Salt diathesis - overproduction of salts in the body

The tendency of the body to excess formation of oxalates, urates and phosphates - that is, urolithic or salt diathesis - is associated with genetically determined metabolic peculiarities.

Until the predisposition has passed into a particular disease, it can be classified as a metabolic disorder, and this is correct from the point of view of etiology.

[1], [2], [3]

Causes of the salt diathesis

Judging by the classification "variations", it is not difficult to imagine certain problems in determining the exact cause of salt diathesis. Features of the course of metabolic processes in the body of different people are embedded in genes, and metabolic disorders, which include salt diathesis, also have an innate character. And very often urologists and nephrologists mark not only an idiopathic (that is for some unknown reason) propensity to salt formation, but often a diagnosis is made, for example - idiopathic kidney stone disease ...

That is, the reasons for the predisposition to excessive formation of salts are much deeper than just the use of products that promote the increase in urine salt levels. Of course, the composition of food consumed affects the appearance of excess salts with salt diathesis, but is an aggravating factor, and not the root cause. Salt diathesis is a consequence of:

• insufficient assimilation of certain substances, their subsequent cleavage and release of the organism from the "waste" of metabolism through the kidneys;
• violations 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 endocrine system - the functioning of the endocrine glands (adrenal glands, pituitary gland, hypothalamus, parathyroid gland), as well as 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) is completed by the formation of amine nitrogen and ammonia, in the neutralization of which the intestine and liver participate, excretion is performed by the kidneys, excreting urea (urea), uric acid, residual nitrogen, ammonia and ammonium salts. The pathogenesis of urate (urate) and phosphate salt diathesis is directly related to the problems of urea synthesis, in particular, with the insufficiency of hepatic transaminases - the enzymes of the ornithine cycle (the Krebs-Hanselayt cycle). Such fermentopathy, according to research, is very often caused by gene mutations. In addition, urine acid 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 violations of urine formation.

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

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

[4], [5], [6], [7], [8], [9]

Symptoms of the salt diathesis

Salt diathesis differs in the form of salts, the overproduction of which is inclined to the organism of a particular person. Subjective symptoms of salt diathesis (that is, felt by the patient) are absent. However, there are objective symptoms, which are identified by the results of a laboratory study of urine.

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

Urine or urate salt diathesis urologists ascertain in the patient with an elevated urinary acid content in urine, which in urinary 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 predisposition to the formation of phosphate salts - phosphate diathesis - is determined at such parameters as urine pH> 7 (urine alkaline) and the presence in it of amorphous calcium phosphate or the smallest crystals of triple salt - ammonium phosphate, phosphoric acid magnesium and ammonium carbonate. The urine is pale, 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 perfectly visible in ultrasound examination of the kidneys. In this case, echoes of salt diathesis are defined as positive, that is, confirming the presence of pathology.

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

As noted by urologists, the effects 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 the fourth grade (endocrine system diseases, eating disorders and metabolic disorders), the revealed deficiency of enzymes in the urea cycle has a code according to the ICD 10 E72.2, and the violation of the exchange of purines and pyrimidines - E79.

If there are deviations in the urinalysis and the diagnosis is not made, then, according to the international classification, this refers to class XVIII, R80-R82. And only diagnosed urolithiasis has a code on the ICD 10 - class XIV, N20-N23.

[10], [11], [12]

Diagnostics of the salt diathesis

The main indicator on which diagnosis of salt diathesis is based is the composition of urine. Therefore, tests must be submitted:

• clinical analysis of urine;
• biochemical analysis of urine (pH, density, salt content);
• daily urine analysis (at the level of salts).

In addition, an experienced specialist will prescribe a biochemical blood test (for 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 there is sand or small stones (which do not yet make themselves felt).

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

[13], [14], [15]

Treatment of the salt diathesis

The tendency of the body to increase the formation of salts is not a disease, so the treatment of salt diathesis is often called management.

Manage is necessary with the help of a significant increase in the volume of water consumption: at least two liters per day, or more. This will increase diuresis, since approximately two-thirds of the fluid will be excreted in the form of urine. Thus, the concentration of oxalate, urate or phosphate in the urine decreases.

The second main method for controlling salt diathesis was formulated by Hippocrates: "Let food be your medicine." That is, it is necessary to introduce cardinal changes in your usual diet. And these adjustments in nutrition entirely depend on which salts "overproduce" the body.

Diet with salt diathesis should be vegetable-milk - for details, see:

• Diet with oxalate in urine
• Diet with increased uric acid
• Diet with kidney stones

Diet with salt diathesis with a tendency to the formation of phosphate salts (№ 14 in Pevzner) will help to increase the acidity of urine due to the limitation of milk and dairy products (because they have a lot of calcium), almost all vegetables (you can eat pumpkin and green peas) and fruits except for acidic 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 the mineral water of the Truskavets springs.

Medicines are prescribed by doctors, usually as soon as sand is detected in the urine. With oxalate and urate acid diathesis, it is vitamin B6, magnesium sulfate (or other magnesium preparations), asparks (0.35 g twice daily), and to neutralize urine pH - potassium citrate (Urozit), Blamaren, Solimok or hydrocitrate complex of potassium and sodium Uralit-U.

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

Alternative treatment with the use of decoctions of medicinal plants with diuretic properties is also used: leaves of bearberry, cowberry or birch, corn stigmas, spores (rhizome), chamomile flowers.

Treatment with herbs phosphate salt diathesis includes daily intake of 2-3 cups of decoction from a mixture of bearberry, gryzhnika and flowers of black elderberry (in a proportion of 3: 1: 1) - 10 grams per 200 ml of water.

To prevent the formation of concrements, homeopathy offers Calcarea carbonica, Lycopodium, Sulfur, Berberis.

Prevention

Prophylaxis of salt diathesis is possible only when you know exactly what you have problems with metabolism. To make sure that the tendency to "saline" urine is available, once a year, go to the urologist and take a urine test. And proper nutrition and the use of the recommended amount of liquid will help to make a prognosis of the metabolic syndrome called "salt diathesis" positive.

[16], [17], [18], [19],