Medicina (Buenos Aires)
versión On-line ISSN 1669-9106
TOBLLI, J. E. et al. Urinary calcium oxalate supersaturation beyond nephrolithiasis: Relationship with tubulointerstitial damage. Medicina (B. Aires) [online]. 2003, vol.63, n.2, pp. 97-104. ISSN 1669-9106.
A number of studies have demonstrated that the urinary ion activity product (IAP) of calcium oxalate (CaOx), as an index of urinary CaOx supersaturation (SS), is higher in renal stone formers than in normal subjects. Besides, the relation between CaOx SS and lithogenesis, crystal CaOx exposition can produce tubular cell as well as renal interstitial lesions. The aim of our study was to evaluate the possible relationship between CaOx SS and tubulointerstitial (TI) damage in an animal model of hyperoxaluria. During four weeks, male Sprague-Dawley rats received: G1 (n=8) control regular water, and G2 (n= 8) 1% ethylene glycol (ETG) (precursor for oxalates) in drinking water. In order to evaluate urinary CaOx SS, IAP assessed by Tisselius formula was performed. At the end of the study, renal lesions were evaluated by light microscopy and immunohistochemistry. Animals from G2 (ETG) presented higher (p< 0.01) values of: a) urinary oxalate excretion; b) urinary CaOx SS; c) crystalluria score; d) proteinuria; and lower (p< 0.01) creatinine clearance, with respect to the control group (G1). Moreover, pathology studies showed that rats from G2 (ETG), presented significant TI lesions characterized by a higher (p< 0.01) score of: a) tubular atrophy; inflammatory infiltrates (monocyte / macrophage); c) crystal deposits; d) intersticial fibrosis; e) interstitial a-smooth muscle actin; f) collagen type III; g) TI TGFb1 compared with G1 (control). Rats from G2 (ETG) presented a high correlation between urinary CaOx SS and most of the TI damage parameters evaluated, in especial with interstitial fibrosis. Both, inflammatory infiltrates and urinary CaOx SS were the most significant variables related to interstitial fibrosis. Finally, since hyperoxaluric animals showed higher urinary CaOx SS associated with higher renal TI damage, the results from this study suggest the presence of a tight link between urinary CaOx SS and renal TI damage. Considering these findings we think that urinary CaOx SS control rises in importance beyond nephrolithiasis.
Palabras clave : Calcium oxalate; Hyperoxaluria.; Urine supersaturation; Ion activity product; Tubulointerstitial damage; Sprague Dawley rats.