Кальциурия – метаболический маркер различных состояний и заболеваний


DOI: https://dx.doi.org/10.18565/urology.2017.5.132-138

Л.В. Егшатян, Н.Г. Мокрышева

ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Министерства здравоохранения Российской Федерации, Москва, Россия; кафедра эндокринологии и диабетологии ГБОУ ВПО «Московский государственный медико-стоматологический университет им. А. И. Евдокимова», Москва, Россия
В статье проанализированы данные литературы об особенностях гомеостаза кальция в организме. Рассмотрена этиопатогенетическая роль кальцитропных гормонов, кислотно-основного состояния плазмы и мочи, различных ионов, образа жизни и питания пациентов и других факторов, приводящих к гиперкальциурии вследствие усиленной абсорбции в кишечнике, резорбции костной ткани, нарушения процессов реабсорбции кальция в канальцах почек и т.д. Обсуждается роль кальциурии как системного фактора формирования мочевых камней, приведены данные собственного наблюдения.
Ключевые слова: кальций, кальциурия, метаболизм кальция, мочекаменная болезнь

Литература


1. Guyton C. & Hall John E.. Textbook of Medical Physiology. Per. s angl. M.: Logosfera. 2008; 1296. Russian (Гайтон А.К., Холл Дж.Э. Медицинская физиология. Пер. с англ. М.: Логосфера. 2008; 1296).

2. Recker R.R. Calcium absorbtion and achlorhydria. N Engl J Med. 1985;313:60–73.

3. Norman D.A., Fordtran J.S., Brinkley L.J., Zerwekh J.E., Nicar M.J., Strowig S.M., Pak C.Y. Jejunal and ileal adaptation to alterations in dietary calcium: changes in calcium and magnesium absorption and pathogenetic role of parathyroid hormone and 1,25-dihydroxyvitamin D. J Clin Invest. 1981; 67(6):1599–1603.

4. Curhan G.C., Willett W.C., Knight E.L., Stampfer M.J. Dietary factors and the risk of incident kidney stones in younger women (Nurses’ Health Study II). Arch Intern Med. 2004;164:885–891.

5. Taylor E.N., Stampfer M.J., Curhan G.C. Dietary factors and the risk of incident kidney stones in men: New insights after 14 years of follow-up. J Am Soc Nephrol. 2004;15:3225–3232.

6. Friedman P.A. Calcium transport in the kidney. Current Opinion in Nephrology & Hypertension. 1999;8(5):589–595.

7. Gesek F.A., Friedman P.A. On the mechanism of parathyroid hormone stimulation of calcium uptake by mouse distal convoluted tubule cells. J Clin Invest. 1992;90(3):749–758.

8. Andrukhova O., Smorodchenko A., Egerbacher M., Streicher C., Zeitz U., Goetz R., Shalhoub V., Mohammadi M., Pohl E.E., Lanske B., Erben R.G. FGF23 promotes renal calcium reabsorption through the TRPV5 channel. EMBO J. 2014;33:229–246.

9. Friedman P.A. Renal calcium metabolism. In: The Kidney: Physiology and Physiopathology, 3rd Ed., edited by Giebisch G, Seldin D, Philadelphia, Lippincott Williams & Wilkins. 2000;1749–1778.

10. Cioppi F., Taddei L., Brandi M.L., Croppi E. Idiopathic hypercalciuria and calcium renal stone disease: our cases. Clin Cases Miner Bone Metab. 2009;6(3):251–253.

11. Curhan G.C., Willett W.C., Speizer F.E., Stampfer M.J. Twenty-four-hour urine chemistries and the risk of kidney stones among women and men. Kidney Int. 2001;59(6):2290–2298.

12. Robertson W.G., Morgan D.B. The distribution of urinary calcium excretions in normal persons and stone-formers. Clin Chim Acta. 1972;37:503–508.

13. Taylor E.N., Curhan G.C. Demographic, dietary, and urinary factors and 24-h urinary calcium excretion. Clin J Am Soc Nephrol. 2009;4(12):1980–1987.

14. Isakova T., Anderson C.A., Leonard M.B., Xie D., Gutiérrez O.M., Rosen L.K., Theurer J., Bellovich K., Steigerwalt S.P., Tang I., Anderson A.H., Townsend R.R., He J., Feldman H.I., Wolf M. Diuretics, calciuria and secondary hyperparathyroidism in the Chronic Renal Insufficiency Cohort. Nephrol Dial Transpl. 2011;26(4):1258–65. Doi: 10.1093/ndt/gfr026.

15. Pak C.Y., Sakhaee K., Moe O.W., Poindexter J., Adams-Huet B., Pearle M.S., Zerwekh J.E., Preminger G.M., Wills M.R., Breslau N.A., Bartter F.C., Brater D.C., Heller H.J., Odvina C.V., Wabner C.L., Fordtran J.S., Oh M., Garg A., Harvey J.A., Alpern R.J., Snyder W.H., Peters P.C. Defining hypercalciuria in nephrolitiasis. Kidney Int. 2011;80(7):777–782.

16. DiBianco J.M., Jarrett T.W., Mufarrij P. Metabolic Syndrome and Nephrolithiasis Risk: Should the Medical Management of Nephrolithiasis Include the Treatment of Metabolic Syndrome? Rev Urol. 2015;17(3):117–128.

17. Moudi E., Hosseini S.R., Bijani A. Nephrolithiasis in elderly population; effect of demographic characteristics. J Nephropathol. 2017;6(2):63–68. Doi: 10.15171/jnp.2017.11.

18. Cappuccio F., Kalaitzidis R., Duneclift S., Eastwood J. Unravelling the links between calcium excretion, salt intake, hypertension, kidney stones and bone metabolism. J Neph. 2000;13(3):169–177.

19. Chan E.L., Ho C.S., MacDonald D., Ho S.C., Chan T.Y., Swaminathan R. Interrelationships between urinary sodium, calcium, hedroxyproline and serum PTH in healthy subjects. Acta Endocrinol. 1992;127:242–245.

20. Yatabe M.S., Yatabe J., Takano K., Murakami Y., Sakuta R., Abe S., Sanada H., Kimura J., Watanabe T. Effects of a high-sodium diet on renal tubule Ca2+ transporter and claudin expression in Wistar-Kyoto rats. BMC Nephrol. 2012;13:160. Doi: 10.1186/1471-2369-13-160

21. van Abel M., Hoenderop J.G., van der Kemp A.W., Friedlaender M.M., van Leeuwen J.P., Bindels R.J. Coordinated control of renal Ca(2+) transport proteins by parathyroid hormone. Kidney Int. 2005;68(4):1708–1721.

22. Hoenderop J.G., Dardenne O., van Abel M., van Der Kemp A.W., van Os C.H., St-Arnaud R., Bindels R.J. Modulation of renal Ca2+ transport protein genes by dietary Ca2+ and 1,25-dihydroxyvitamin D3 in 25-hydroxyvitamin D3-1alpha-hydroxylase knockout mice. FASEB J. 2002;16(11):1398–1406.

23. Lytton J., Lee S.L., Lee W.S., van Baal J., Bindels R.J., Kilav R., Naveh-Many T., Silver J. The kidney sodium-calcium exchanger. Ann N Y Acad Sci. 1996;779:58–72.

24. Taylor E.N., Curhan G.C. Demographic, Dietary, and Urinary Factors and 24-h Urinary Calcium Excretion. Clin J Am Soc Nephrol. 2009;4(12):1980–1987. Doi: 10.2215/CJN.02620409.

25. Mendel L., Benedict S. The paths of excretion for inorganic compounds: The excretion of magnesium. Am J Physiol 1909;25:1–22.

26. Cruikshank D.P., Pitkin R.M., Donnelly E., Reynolds W.A. Urinary magnesium, calcium, and phosphate excretion during magnesium sulfate infusion. Obstet Gynecol. 1981;58(4):430–434.

27. Nilius B., Vennekens R., Prenen J., Hoenderop J.G., Droogmans G., Bindels R.J. The single pore residue Asp542 determines Ca2+ permeation and Mg2+ block of the epithelial Ca2+ channel. J Biol Chem. 2001;276:1020–1025.

28. Bonny O., Rubin A., Huang C.L., Frawley W.H., Pak C.Y., Moe O.W. Mechanism of Urinary Calcium Regulation by Urinary Magnesium and pH. J Am Soc Nephrol. 2008;19(8):1530–1537. Doi: 10.1681/ASN.2007091038.

29. Li M., Du J., Jiang J, Ratzan W., Su L., Runnels L., Yue L. Molecular determinants of Mg+ and Ca+ permeability and pH sensitivity in TRPM6 and TRPM7. J Biol Chem. 2007;282(35)25817–25830.

30. Massey L.K., Opryszek A.A. No effects of adaptation to dietary caffeine on calcium excretion in young women. Nutr Res. 1990;(10)7:741–747.

31. Hallström H., Wolk A., Glynn A., Michaëlsson K. Coffee, tea and caffeine consumption in relation to osteoporotic fracture risk in a cohort of Swedish women. Osteoporos Int. 2006;17(7):1055–1064.

32. Gleeson M.J., Thompson A.S., Mehta S., Griffith D.P. Effect of unprocessed wheat bran on calciuria and oxaluria in patients with urolithiasis. Urology. 1990;35(3):231–234.

33. Reddy S.T., Wang C.Y., Sakhaee K., Brinkley L., Pak C.Y. Effect of low-carbohydrate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolism. Am J Kidney Dis. 2002;40(2):265–274.

34. Martini L., Wood R.J. Relative bioavailability of calcium-rich dietary sources in the elderly. Am J Clin Nutr. 2002;76:1345–1350.

35. Itoh Y., Yoshimura M., Niimi K., Usami M., Hamamoto S., Kobayashi T., Hirose M., Okada A., Yasui T., Tozawa K., Kohri K. The role of long term loading of cholesterol in renal crystal formation. Arch Ital Urol Androl. 2011;83(1):23–25.

36. Jacobsen R. Effect of short-term high dietary calcium intake on 24-h energy expenditure, fat oxidation, and fecal fat excretion. Int J Obes (Lond). 2005;29(3):292–301.

37. Cunningham J., Fraher L.J., Clemens T.L., Revell P.A., Papapoulos S.E. Chronic acidosis with metabolic bone disease. Am J Med. 1982;73:199–204.

38. Moe O.W., Huang C.L. Hypercalciuria from acid load: renal mechanisms. J Nephrol. 2006;19(3):53–61.

39. Yeh B.I., Sun T.J., Lee J.Z., Chen H.H., Huang C.L. Mechanism and molecular determinant for regulation of rabbit transient receptor potential type 5 (TRPV5) channel by extracellular pH. J Biol Chem. 2003;278:51044–1052.

40. Yeh B.I., Yoon J., Huang C.L. On the role of pore helix in regulation of TRPV5 by extracellular protons. J Membr Biol. 2006;212:191–198.

41. Schwille P.O., Schmiedl A., Herrmann U., Fan J., Gottlieb D., Manoharan M., Wipplinger J. Magnesium, citrate, magnesium citrate and magnesium-alkali citrate as modulators of calcium oxalate crystallization in urine: observations in patients with recurrent idiopathic calcium urolithiasis. J Urol Res. 1999;27(2):117–126.

42. Sebastian A., Harris S.T., Ottaway J.H., Todd K.M., Morris R.C. Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. Jr. N Engl J Med. 1994;330(25):1776–1781.

43. Morin P.J. Protein family review the claudins. Genome Biology. 2009;10.235.

44. Kausalya P., Amasheh S., Gunzel D., Wurps H., Muller D., Fromm M., Hunziker W. Disease-associated mutations affect intracellular traffic and paracellular Mg2+ transport function of claudin-16. J. Clin. Invest. 2006;116:878–891.

45. Raskin P., Stevenson M.R., Barilla D.E., Pak C.Y. The hypercalciuria of diabetes mellitus: its amelioration with insulin. Clin Endocrinol (Oxf). 1978;9(4):329–335.

46. Simpkin A., Cochran E., Cameron F., Dattani M., de Bock M., Dunger D.B., Forsander G., Guran T., Harris J., Isaac I., Hussain K., Kleta R., Peters C., Tasic V., Williams R., Yap Kok Peng F., O’Rahilly S., Gorden P., Semple R.K., Bockenhauer D. Insulin Receptor and the Kidney: Nephrocalcinosis in Patients with Recessive INSR Mutations. Nephron Physiol. 2014. Doi: 10.1159/000366225.

47. Chechurin R.E., Ametov A.S. Sakharnyy diabet I tipa i osteoporoz. Osteoporoz i osteopatii. 1999;(1):2–5.

48. Zhang C., Miller C.L., Gorkhali R., Zou J., Huang K., Brown E.M., Yang J.J. Molecular Basis of the Extracellular Ligands Mediated Signaling by the Calcium Sensing Receptor. Front Physiol. 2016;7:441.

49. Hendy G.N., Canaff L. Calcium-Sensing Receptor Gene: Regulation of Expression. Front Physiol. 2016;7:394.

50. Seth-Vollenweider T., Joshi S., Dhawan P., Sif S., Christakos S. Novel mechanism of negative regulation of 1,25-dihydroxyvitamin D3-induced 25-hydroxyvitamin D3 24-hydroxylase (Cyp24a1) Transcription: epigenetic modification involving cross-talk between protein-arginine methyltransferase 5 and the SWI/SNF complex. J Biol Chem. 2014;289(49):33958–70. Doi: 10.1074/jbc.M114.583302.

51. Scarpelli D.G., Tremblay G., Pearse A.G. A comparative cytochemical and cytologic study of vitamin D induced nephrocalcinosis. Am J Pathol. 1960;36():331–353.

52. Nesterova G., Malicdan M.C., Yasuda K., Sakaki T., Vildoux T., Cicone C., Horst R., Huang Y., Golas G., Introne W., Huizing M., Adams D., Boerkoel C.F., Collins M.T., Gahl W.A. 1,25(OH)2D-24 Hydroxylase (CYP24A1) deficiency as a cause of nephrolithiasis. Clin J Am Soc Nephrol. 2013;8(4):649–657.

53. Chandrashekariah S., Rosha D. Sarcoidosis in India: Investigation into vitamin D and calcium metabolism. Eur. Respir. J. 2014;44(58):3777.

54. Blaine J., Chonchol M., Levi M. Renal control of calcium, phosphate, and magnesium homeostasis. Clin J Am Soc Nephrol. 2015;10:1257–1272.

55. Bacic D., Lehir M., Biber J., Kaissling B., Murer H., Wagner C.A. The renal Na/phosphate cotransporter NaPi-IIa is internalized via the receptor-mediated endocytic route in response to parathyroid hormone. Kidney Int. 2006;69:495–503.

56. Lee J.Y., Imel E.A. The Changing Face of Hypophosphatemic Disorders in the FGF-23. Era. Pediatr. Endocrinol. Rev. 2013;10(2):367–379.

57. Lee M., Partridge N.C. Parathyroid hormone signaling in bone and kidney. Curr Opin Nephrol Hypertens. 2009;18(4):298–302.

58. Vella M., Karydi M., Coraci G., Oriti R., Melloni D. Patophysiology and clinical aspects of urinary lithiasis. Urologia Int. 2007;79(1):26–31.

59. Nordin B.E., Need A.G., Morris H.A., Horowitz M., Robertson W.G. Evidence for a renal calcium leak in postmenopausal women. J Clin Endocrinol Metab. 1991;72:401–407.

60. Lips P., Duong T., Oleksik A., Black D., Cummings S., Cox D., Nickelsen T. A global study of vitamin D and parathyroid function in postmenopausal women with osteoporosis: baseline data from the multiple outcomes of raloxifene evaluation clinical trial. J Clin Endocrinol. Metab. 2001;86:1212–1221.

61. Popovtzer M.M., Knochel J.P., Kumar R. Disorders of calcium, phosphorus, vitamin D and parathyroid hormone activity. Renal and Electrolyte Disorders. 1996;34–41.

62. Galitzer H., Ben-Dov I.Z., Silver J., Naveh-Many T. Parathyroid cell resistance to fibroblast growth factor 23 in secondary hyperparathyroidism of chronic kidney disease. Kidney Int. 2010;77(3):211–218.

63. Isakova T., Anderson C.A., Leonard M.B., Xie D., Gutiérrez O.M., Rosen L.K., Theurer J., Bellovich K., Steigerwalt S.P., Tang I., Anderson A.H., Townsend R.R., He J., Feldman H.I., Wolf M. Diuretics, calciuria and secondary hyperparathyroidism in the Chronic Renal Insufficiency Cohort. Nephrol Dial Transpl. 2011;26(4):1258–1265. Doi: 10.1093/ndt/gfr026.

64. Rejnmark L., Vestergaard P., Heickendorff L., Andreasen F., Mosekilde L. Loop diuretics increase bone turnover and decrease BMD in osteopenic postmenopausal women: results from a randomized controlled study with bumetanide. J Bone Miner Res. 2006;21(1):163–170.

65. Hoenderop J.G., van Leeuwen J.P., van der Eerden B.C., Kersten F.F., van der Kemp A.W., Mérillat A.M., Waarsing J.H., Rossier B.C., Vallon V., Hummler E., Bindels R.J. J Clin Invest. Renal Ca2+ wasting, hyperabsorption, and reduced bone thickness in mice lacking TRPV5. J Clin Invest. 2003;112(12):1906–1914.

66. Elaine M. and Fredric L. Coe. Nephrolithiasis. Prim Care. 2008;35(2):369.

67. Siener R., Albrecht H. The effect of Different Diets on Urine Composition and the of Calcium Oxalate Cristallisation in Healthy Subject. Eur Ur. 2002;42:289–296.

68. Дзеранов Н.К, Егшатян Л.В., Мокрышева Н.Г., Перетокина Е.В. Клинико-лабораторные показатели у пациентов с мочекаменной болезнью при наличии и отсутствии первичного гиперпаратиреоза. Урология. 2013;6:14–19.


Об авторах / Для корреспонденции


А в т о р д л я с в я з и: Л. В. Егшатян – к.м.н., старший научный сотрудник центра патологии околощитовидных желез ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Министерства здравоохранения Российской Федерации, ассистент кафедры эндокринологии и диабетологии МГМСУ им. А.И. Евдокимова, Москва, Россия; е-mail: lilit.egshatyan@yandex.ru


Бионика Медиа