urovestВестник урологииUrology Herald2308-6424Rostov State Medical University10.21886/2308-6424-2022-10-4-120-140urovest-619Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWS ARTICLEКислотно-основное состояние (pH) мочи: механизм регуляции и его роль в метафилактике мочекаменной болезниUrinary pH: its regulation and relevance in urolithiasis metaphylaxishttps://orcid.org/0000-0002-6255-0193ГаджиевН. К.GadzhievN. K.

Гаджиев Нариман Казиханович — доктор медицинских наук, заместитель директора по медицинской части (урология) Клиники высоких медицинских технологий им. Н.И. Пирогова СПбГУ.

199034, Санкт-Петербург, набережная реки Фонтанки, д. 154

Nariman K. Gadzhiev — M.D., Dr.Sc.(Med.), Deputy СEO for Medical (Urology), Pirogov Сlinic of Advanced Medical Technologies, St. Petersburg State University.

154 Fontanka River Emb., St. Petersburg, 199034

nariman.gadjiev@gmail.comhttps://orcid.org/0000-0003-4876-183XГелигВ. А.GeligV. A.

Гелиг Виталий Аркадьевич — врач-уролог урологического отделения Клиники высоких медицинских технологий им. Н.И. Пирогова СПбГУ.

199034, Санкт-Петербург, набережная реки Фонтанки, д. 154

Vitalii A. Gelig — M.D., Urologist, Urology Division, Pirogov Сlinic of Advanced Medical Technologies, St. Petersburg State University.

154 Fontanka River Emb., St. Petersburg, 199034

vgelig@yandex.ruhttps://orcid.org/0000-0002-8970-9854КутинаА. В.KutinaA. V.

Кутина Анна Вячеславовна — кандидат медицинских наук, заведующая лабораторией физиологии почки и водно-солевого обмена ИЭФБ РАН.

194223, Санкт-Петербург, проспект Тореза, д. 44

Anna V. Kutina — M.D., Cand.Sc.(Med), Head, Leading Researcher, Laboratory of Renal Physiology and Water-Salt Balance, Sechenov Institute of Evolutionary Physiology and Biochemistry — the Russian Academy of Science.

44 Torese Ave., St. Petersburg, 194223

kutina_anna@mail.ruhttps://orcid.org/0000-0002-7860-0626ГоргоцкийИ. A.GorgotskyI. A.

Горгоцкий Иван Александрович — кандидат медицинских наук, врач-уролог урологического отделения Клиники высоких медицинских технологий им. Н.И. Пирогова СПбГУ.

199034, Санкт-Петербург, набережная реки Фонтанки, д. 154

Ivan A. Gorgotskiy — M.D., Cand.Sc.(Med), Urologist, Urology Division, Pirogov Сlinic of Advanced Medical Technologies, St. Petersburg State University.

154 Fontanka River Emb., St. Petersburg, 199034

igorgotsky@gmail.comhttps://orcid.org/0000-0003-2491-095XKapпищeнкoА. И.KarpishchenkoA. I.

Kapпищeнкo Анатолий Иванович — доктор медицинских наук, профессор, руководитель сектора клинической лабораторной диагностики и метрологии организационно-методического отдела мониторинга качества медицинской деятельности МИАЦ.

198095, Санкт-Петербург, ул. Шкапина, д. 30

Anatoly I. Karpishchenko — M.D., Dr.Sc.(Med.), Full Prof., Head, Clinical Laboratory Diagnostics and Metrology Sector, Organizational and Methodological Department for Monitoring the Quality of Medical Activity, St. Petersburg State Medical Institution "Medical Information and Analytical Center".

30 Shkapina St., St. Petersburg, 198095

anatolykarpishenko@yandex.ruhttps://orcid.org/0000-0002-7592-8167ГореловД. С.GorelovD. S.

Горелов Дмитрий Сергеевич — врач-уролог отделения дистанционной литотрипсии и эндовидеохирургии НИЦ урологии ПСПбГМУ им. акад. И.П. Павлова Минздрава России.

197022, Санкт-Петербург, ул. Льва Толстого, д. 6‒8

Dmitry S. Gorelov — M.D., Urologist, ESWL and Endovideosurgery Division, Research Center of Urology, Pavlov First St. Petersburg State Medical University.

6-8 Lev Tolstoy St., St. Petersburg, 197022

dsgorelov@mail.ruhttps://orcid.org/0000-0003-3246-7337СеменякинИ. В.SemenyakinI. V.

Семенякин Игорь Владимирович — доктор медицинских наук, врач-уролог Клинико-диагностического центра МЕДСИ.

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Igor V. Semenyakin — M.D., Dr.Sc.(Med.), MEDSI Clinical and Diagnostic Center.

16 Krasnaya Presnya St., Moscow, 123242

dr.Semeniakin@gmail.comhttps://orcid.org/0000-0001-7328-8082ЗакуцкийА. Н.ZakutskyA. N.

Закуцкий Александр Николаевич — кандидат медицинских наук, врач-уролог Центра Stonelab Многопрофильной клиники ОсНова.

197227, Санкт-Петербург, Серебристый бульвар, д. 20

Alexander N. Zakutsky — M.D., Cand.Sc.(Med), Urologist, Stonelab Centre,  Multidisciplinary Clinic OsNova.

20 Serebristy Blvd., St. Petersburg, 197227

alexzac@list.ruhttps://orcid.org/0000-0001-5177-2527КулешовО. В.KuleshovO. V.

Кулешов Олег Владимирович — кандидат медицинских наук; заведующий отделением анестезиологии – реанимации Клиники высоких медицинских технологий им. Н.И. Пирогова СПбГУ.

199034, Санкт-Петербург, набережная реки Фонтанки, д. 154

Oleg V. Kuleshov — M.D., Cand.Sc.(Med), Head, Anesthesiology – Intensive Care Division, Pirogov Clinic of Advanced Medical Technologies, St. Petersburg State University.

154 Fontanka River Emb., St. Petersburg, 199034

o.v.kuleshov@mail.ruhttps://orcid.org/0000-0003-0489-3451ШкарупаД. Д.ShkarupaD. D.

Шкарупа Дмитрий Дмитриевич — доктор медицинских наук, заместитель директора по организации медицинской помощи Клиники высоких медицинских технологий им. Н.И. Пирогова СПбГУ.

199034, Санкт-Петербург, набережная реки Фонтанки, д. 154

Dmitry D. Shkarupa — M.D., Dr.Sc.(Med), Deputy Director for Medical Care Organization, Pirogov Clinic of Advanced Medical Technologies, St. Petersburg State University.

154 Fontanka River Emb., St. Petersburg, 199034

shkarupa.dmitry@mail.ruСанкт-Петербургский государственный университет — Клиника высоких медицинских технологий им. Н.И. ПироговаРоссияSt. Petersburg State University – Pirogov Clinic of Advanced Medical TechnologiesRussian FederationИнститут эволюционной физиологии и биохимии им. И.М. Сеченова Российской академии наукРоссияSechenov Institute of Evolutionary Physiology and Biochemistry — the Russian Academy of ScienceRussian FederationСПб ГБУЗ Медицинский информационно-аналитический центрРоссияSt. Petersburg State Medical Institution "Medical Information and Analytical Center"Russian FederationПервый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова Минздрава РоссииРоссияPavlov First St. Petersburg State Medical UniversityRussian FederationКлинико-диагностический центр МЕДСИРоссияMEDSI Clinical and Diagnostic CentreRussian FederationМногопрофильная клиника ОсНоваРоссияMultidisciplinary Clinic OsNovaRussian Federation202226122022104120140Copyright © Гаджиев Н.К., Гелиг В.А., Кутина А.В., Горгоцкий И.A., Kapпищeнкo А.И., Горелов Д.С., Семенякин И.В., Закуцкий А.Н., Кулешов О.В., Шкарупа Д.Д., 20232023Гаджиев Н.К., Гелиг В.А., Кутина А.В., Горгоцкий И.A., Kapпищeнкo А.И., Горелов Д.С., Семенякин И.В., Закуцкий А.Н., Кулешов О.В., Шкарупа Д.Д.Gadzhiev N.K., Gelig V.A., Kutina A.V., Gorgotsky I.A., Karpishchenko A.I., Gorelov D.S., Semenyakin I.V., Zakutsky A.N., Kuleshov O.V., Shkarupa D.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.urovest.ru/jour/article/view/619

Мочекаменная болезнь является распространённым многофакторным заболеванием, отличающимся высокой частотой рецидивирования. Данный обзор посвящён кислотно-основному состоянию (pH) мочи как одному из основных факторов, определяющим её литогенные свойства. Показатель pH оказывает влияние на экскрецию литогенных веществ и ингибиторов камнеобразования, растворимость и кристаллизацию участвующих в камнеобразовании веществ. Растворимость мочевой кислоты в моче существенно снижается при pH ниже 5,5. Это объясняет высокую встречаемость мочекислых конкрементов у пациентов с метаболическим синдромом. Свойственная им инсулинорезистентность приводит к снижению экскреции ионов аммония в проксимальными канальцах, приводя к стойкой ацидофикации мочи. К изменениям системного или локального рН чувствительна активность многих транспортных процессов, участвующих в обработке кальция, цитратов и фосфатов. Остаются противоречивыми данные о влиянии pH на растворимость оксалата кальция. Вместе с тем не вызывает сомнений определяющая роль pH мочи в экскреции цитрата — важнейшего ингибитора камнеобразования. Щелочной рН способствует образованию конкрементов, содержащих фосфаты кальция. В условиях постоянно повышенного pH мочи у пациентов с персистирующей уреазопродуцирующей инфекцией мочевыводящих путей происходит быстрый рост «инфекционных» конкрементов. В обзоре обобщена информация о причинах снижения и повышения pH мочи, а также о возможностях медикаментозных и немедикаментозных способов модификации pH мочи при проведении профилактики рецидивирования камнеобразования.

Urolithiasis is a common multifactorial disease characterized by a high recurrence rate. This review is devoted to the urine pH as one of the main factors determining its lithogenic properties. It affects the excretion of lithogenic substances and stone formation inhibitors, the solubility, and the crystallization of substances involved in stone formation. The urine pH significantly affects the solubility of uric acid in urine, which decreases at a pH < 5.5. This explains the high incidence of uric acid concretions in patients with metabolic syndrome. Their insulin resistance leads to a decrease in the excretion of ammonium ions in the proximal tubules, leading to persistent urine acidification. The activity of many transport processes involved in the processing of calcium, citrates and phosphates is sensitive to changes in systemic or local pH. The data on the effect of urine pH on the solubility of calcium oxalate remain contradictory. At the same time, there is no doubt about the determining role of urine pH in the excretion of citrate, the most important stone formation inhibitor. The alkaline urine pH promotes the formation of concretions containing calcium phosphates. In conditions of constantly elevated urine pH in patients with persistent urease-producing urinary tract infection, a rapid growth of "infectious" concretions occurs. The review summarizes information on the causes of the decrease and increase in the urine pH, as well as the possibilities of medicinal and non-medicinal methods of modifying the urine pH during the prevention of stone formation recurrence.

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The authors declare that there are no conflicts of interest present.