Nowadays urolithiasis (nephrolithiasis) is a common disease, which treatment is a serious task of health care ser- vices not only in Russia, but throughout the world. At the same time, stones of a calcium-oxalate nature are the most common stones in patients with this pathology – in about 70-80% of cases. It is also worth noting that this disease not only has rather painful manifestations, and its treatment requires large financial costs, but also has a complex multi- factorial multistage pathogenesis, understanding the mechanisms of which can provide a key to the development of the most successful therapy. Pathogenesis itself consists of several stages, such as nucleation with the formation of a crystallization center, crystal growth, aggregation and their attachment to the surface of epithelial cells. It is known that the human body contains various substances that affect the processes of stone formation. Thus, stone formation promoters facilitate their crystallization, and inhibitors prevent it. There is a delicate balance between promoters and inhibitors, and their imbalance is often a decisive factor in pathogenesis. By their chemical nature, inhibitors can be both inorganic and organic (proteins, glycosaminoglycans) substances. The latter are especially attracting attention, since at various concentrations they can act as both inhibitors and promoters of stone formation. To fully understand the mechanisms of calcium oxalate stone formation, this review analyzes current data on inhibitors of recurrent nephrolithiasis and their role in the pathophysiology of the process of renal stone formation.

Objective To evaluate the results of extracorporeal shockwave lithotripsy (ESWL) versus retrograde intrarenal surgery (RIRS) for the treatment of calcium oxalate nephrolithiasis, as well as the damaging effects on renal function, taking into account the dynamics of blood cystatin C and urine beta2-microglobulin.Material and Methods Of 94 patients with calcium oxalate nephrolithiasis aged 23–78 included in the study,  42 patients were classified as having undergone ESWL (group I) and 52 patients as having undergone RIRS (group II). Group II patients were then stratified into subset 2A (n = 32) as having undergone RIRS through rigid ureteroscope and subset 2B (n = 20) as having undergone RIRS through flexible ureteroscope. We performed plain urography and nephrosonography at 24–48 hours postoperatively and unenhanced computed tomography 4–6 weeks after surgery. We measured concentrations of serum cystatin C and urinary beta2-microglobulin as a marker for kidney damage. In group I, samples of peripheral blood andurine were taken before and after the first, third sessions and 30 days after the last ESWL session. In group  II, samples were analyzed before surgery, on the first and 30th postoperative days.Results The average size of calculi in the group with RIRS was 16.91 ± 2.79 mm, in the group with ESWL  12.31 ± 2.27 mm. The need for reoperation after RIRS was 19.2%, which was lower than after ESWL. Stone-free effect (no stones, or residual stones less than 3 mm) was observed in 95% of cases in patients with RIRS, and in 78% with ESWL. Group I patients demonstrated an increase in the blood leukocytes total number more often than subsets 2A (rigid RIRS) and 2B (flexible RIRS) patients. Leukocyturia was also a more common complication in group I. In the RIRS group, there was no statistically significant change in the level of blood cystatin C and urine beta2-microglobulin, on the contrary, a moderate increase in the endogenous marker of cystatin C was noted after one ESWL session. The increase in urine beta2-microglobulin levels in patients after the first and third ESWL sessions was significantly higher than after RIRS.Conclusion Flexible RIRS may be suggested as the preferred procedure for patients requiring additional protection of renal function in the treatment of renal stones less than 20 mm. ESWL of stones less than 20 mm can be used as an alternative treatment, since it is characterized by a rather long period of stone eradication from the urinary tract, a high frequency of residual calculi after the procedure, and also has a damaging effect on the renal tissue.

Background. The present article studies a possible role of parathyroid hormone-related protein (PTHrP) in urolithiasis pathogenesis.Aim. To consider PTHrP level as a predictor of the urolithiasis development.Material and methods. We presented an analysis of treatment in 79 patients with primary and recurrent nephrolithiasis that had underwent surgical treatment in the Uronephrological Center of Scientific Research Institute – Ochapovsky Regional Clinical Hospital #1, Krasnodar from 2017 to 2019. All observed patients were divided in two groups: patients with primary and recurrent nephrolithiasis. A group of 10 relatively healthy people was included in the study as well. All patients and conditionally healthy people had a test for blood parameters; in particular, the level of parathyroid hormone-related protein was assessed in order to compare the indicators in all three groups.Conclusions. The PTHrP level was showed to be statistically significantly different in patients with urolithiasis from the group with relatively healthy people. Groups with primary and recurrent nephrolithiasis show not difference in the level of PTHrP. Further studies are necessary to consider this protein as one of the predictors of urolithiasis and study its role in the pathogenesis of nephrolithiasis.

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