Рurinergic regulation of stones elimination from the upper part of the ureter during lithokinetic therapy

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Abstract

The reasons for the low efficiency of the α1A-blockers using in the scheme of lithokinetic therapy (LCT) remain unclear. The aim of the study was to evaluate the activity of the purinergic P2X1 receptor in the blockade of the α1A-adrenergic receptor during LCT in patients with calculi localization in the upper third of the ureter. Material and methods. The study was prospective and included 61 patients with calculi in the upper third of the ureter. For 7 days, patients underwent standard LBT, including an α1A-blocker, non-steroidal anti-inflammatory drugs (NSAIDs), and antibiotics. According to the imaging control of calculus traffic, the cohort of patients was divided into two groups: with effective (group 1) and ineffective (group 2) elimination of calculus. The activity of the P2X1 receptor was studied in vitro on a suspension of platelets. Platelet aggregation was assessed by the turbidimetric method using a ChronoLog analyzer (USA). Results. During hospitalization of patients, the P2X1-receptor hyperreactivity was revealed. When the standard LCT was prescribed after 7 days in the 1st group, the elimination of calculi from the upper third of the ureter was observed; the effect was reproduced in case of P2X1 receptor hyporeactivity. Fast and slow elimination of calculi. was determined by the kinetics of inhibition of ATP-induced intracellular signaling. In group 2, this phenomenon was not reproduced, while the P2X1 receptor hyperreactivity persisted for 7 days. According to the results of modeling the risk of ineffective elimination of calculi 72 h after the onset of LCT, the critical threshold of P2X1 receptor activity (P2X-R crit) was >58%. Conclusion. The effectiveness of LCT, associated, among other things, with the appointment of blockers of α1A-adrenergic receptors, is dependent of the activity P2X1 receptor, which modulates the contraction of the muscular layer of the ureter.

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Edward Fedorovich Barinov

State educational organization of higher professional education «M. Gorky Donetsk National Medical University»

Author for correspondence.
Email: barinov.ef@gmail.com
Head of the department the Histology, Cytology and Embryology State educational organization of higher professional education Avenue Ilyicha 16, Donetsk, 83003, Ukraine

Yury Yuryevich Malinin

State educational organization of higher professional education «M. Gorky Donetsk National Medical University»

Email: jora2@list.ru
Head at the Department of Urology State educational organization of higher professional education; Candidate of Medical Sciences Avenue Ilyicha 16, Donetsk, 83003, Ukraine

Khachen Vladimirovich Grigoryan

State educational organization of higher professional education «M. Gorky Donetsk National Medical University»

Email: khachengrigoryan@gmail.com
assistant at the Department of Urology State educational organization of higher professional education; Candidate of Medical Sciences. Avenue Ilyicha 16, Donetsk, 83003, Ukraine

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2. Curves of operating characteristics (ROC) for determining the risk of ineffective elimination of calculi from the upper third of the ureter by the activity of the P2X1 receptor (%) after 72 hours of lithokinetic therapy)

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