[Effects of oral hypoglycemic drugs on lithogenic properties of urine in nephrolithiasis patients with concurrent type 2 diabetes].

AIM: To investigate the effects of oral hypoglycemic drugs on the lithogenic properties of urine in nephrolithiasis patients with concurrent type 2 diabetes. MATERIALS AND METHODS: The study comprised 376 patients with recurrent nephrolithiasis and compensated type II diabetes mellitus who attended the N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - branch of the NMRRC of Minzdrav of Russia and D.D. Pletnev City Clinical Hospital, Moscow Health Department in 2012-2017. Patients were divided into five groups according to the administered oral hypoglycemic agent: metformin, glibenclamide, pioglitazone, canagliflozin, vildagliptin. The control group consisted of patients receiving insulin therapy. RESULTS: Metformin tended to acidify urine, thus producing a negative effect on urate nephrolithiasis, which is the most prevalent form of nephrolithiasis among patients with type II diabetes. Glibenclamide, on the contrary, alkalized the urine, but urine pH did not go beyond the ranges of normal values. Pioglitazone increased urine density with a simultaneous tendency to decrease diuresis, which is bad for any form of nephrolithiasis. Empagliflozin increased diuresis due to drug-induced glucosuria and also increased renal excretion of uric acid salts. However, at normal urine pH values, the uricosuric effect of the drug did not lead to a significantly increased risk of urate stone formation. Vildagliptin did not have a significant effect on urine output, urine pH, and renal salt excretion. CONCLUSION: Drug therapy for type II diabetes significantly affects the properties of urine in patients with nephrolithiasis, and it should be taken into account in the metaphylaxis of nephrolithiasis.

[Percutaneous nephrolithotripsy in a patient with primary immunodeficiency (a case report)].

This article presents a case study of a female patient with primary immunodeficiency, who underwent percutaneous nephrolithotripsy. The presence of a serious concomitant disease affects different aspects of preoperative and postoperative management of the patient. The choice of percutaneous nephrolithotripsy is necessitated by the need to render the patient stone free using a one-stage and the most effective surgical modality. The article describes the choice of antibacterial therapy to treat inflammatory complications in this category of patients. Broad-spectrum antibiotics should be used to prevent the onset of pyelonephritis, while pyelonephritis exacerbation requires administration of reserve antibiotics in combination with human immunoglobulin.

[Nephrolithiasis coexisting with type 2 diabetes: current concept of the features of stone formation and the effects of hypoglycemic therapy on lithogenesis].

The article analyzes Russian and international literature examining specific features of the pathogenesis of renal stones in the setting of carbohydrate metabolism disorders. The authors outline the renal effects of the main pharmacological groups of oral hypoglycemic drugs regarding metaphylaxis of nephrolithiasis. An increased risk of nephrolithiasis in type 2 diabetes mellitus is realized through hyperuricemia with concurrent urine acidification. Current literature is lacking studies on the effects of oral hypoglycemic drugs on urine properties. There are reports about the tendency of biguanides (metformin) to shift the urine reaction to the acid side. Derivatives of sulfonylureas, incretins and inhibitors of dipeptidyl peptidase-4, do not significantly affect the urinary acidity and urinary salt excretion. Inhibitors of sodium-glucose cotransporter type 2 (gliflozins) tend to reduce the blood level of urate, but the mechanism of this effect and the safety of these drugs in the setting of urolithiasis have not yet been investigated.