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Abstract：
Background The diverse manifestations of urolithiasis provide very interesting epidemiological data. This has prompted various studies to look into the etiopathogenesis of renal stones, which is believed to be multifactorial, both exogenous and endogenous. VDR Fok1 is a risk factor for renal stone formation and could cause the formation of renal stones through the mechanism of crystal induction and crystallization in the urine. While a few recent studies have shown the role of heavy metals like cadmium and lead in the formation of renal stones, the current knowledge is still insufficient. Methods This case-control prospective study was conducted in Guru Teg Bahadur (GTB) Hospital, a tertiary care facility in Delhi with 30 cases and 30 controls. Patients visiting the department of surgery between November 2011 and April 2013 were enrolled in the study. Cases were defined as patients with renal stones diagnosed on the basis of history and radiological investigations. Controls were selected from the patients admitted to the department of surgery for reasons other than renal stones. The study protocol was approved by the Institutional Ethical Committee of the University College of Medical Sciences, GTB Hospital, Delhi. Written informed consent was obtained from all patients. A structured questionnaire was used to collect data. Metal levels were analyzed by an atomic absorption spectrophotometer (Shimadzu Flame AA-680, Shimadzu Corp., Kyoto, Japan) at Delhi University. The vitamin D receptor gene was measured using genomic DNA. Horizontal agarose gel electrophoresis was used for the quantification of the genomic DNA. Results There were 30 cases and 30 controls in the study. Stress was more prevalent among cases (63%) compared to controls (36%). Nearly 83% of cases had the ff allele of the Vitamin D receptor gene compared to 46% of controls. The median arsenic and lead levels were higher among cases compared to controls. In the unadjusted model of logistic regression, we found stressed patients had three times higher odds of developing renal stones compared to non-stressed patients (OR (95% CI): 2.98 (1.04-8.52); p=0.04). Similarly, patients with higher blood concentrations of arsenic and lead had higher odds of developing renal stones compared to those with lower concentrations. Conclusions There was a definitive role of heavy metals, including lead, cadmium, and arsenic, seen with renal stones. A significant association was seen between the ff allele of VDR polymorphism (Fok1 enzymes) and patients with renal stones. Other parameters, including male and stress factors, seem to have an important role in renal stone formation.
摘要：
背景尿石症的各种表现提供了非常有趣的流行病学数据。这促使各种研究探讨肾结石的病因，这被认为是多因素的，既有外源性的，也有内源性的。VDRFok1是肾结石形成的危险因素，可通过尿液中晶体诱导和结晶的机制引起肾结石的形成。虽然最近的一些研究表明镉和铅等重金属在肾结石形成中的作用，目前的知识仍然不足。方法本病例对照前瞻性研究在GTB（GTB）医院进行，德里的一家三级护理机构，有30例病例和30例对照。在2011年11月至2013年4月期间访问外科的患者被纳入研究。病例定义为根据病史和放射学检查诊断的肾结石患者。从因肾结石以外的原因入院的患者中选择对照组。该研究方案由大学医学院的机构伦理委员会批准，GTB医院,德里。从所有患者获得书面知情同意书。使用结构化问卷收集数据。通过原子吸收分光光度计（ShimadzuFlameAA-680，ShimadzuCorp.,京都,日本）在德里大学。使用基因组DNA测量维生素D受体基因。水平琼脂糖凝胶电泳用于基因组DNA的定量。结果本研究共30例，30例对照。与对照组（36％）相比，病例中的压力更为普遍（63％）。与46％的对照相比，将近83％的病例具有维生素D受体基因的ff等位基因。与对照组相比，病例中砷和铅的中位数水平更高。在未调整的逻辑回归模型中，我们发现,与非应激患者相比,应激患者发生肾结石的几率高3倍(OR(95%CI):2.98(1.04~8.52);p=0.04).同样，与血砷和铅浓度较低的患者相比,血砷和铅浓度较高的患者发生肾结石的几率较高.结论重金属具有确定的作用，包括铅,镉,还有砷,看到肾结石。VDR多态性的ff等位基因（Fok1酶）与肾结石患者之间存在显着关联。其他参数,包括男性和压力因素，似乎在肾结石形成中起重要作用。
