FOSFATURIYA

From Big Medical Encyclopedia

FOSFATURYYa (phosphate[s] + wetting Greek uron) — existence of a deposit of phosphate salts in svezhevypushchen-ache to urine.

Kidneys allocate 50 — 80% of the phosphates excreted from an organism. According to different researchers, from 75 to 100% of the phosphates which are contained in blood serum are exposed to glomerular ultrafiltration, and 65 — 85% from them reabsorbiru-tsya then in proximal departments of renal tubules. The canalicular reabsorption of phosphates is regulated by hormones and vitamin D. A part of the phosphates which are emitted with urine is formed directly in kidneys of organic compounds of phosphorus under the influence of renal phosphatases (see). Uric excretion of phosphates increases under the influence of parathormone (see), a calcitonin (see), cortisol (see the Hydrocortisone), nek-ry estrogen (see), at administration of glucose (see) and urea (see).

Distinguish true, or primary (aseptic), and false, or secondary, F. Istinnaya F. arises most often at the so-called phosphate diathesis which is characterized by an atsidotichesky orientation of a metabolism (the essence of primary metabolic defect at this state is still insufficiently clear). Inorganic phosphorus is emitted with kidneys of hl. obr. in a look one - and disubstituted sodium phosphates and potassium, to a lesser extent — in the form of calcium phosphates and magnesium (fresh-frozen. Phosphoric acids). Normal

NRO anions * and H2P04 contain in a glomerular filtrate

in the ratio 4:1, at phosphate diathesis in connection with acidosis in renal tubules and final urine the ratio of these anions reaches 50: 1 and even 200: 1. Urine at the same time gets alkali reaction therefore insoluble phosphate salts of calcium, magnesium, ammonium in alkaline condition drop out in a deposit. On the basis of it nek-ry researchers believe that true F. it is connected with insufficiency of a canalicular reabsorption of the bases. True F. it is observed also at the diseases which are followed by disturbance of phosphorus-calcium exchange: primary

hyperparathyreosis (see), a renal failure (see) as at it the secondary hyperparathyreosis, a multiple myeloma (see), primary and metastatic tumors of bones (see the Bone), a lymphogranulomatosis (see), a sarcoidosis (see), a thyrotoxicosis (see), diabetic ketoacidosis (see a diabetes mellitus develops), intoxications vitamin D (see Calciferols); at renal tubulopatiya — phosphate diabetes (skhm.), de Tony's syndrome — Debra — Fankoni (see De Tony — Debra — Fankoni a syndrome), a cystinosis (see), renal canalicular acidosis (see), at a hypopotassemia (see) various origins (a gipokaliyemi-chesky tubulopatiya), at reception of the benzotiazinovy diuretics stimulating secretory activity of epithelial bodies.

At expressed F. rather coarse particles of a deposit (salt sand) in urinary tract are quite often formed; in such cases a dysuria (see), back pains are possible. The long irritation salt sand of a mucous membrane of uric ways leads to its aseptic, and then and bacterial inflammation. Quite often F. accompanies formation of phosphatic urinary stones (see).

False F. arises when urine gets alkali reaction owing to a bacterial infection of urinary tract. At the same time decomposition of urea is enzymes of the bacteria which are contained in urine the reason of increase in pH of urine (white and golden staphylococcus, vulgar proteas, a pyocyanic stick). Other reason false F. — surplus in a diet of the vegetables having ability to alkalize urine (see Vegetables). At alkali reaction of urine the deposit of phosphates even in case of their quantitatively not changed excretion is formed. In old literature it is possible to meet the term «pseudophosphaturia» designating a state, at a thunder the uric phosphatic deposit is formed in connection with primary and excess removal of calcium at not changed excretion of phosphates.

Urine at F. usually muddy, has alkali reaction. In an uric deposit apply qualitative test from 10% to identification of phosphates acetic to - that, several drops add a cut to 2 — 3 ml of heated urine (disappearance of opacification demonstrates existence in the draft of phosphates). At microscopy of a deposit find amorphous phosphates, crystals of neutral phosphate lime and tripelfos-fat (see Urine). Besides, phosphatic character of salts can be verified by means of infrared spectroscopy of the dried-up and ozolenny test of a deposit of daily urine. Quantitative definition of phosphates in urine is made as well as in blood (see Fosfatemiya, Phosphorus).

At treatment of the diseases which are followed F., limit the use of vegetables, products, calciferous (dairy products, eggs, etc.), increase contents in food of the products providing acid reaction of urine (meat, a liver, creamy and vegetable oils, a herring, white loaf, rice, semolina both grits and Kommersant.). For acidulation of urine mineral waters are shown (Truskavets, Naf-tusya, Arzni, dolomite narzan); with the same purpose appoint ammonium chloride.

Bibliography: Weinberg 3. C. Stones of kidneys, M., 1971; Calcium, phosphate and magnesium metabolism, ed. by B. E. Nor-din, Edinburgh a. o., 1976;

Plasma-pho-sphate and tubular reabsorption of phosphate, Lancet, v. 1, p. 820, 1970.

V. K. Velikov

Яндекс.Метрика