Klyus A. Metaphylactics of phosphoroacidic nephrolithiasis with regard for preconditions to the development of recurrent lithogenesis

The dissertation is devoted to the improvement of efficacy in treatment of recurrent phosphoroacidic nephrolithiasis (PAL) by perfecting the schemes of metaphylactics of this pathology both early and remote, which takes into account various stages of activity of chronic pyelonephritis, individual condition of risk factors and course of disease. The scheme of early metaphylactics includes the following: identification of a pathogen, urinary pH determination, further administration of the adequate antibacterial therapy even at the preoperative period; full removal of a concrement under the condition of outer and inner draining of a kidney; acidification of urine with the inclusion of phyto- and medicamental preparations. Independently of different stages of traumatism caused by a selected method to remove a stone, the whole complex of the objective indices, usage of the scheme of early metaphylactics in 118 patients under study at the pre- and early postoperative period improved the course, shortened the postoperative rehabilitation, hastened the resumption of functional ability of an injured kidney by the indices of a complex laboratory and instrumental examination. In case of further monitoring of clinical analysis and determination of a stable tendency to their normalization, the regimen of remote antirecurrent therapy is used which includes regular microbiologic and pH control of urine, if necessary, all-laboratory, US and roentgen examinations along with the control of the efficacy of treatment and the correction of the adequate antibacterial therapy, urinary pH and water discipline.The implementation of all conditions of PAL metaphylactics schemes, in particular at the presence of "infectious concrement", allowed during the most dangerous first year after its removal to reduce the percentage of recurrent lithogenesis to 17 (16.0%) cases at a whole, that is rather less than the literature shows the frequency of PAL recurrence (40 - 70%).