Epidemiyoloji ve Etyopatogenez
Özet
Üriner sistem taş hastalığı, üroloji pratiğinde en sık karşılaşılan, hastaların yaşam kalitesini düşüren ve ciddi sosyoekonomik kayıplara yol açan köklü bir sağlık problemidir. Geçmişi MÖ 4800’lü yıllara dayansa da hastalığın kesin nedenleri henüz tam olarak aydınlatılamamış olup taş oluşumunun çok faktörlü süreçlerden kaynaklandığı bilinmektedir. Hastalığın epidemiyolojisi coğrafya, iklim, yaş, cinsiyet, genetik, beslenme, vücut ağırlığı ve meslek gibi unsurlarla doğrudan ilişkilidir. Dünya genelinde prevalansı %1 ile %20 arasında değişen bu hastalık, Türkiye'de yaklaşık %11,1 oranında görülmektedir. Erkeklerde kadınlara oranla tarihsel olarak daha sık rastlansa da değişen diyet ve metabolik sendrom gibi etkenlerle günümüzde cinsiyetler arası bu fark giderek kapanmaktadır. Fizyokimyasal olarak taş oluşumu; idrardaki tuzların süpersatürasyonu, nükleasyon, agregasyon ve kristal büyümesi aşamalarıyla gerçekleşir; süreçte kalsiyum ve oksalat gibi promoterlar ile sitrat ve magnezyum gibi inhibitörler önemli rol oynar. Ayrıca hiperparatiroidizm, metabolik sendrom gibi sistemik rahatsızlıklar, sistinüri gibi genetik hastalıklar, idrar akışını engelleyen anatomik anomaliler, yüksek ısıya maruz bırakan meslekler ve bazı ilaçlar da taş nüksünü ve oluşum riskini artıran temel predispozan faktörler arasında yer almaktadır.
Urinary system stone disease is a deeply rooted health problem in urology practice that is most frequently encountered, reduces the quality of life of patients, and causes serious socioeconomic losses. Although its history dates back to 4800 BC, the exact causes of the disease have not yet been fully elucidated, and it is known that stone formation results from multi-factorial processes. The epidemiology of the disease is directly related to factors such as geography, climate, age, gender, genetics, nutrition, body weight, and occupation. This disease, with a global prevalence varying between 1% and 20%, is observed at a rate of approximately 11.1% in Turkey. Although historically more common in men than in women, this gender gap is gradually closing today due to factors such as changing diet and metabolic syndrome. Physicochemically, stone formation occurs through the stages of supersaturation of salts in urine, nucleation, aggregation, and crystal growth; promoters such as calcium and oxalate, and inhibitors such as citrate and magnesium play important roles in the process. Additionally, systemic disorders like hyperparathyroidism and metabolic syndrome, genetic diseases such as cystinuria, anatomical anomalies blocking urine flow, occupations involving high heat exposure, and certain medications are among the primary predispozan factors increasing the risk of stone formation and recurrence.
Referanslar
Anafarta, K., Bedük, Y., & Arıkan, N. (Eds.). 4. Baskı (2011). Temel üroloji. Güneş Kitabevi.
Trinchieri A. et al. Epidemiology, In: Stone Disease, K.S. C.P. Segura JW, Pak CY, Preminger GM, Tolley D., Editor. 2003, Health Publications: Paris
Ramello, A., Vitale, C., &Marangella, M. (2001). Epidemiology of nephrolithiasis. Journal of nephrology, 13, S45-S50.
Pinduli, I., Spivacow, R., Del Valle, E., Vidal, S., Negri, A. L., Previgliano, H., ... &Boffi-Boggero, H. J. (2006). Prevalence of urolithiasis in theautonomouscity of Buenos Aires, Argentina. Urologicalresearch, 34(1), 8-11. doi:10.1007/ s00240-005-0003-7
Medina-Escobedo, M., Zaidi, M., Real-de León, E., &Orozco-Rivadeneyra, S. (2002). Urolithiasisprevalenceand risk factors in Yucatan, Mexico. Saludpublica de Mexico, 44(6), 541-545.
Stamatelou, K. K., Francis, M. E., Jones, C. A., NybergJr, L. M., &Curhan, G. C. (2003). Time trends in reportedprevalence of kidneystones in the United States:1976-1994. Kidneyinternational, 63(5),1817-1823. https://doi.org/10.1046/j.1523-1755.2003.00917.x
Hesse, A., Brändle, E., Wilbert, D., Köhrmann, K. U., & Alken, P. (2003). Study on theprevalenceandincidence of urolithiasis in Germany comparingtheyears 1979 vs. 2000. Europeanurology, 44(6),709-713. https://doi.org/10.1016/S0302-2838(03)00415-9
Sánchez-Martín, F. M., &Martínez-Rodríguez, R. (2007). Incidenceandprevalence of publishedstudiesabouturolithiasis in Spain. A review. Actasurologicasespanolas, 31(5), 511-520. doı: 10.1016/s0210-4806(07)73675-6
Akinci, M., Esen, T., &Tellaloğlu, S. (1991). Urinary stone disease in Turkey:an updated epidemiological study. Europeanurology, 20,200-203. https://doi.org/10.1159/000471700
Muslumanoglu, A. Y., Binbay, M., Yuruk, E., Akman, T., Tepeler, A., Esen, T., &Tefekli, A. H. (2011). Updated epidemiologic study of urolithiasis in Turkey. I: Changing characteristics of urolithiasis. Urologicalresearch, 39(4), 309-314. doı: 10.1007/s00240-010-0346-6
Walker, V., Stansbridge, E. M., &Griffin, D. G. (2013). Demography and biochemistry of 2800 patients from a renal Stones clinic. Annals of clinicalbiochemistry, 50(2), 127-139. doi:10.1258/ acb.2012.012122
Zeng, Q., & He, Y. (2013). Age-specific prevalence of kidney stones in Chinese urban inhabitants. Urolithiasis, 41(1), 91-93. doi:10.1007/s00240-012-0520-0
Lieske, J., De La Vega, L. P., Slezak, J. M., Bergstralh, E. J., Leibson, C. L., Ho, K. L., &Gettman, M. T. (2006). Renal stone epidemiology in Rochester, Minnesota: an update. Kidneyinternational, 69(4), 760-764. doi:10.1038/sj.ki.5000150
McGeown, M. G. (1960). Heredity in renalstonedisease. Clinicalscience, 19, 465-471.
Stechman, M. J., Loh, N. Y., &Thakker, R. V. (2007). Genetics of hypercalciuricnephrolithiasis: renalstonedisease. Annals of the New York Academy of Sciences, 1116(1), 461-484. doi:10.1196/annals.1402.030
Estepa, L., Daudon, M., Hennequin, C., Lacour, B., Jungers, P., Jungers, P., &Daudon, M. (1997). Gender and age dependence of urinary stone composition in France. Renalstonedisease. Elsevier, Paris, 8-9.
Michaels, E. K., Nakagawa, Y., Miura, N., Pursell, S., &Ito, H. (1994). Racial variation in gender frequency of calcium urolithiasis. TheJournal of urology, 152(6), 2228-2231.
Robertson, W. J., &Peacock, M. (1981). Epidemiologicalfactors in thegenesis of calcium-containing urinary stones. Metabolic, physico-chemical, therapeutical aspects of urolithiasis. Milano: Wichting Editor, 5-20.
Evans, K., &Costabile, R. A. (2005). Time to development of symptomatic urinary calculi in a high risk environment. The Journalofurology, 173(3),858-861. https://doi.org/10.1097/01.ju.0000152578.07262.1c
Saigal, C. S., Joyce, G., Timilsina, A. R., &UrologicDiseases in America Project. (2005). Direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management?. Kidneyinternational, 68(4),1808-1814. doi:10.1111/j.1523-1755.2005.00599.x
Hiatt, R. A., Dales, L. G., Friedman, G. D., &Hunkeler, E. M. (1982). Frequency of urolithiasis in a prepaid medicalcare program. Americanjournal of epidemiology, 115(2), 255-265. https://doi.org/10.1093/oxfordjournals.aje.a113297
Croppi, E., Ferraro, P. M., Taddei, L., &Gambaro, G. (2012). Prevalence of renalstones in an Italian urban population: a general practice-basedstudy. Urologicalresearch, 40(5), 517-522. doi:10.1007/s00240-012-0477-z
Daudon, M., Doré, J. C., Jungers, P., &Lacour, B. (2004). Changes in stone composition according to age and gender of patients: a multivariate epidemiological approach. Urologicalresearch, 32(3),241-247. doi:10.1007/s00240-004-0421-y
Knoll, T., Schubert, A. B., Fahlenkamp, D., Leusmann, D. B., Wendt-Nordahl, G., & Schubert, G. (2011). Urolithiasis through the ages: data on morethan 200,000 urinary stone analyses. TheJournal of urology, 185(4), 1304-1311. doi:10.1016/j.juro.2010.11.073
Osther, P. J. (2012). Epidemiology of kidney stones in the European Union. In Urolithiasis (pp. 3-12). Springer, London.
Curhan, G. C. (2007). Epidemiology of stone disease. UrologicClinics of North America, 34(3), 287-293. doi:10.1016/j.ucl.2007.04.003
Goldfarb, D. S., &Arowojolu, O. (2013). Metabolic evaluation of first-time and recurrent stone formers. UrologicClinics, 40(1),13-20. doi:10.1016/j.ucl.2012.09.007
Atan, L., Andreoni, C., Ortiz, V., Silva, E. K., Pitta, R., Atan, F., &Srougi, M. (2005). High kidneystone risk in men working in steelindustry at hot temperatures. Urology, 65(5), 858-861. https://doi.org/10.1016/j.urology.2004.11.048
Ross, W. R., &McGill, J. B. (2006). Epidemiology of obesity and chronic kidney disease. Advances in chronic kidney disease, 13(4),325-335. https://doi.org/10.1053/j.ackd.2006.07.012
Taylor, E. N., Stampfer, M. J., &Curhan, G. C. (2005). Obesity, weight gain, and the risk of kidney stones. Jama, 293(4), 455-462. doi:10.1001/jama.293.4.455
Taylor, E. N., &Curhan, G. C. (2006). Body size and 24-hour urine composition. Americanjournal of kidneydiseases, 48(6), 905-915. https://doi.org/10.1053/j.ajkd.2006.09.004
Rodgers, A. L., Webber, D., de Charmoy, R., Jackson, G. E., &Ravenscroft, N. (2014). Malic acid supplementation increase urinary citrate excretion and urinary pH: implications for the potential treatment of calcium oxalate stone disease. JournalofEndourology, 28(2),229.236. https://doi.org/10.1089/end.2013.0477
Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, Monga M, Penniston KL, Preminger GM, Turk TM, White JR, AmericanUrological A (2014) Medical management of kidney stones: AUA guideline. J Urol 192(2):316– 324. doi:10.1016/j.juro.2014.05.006
Bultitude, M. F. (2012). Campbell‐Walsh Urology Tenth Edition.
Balaji, K. C., &Menon, M. (1997). Mechanism of stoneformation. UrologicClinics of North America, 24(1), 1-11. https://doi.org/10.1016/S0094-0143(05)70350-5
Nakagawa, Y., Ahmed, M., Hall, S. L., Deganello, S., &Coe, F. L. (1987). Isolation from human calcium oxalate renal stones of nephrocalcin, a glycoprotein inhibitor of calcium oxalate crystal growth. Evidence that nephrocalcin from patients with calcium oxalate nephrolithiasis is deficient in gamma-carboxyglutamicacid. TheJournal of clinicalinvestigation, 79(6), 1782-1787.
Tiselius, H. G., Fornander, A. M., &Nilsson, M. A. (1993). Theeffects of citrate and urine on calcium oxalate crystal aggregation. Urologicalresearch, 21(5), 363-366.
Morse, R. M. (1988). Currenttrends in urologicresearch. Urinary stone matrix. J. Urol., 139, 602-606.
Nishio, S., Abe, Y., &Wakatsuki, A. (1985). Iwata H, Ochi K, Takeuchi M, Matsumoto A. Matrixglycosaminoglycan in urinarystones. J Urol, 134, 503-505.
Skolarikos A, Neisius A, Petřík A, et al. EAU Guidelines on Urolithiasis.European Association of Urology. https://uroweb.org/guidelines/urolithiasis/chapter/guidelines [Accessed 15th March 2022].
Rivers, K., Shetty, S., &Menon, M. (2000). When and how to evaluate a patient with nephrolithiasis. UrologicClinics of North America, 27(2), 203-213. https://doi.org/10.1016/S0094-0143(05)70251-2
Hara, A., Yang, W. Y., Petit, T., Zhang, Z. Y., Gu, Y. M., Wei, F. F., ... &Staessen, J. A. (2016). Incidence of nephrolithiasis in relation to environmental exposure to lead and cadmium in a populationstudy. Environmentalresearch, 145,18. https://doi.org/10.1016/j.envres.2015.11.013
