Salt diathesis - overproduction of salts in the body

The body's tendency to excessive formation of oxalates, urates and phosphates - that is, urolithiasis or salt diathesis - is associated with genetically determined metabolic characteristics.

Until the predisposition has developed into a specific disease, it can be classified as a metabolic disorder, and this is correct from an etiological point of view.

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Causes salt diathesis

Judging by the classification "variations", it is easy to imagine certain problems in determining the exact cause of salt diathesis. The peculiarities of the metabolic processes in the body of different people are embedded in genes, and metabolic disorders, which include salt diathesis, are also congenital. And very often urologists and nephrologists note not only an idiopathic (that is, for an unknown reason) tendency to form salts, but often make a diagnosis, for example, - idiopathic kidney stone disease...

That is, the causes of predisposition to excessive salt formation are much deeper than just eating foods that contribute to an increase in the levels of salts in the urine. Of course, the composition of the food consumed affects the appearance of excess salts in salt diathesis, but it is an aggravating factor, not the root cause. Salt diathesis is a consequence of:

• insufficient absorption of certain substances, their subsequent breakdown and release of the body from metabolic “waste” through the kidneys;
• disorders of glomerular filtration or tubular reabsorption in the kidneys;
• problems with neurohormonal regulation of metabolic processes.

In the latter case, the pathogenesis of salt diathesis is associated with the work of the endocrine system - the functioning of the endocrine glands (adrenal glands, pituitary gland, hypothalamus, parathyroid gland), as well as with the action (or inaction) of the hormones they produce, such as vasopressin, renin, angiotensin, aldosterone, parathyroid hormone, etc.

As is known, the metabolism of nitrogenous substances (proteins, amino acids, purine and pyrimidine nucleotides) ends with the formation of amine nitrogen and ammonia, the neutralization of which involves the intestine and liver, and the excretion is carried out by the kidneys, removing urea (carbamide), uric acid, residual nitrogen, ammonia and ammonium salts with urine. The pathogenesis of urate (uric acid) and phosphate salt diathesis is directly related to problems with urea synthesis, in particular, with the insufficiency of liver transaminases - enzymes of the ornithine cycle (Krebs-Henseleit cycle). Such fermentopathy, according to research, is very often caused by gene mutations. In addition, uric acid salt diathesis in children can develop due to congenital anomalies of the pituitary-hypothalamic zones of the brain, which causes problems with the synthesis of antidiuretic hormone (vasopressin) and leads to various disorders of urine formation.

The key causes of salt diathesis with increased formation of oxalates are the disruption of the glyoxalate cycle in the process of endogenous oxalic acid metabolism due to a congenital deficiency of the enzyme glycoxylate aminotransferase. Excessive accumulation of oxalic acid (hyperoxaluria) increases its content in the urine. This salt diathesis in children under 4 years of age leads to oxalate (oxalate-calcium) nephropathy (ICD 10 code - E74.8) and severe kidney pathology. Insoluble crystals of calcium salt are formed even with a normal level of urine acidity. Excess oxalates in the urine quickly form oxalate stones in the bladder, so such cases can be considered as salt diathesis of the bladder.

Some specialists still see the main reason for the increased formation of oxalates in exogenous oxalic acid (i.e., entering the body with food), as well as with a violation of calcium metabolism - since this acid forms insoluble salts with calcium. By the way, uric acid also "prefers" Ca, and its level in the body increases with an increase in the activity of parathyroid hormone or with increased absorption of calcium in the intestine.

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Symptoms salt diathesis

Salt diathesis differs by the type of salts, the overproduction of which is prone to a particular person's body. Subjective symptoms of salt diathesis (i.e., those felt by the patient) are absent. However, there are objective symptoms that are revealed by the results of laboratory urine testing.

With oxalate (oxalate) diathesis, urine has a pH of 5.5-6 and a higher density; calcium oxalate crystal hydrate and calcium carbonate are found in it.

Urologists diagnose uric acid or urate salt diathesis in a patient with an increased content of uric acid in the urine, which in acidic urine (pH <5.5) can form crystals and urate salts of sodium, calcium, potassium or magnesium. The urine has a darker color.

Symptoms of salt diathesis with a predisposition to the formation of phosphate salts - phosphate diathesis - are determined by such indicators as urine pH> 7 (alkaline urine) and the presence of amorphous calcium phosphate or tiny crystals of triple salt - ammonium phosphate, magnesium phosphate and ammonium carbonate. In this case, the urine is pale in color, slightly turbid, with a low specific gravity and a peculiar odor.

In domestic urology, salt diathesis of the kidneys is determined by the presence of sand in the renal pelvis, which is clearly visible during ultrasound examination of the kidneys. In this case, echo signs of salt diathesis are determined as positive, that is, confirming the presence of pathology.

The first signs of salt urate diathesis may appear due to a sharp increase in urine acidity, when over-acidified urine irritates the mucous membranes and causes a burning sensation during emptying of the bladder. Even if there is no sand in the kidneys or bladder, complications occur in many patients: in women - in the form of cystitis with its typical symptoms of inflammation of the bladder mucosa (frequent urges and burning during urination), in men - in the form of painful urination, as with urethritis.

As urologists note, the consequences of salt diathesis increase the number of their regular patients, since this pathology is the first step to the development of urolithiasis and nephrolithiasis.

Forms

In class IV (diseases of the endocrine system, nutritional disorders and metabolic disorders), the identified deficiency of urea cycle enzymes has the ICD 10 code E72.2, and disorders of purine and pyrimidine metabolism - E79.

If abnormalities are found in the urine analysis, but no diagnosis is made, then, according to the international classification, this refers to class XVIII, R80-R82. And only diagnosed urolithiasis has a code according to ICD 10 - class XIV, N20-N23.

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Diagnostics salt diathesis

The main indicator on which the diagnosis of salt diathesis is based is the composition of urine. Therefore, the following tests are required:

• clinical urine analysis;
• biochemical analysis of urine (pH, density, salt content);
• daily urine analysis (for salt levels).

In addition, an experienced specialist will prescribe a biochemical blood test (for the level of urea, creatinine and nitrogen); a blood test for ammonia and other products of the urea cycle, as well as a blood test for sugar.

Instrumental diagnostics – ultrasound of the kidneys, bladder and urinary tract – allows doctors to see what is happening in these organs and whether there is sand or small stones there (which are not yet making themselves known).

Differential diagnosis should be based on clinical urine analysis, since uric acid crystallizes in patients with leukemia, and calcium phosphate often forms crystals in patients with bladder and urinary tract infections, increased gastric acidity, rheumatic diseases, or spinal cord pathologies.

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Treatment salt diathesis

The body's tendency to increased salt formation is not a disease, so treatment of salt diathesis is often called management.

It is necessary to manage by significantly increasing the volume of water consumption: at least two liters per day, and possibly more. This will increase diuresis, since approximately two thirds of the liquid drunk will be excreted in the form of urine. Thus, the concentration of oxalates, urates or phosphates in the urine decreases.

The second main method of managing salt diathesis was formulated by Hippocrates: "let food be your medicine." That is, it is necessary to make radical changes to your usual diet. And these adjustments in nutrition depend entirely on what salts the body "overproduces."

The diet for salt diathesis should be plant-based and dairy-based - for more details, see:

• Diet for oxalates in urine
• Diet for high uric acid
• Diet for kidney stones

A diet for salt diathesis with a tendency to form phosphate salts (No. 14 according to Pevzner) will help increase the acidity of urine by limiting dairy and fermented milk products (since they contain a lot of calcium), almost all vegetables (you can eat pumpkin and green peas) and fruits (except sour ones). You can eat meat, fish (except salted and smoked), cereals, bakery products. The daily norm of table salt is 12 g. It is useful to drink mineral water from Truskavets springs.

Medicines are prescribed by doctors, as a rule, when sand is detected in the urine. For oxalate and urate diathesis, this is vitamin B6, magnesium sulfate (or other magnesium preparations), Asparkam (0.35 g twice a day), and to neutralize the pH of urine - Potassium Citrate (Urocit), Blemaren, Solimok or the potassium and sodium hydrocitrate complex Uralit-U.

And for phosphate diathesis, it is recommended to take drugs containing magnesium, as well as Phosphotech (other trade names - Etidronic acid, Xidifon).

Traditional treatment is also used by consuming decoctions of medicinal plants with diuretic properties: bearberry, lingonberry or birch leaves, corn silk, knotweed (rhizome), and chamomile flowers.

Herbal treatment of phosphate salt diathesis includes daily consumption of 2-3 glasses of a decoction of a mixture of bearberry, hernia and black elderberry flowers (in a ratio of 3:1:1) - 10 g per 200 ml of water.

To prevent the formation of stones, homeopathy offers the following preparations: Calcarea carbonica, Lycopodium, Sulfur, Berberis.

Prevention

Prevention of salt diathesis is possible only when you know for sure that you have problems with metabolism. To make sure that there is a tendency to "oversalt" urine, it is enough to visit a urologist once a year and take a urine test. And proper nutrition and drinking the recommended amount of liquid will help make the prognosis of metabolic syndrome called "salt diathesis" positive.

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