Gender characteristics of hematuria during lithokinetic therapy in patients with nephrolithiasis

Abstract

Purpose. To study gender characteristics of the severity of hematuria and compensatory mechanisms of the proaggregant component of hemostasis in patients with nephrolithiasis when prescribing litokinetic therapy (LCT), including nonsteroidal anti-inflammatory drugs (NSAIDs). Material and methods. The prospective study included 60 patients (group 1 – 30 men; group 2 – 30 women) with imaging signs of the presence of stones in the urinary tract. For 7 days, patients underwent standard LCT, including NSAIDs, an α1A-blocker (tamsulosin) and antibiotics. In vitro, the activity of the TP receptor for TxA2 and purine P2Y receptors (P2Y1 and P2Y12) was studied on a platelet suspension after 24, 48, 72 hours, 5 and 7 days. Platelet aggregation was assessed using the turbidimetric method using a ChronoLog analyzer (USA). Results. At the hospitalization stage, in both groups (before the introduction of NSAIDs), hyperreactivity of the TP-receptor was observed, and in men the activity of the TP receptor was lower, and hematuria (p<0.05) was higher than in women. The pharmacokinetics of NSAIDs in men was characterized by inhibition of cyclooxygenase (COX) in two time periods – 72 hours and 7 days, as a result of which the synthesis of TхA2 in platelets decreased and hematuria increased 4.4 times (p<0.001) compared with the hospitalization stage. In women, COX inhibition occurred within 5 days; At the same time, the preservation of normal reactivity of the TP-receptor and purine P2Y receptors ensured the implementation of a compensatory platelet response, limiting the severity of hematuria. Conclusion. Analysis of the mechanisms of gender differences in hematuria in nephrolithiasis is important for developing a personalized medicine strategy when prescribing NSAIDs.