V L
authors.initials: VL
authors.lastname: Medvedev
authors.affiliation: Department of Urology, Kuban State Medical University, Krasnodar.
authors.forename: A G
authors.initials: AG
authors.lastname: Tonyan
authors.affiliation: Department of Urology, Kuban State Medical University, Krasnodar.
authors.forename: S S
authors.initials: SS
authors.lastname: Ryabokon'
mesh_terms: D019343:Citric Acid / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D053040:Nephrolithiasis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000652:urine*; D014527:Uric Acid
chemical_list: D014527:Uric Acid; D019343:Citric Acid
keywords: citrate therapy; iso-aciduria; prognosis of nephrolithiasis; severity of nephrolithiasis; uric acid urolithiasis