[Specific immunization for the prevention of recurrent nephrolithiasis after percutaneous nephrolithotomy].

AIM: To study the effect of prophylactic immunization with combined Staphylococcus-Proteus-Pseudomonas vaccine in combination with the probiotic Bacillus subtilis on the development of recurrent nephrolithiasis in patients after percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: A total of 76 patients with a high infectious risk of stone formation in the early postoperative period after PCNL were included in the study. All patients received antibiotic therapy in accordance with the current guidelines as indicated. The patients were divided into 3 groups. In the comparison group (n=30), patients continued to receive antibiotics on the outpatient basis. In the group A (n=20), in addition to antibiotics, two-stage immunization with Staphylococcus-Proteus-Pseudomonas vaccine was performed. In the group B (n=26), additionally, patients received probiotic preparation "Bactisporin dry", which is a lyophilized spore-forming bacteria Bacillus subtilis strain 3N. All participants had urine culture and stone analysis using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. A study of specific antibodies level and factors of cellular and humoral immunity was carried out at specific time points. The duration of follow-up was 36 months. RESULTS: The study revealed a difference in the pathogens isolated from urine and infection stones in the same patient. This convincingly suggests that pathogens form biofilms in the stones and are not detected during routine urine culture. The main pathogens isolated from the stones were Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus epidermidis and Klebsiella pneumonia. Microbial associations were found in 25.7% of cases. The Staphylococcus-Proteus-Pseudomonas vaccine demonstrated good immunogenicity, its antigenic components provided protective properties against autologous and opportunistic bacteria. In addition to the ability to induce a specific response to antigens, the vaccine stimulated the phagocytic activity of neutrophils. Immunization with the combined Staphylococcus-Proteus-Pseudomonas vaccine in combination with probiotic results in uncomplicated postoperative course in 84% of patients. Hospital-acquired infectious and inflammatory complications were seen in 16.2% of cases. The recurrence of stone formation in this group of patients within 36 months was 8.2%. In patients receiving only combined Staphylococcus-Proteus-Pseudomonas vaccine after PCNL, the postoperative period was uneventful in 65% of cases. The rate of upper urinary tract infection was 35%, while the inflammatory process was accompanied by mild clinical manifestations and quickly resolved. Recurrence of stone formation during the follow-up was seen in 18% of patients. In the control group, the proportion of uncomplicated cases in patients with nephrostomy tube was 40%, the development of pyelonephritis was noted in 60% of cases, and recurrent stones within 36 months were diagnosed in 46.7% of cases. CONCLUSION: Our results emphasize that the role of an infectious factor in the development of recurrent nephrolithiasis after PCNL is often underestimated. The use of a specific vaccination and the Bacillus subtilis preparation in patients with a high infectious risk of recurrent stone formation allows to achieve a significant reduction in the recurrence rate (more than 5 times) compared to the control group during 36 months of postoperative follow-up.

[Genetic aspects of primary hyperoxaluria: epidemiology, ethiology, pathogenesis, and clinical signs of the disorder].

Primary hyperoxaluria is a group of rare inherited diseases characterized by impaired oxalate metabolism with the early manifestation of urolithiasis and the development of the chronic kidney disease. The mutations in the AGXT, GRHPR, HOGA1 genes are attributable for different types of primary hyperoxaluria leading to the dysfunction of specific enzymes involved in the oxalate metabolism. The article summary the current data on the epidemiology, genetic and biochemical aspects of pathogenesis of the primary hyperoxaluria types 1-3. The variety of clinical signs and disease severity depend on the type of hyperoxaluria.

[Urinary disturbances in patients with diabetes].

The significance of diabetes is not only due to its high prevalence, but also to its serious complications. Urinary disturbances, which are referred as diabetic cystopathy, are among the most common complications of diabetes. The current data on the prevalence, manifestations, and possible pathogenesis of diabetic cystopathy are presented in the review of literature.

[Biomarkers of renal injury in contact ureteral lithotripsy].

AIM: To optimize the transurethral endoscopic management of patients with ureterolithiasis by measuring biomarkers of renal parenchymal damage. MATERIALS AND METHODS: One hundred fifty-one patients with solitary ureteral stones were tested for levels of cystatin C, neutrophil gelatinase-associated lipocalin, 2-microglobulin and interleukin 18. RESULTS: An increase in the levels of markers of renal injury was observed both in the preoperative period and after CULT. Differences in the values of these indices depended on the timing of the CULT, the size and location of the stone and the type of lithotripter. CONCLUSIONS: All patients were found to have damage to the renal tubular system. The established critical values of the markers of renal injury in ureterolithiasis may be used as diagnostic criteria for renal injury.

[The role of urinary tract infection in the development of recurrent nephrolithiasis].

This is a literature review on the role of microbial flora in the development of recurrent urolithiasis. The authors outline pathogenetic aspects of recurrent stone formation associated bacterial flora. A number of studies reported that standard urine culture has limited sensitivity in detecting urinary tract infection.

[Extracorporeal shock wave lithotripsy: benefits, limitationsand prospects].

The article provides an overview of current approaches to the treatment of urolithiasis using extracorporeal shock wave lithotripsy (ESWL). The clinical aspects of use of ESWL in patients with urolithiasis are reported; the main technical specifications of lithotripters are described; the limitations and contraindications for lithotripsy are discussed. Based on the analysis of the main barriers to successful ESWL, data on current trends in the development of this method and increase of its efficacy are presented.

[MARKERS OF KIDNEY DAMAGE AND NEPHROPROTECTIVE THERAPY IN RADICAL CYSTECTOMY].

The comparative analysis of changes of the functional (osmolar clearance and fractional excretion of urea) and structural (NGAL, ß2-microglobulin in the blood plasma, and NGAL, ß2-microglobulin, microalbumin in the urine) biomarkers of kidney damage before and at various stages after radical cystectomy was performed. The study included patients with T2N0M0 stage bladder cancer. The main group consisted of 37 patients receiving nephroprotective treatment (N-acetylcysteine), the comparison group--31 patients receiving background therapy. It was revealed that severity of kidney dysfunction and the incidence of chronic kidney disease in the long-term period after surgery decreased in the main group.

[Use of antagonistic Bacillus subtilis bacteria for treatment of nosocomial urinary tract infections].

Effect of Bactisporin--a probiotic, containing spores of aerobic Bacillus subtilis 3H bacterium--for complex treatment of patients with nosocomial urinary tract infections was studied. 68 Cultures of different species of conditionally pathogenic bacteria were isolated from urine of the patients. Susceptibility of the isolated cultures to antibiotics before and after application of B. subtilis 3H metabolites was determined. The metabolites were accumulated on potato-glucose agar (PGA) while bacterium was cultivated on kapron membranes placed on surface of the medium. Influence of obtained metabolites on isolated strains was assessed by cultivation of each strain in metabolites-rich PGA during 24 h. Metabolites of B. subtilis led to decrease in resistance of isolated uropathogenic microflora to antibiotics. Use of Bactisporin in complex treatment of nosocomial urinary tract infections resulted in accelerated elimination of causative microorganism.

[Efficacy of probiotic bactisporin in therapy of intrahospital urinary infection].

We studied efficacy of bactisporin (probiotic based on aerobic spore-forming culture Bacillus subtilis, strain 3H) in combined treatment of intrahospital urinary infection (IUI) in 36 patients with infravesical obstruction. These patients developed postoperative complications due to IUI caused by antibiotic-resistant hospital flora. The control group consisted of 35 patients matched by age and disease given conventional postoperative etiotropic therapy. Bacterial translocation enables bactisporin to enter blood through gastric mucosa. Blood flow delivered the drug to the inflammation focus. Bactisporin can also directly affect IUI pathogen if bacterial suspension is introduced into the cavity. Bacteriological efficacy of the etiotropic scheme including bactisporin against Proteus spp., Ps aeruginosa, Enterobacter spp., Klebsiella spp. made up 72.7-92%. Bactisporin shortened the time of clinical normalization as well as normalization of absolute count of T- and B-lymphocytes, phagocyting leukocytes and immunoglobulin G. Thus, probiotic bactisporin is effective against antibiotic-resistant agents of IUI. It also stimulates immunity promoting clinicoimmunological remission.