環境中三聚氰胺暴露增加含鈣尿路結石患者腎小管傷害:三聚氰胺相關結石生成的可能機轉
劉家駒1-3、謝翠娟4,5、吳佳芳5,6、蔡宜純7、黃書彬1,2、李永進1,2,8、黃琮懿2、沈榮宗8、周以和1,2、黃俊農1,2、吳文正1,2、吳明蒼5,6,9
1高雄醫學大學 醫學院 泌尿學科；2高雄醫學大學附設醫院 泌尿部; 3衛生福利部 屏東醫院 泌尿科; 4高雄醫學大學 醫學院 醫學研究所; 5高雄醫學大學 環境研究中心; 6高雄醫學大學 健康科學院 公共健康學系; 7高雄醫學大學附設醫院 內科部 腎臟科; 8高雄市立小港醫院 泌尿科; 9高雄醫學大學 醫學院 臨床醫學研究所
Environmental melamine exposure increase renal tubular injury in patients with calcium urolithiasis: The possible mechanism of melamine associated urolithiasis formation
Chia-Chu Liu1-3, Tusty-Jiuan Hsieh4,5, Chia-Fang Wu5,6, Yi-Chun Tsai7, Shu-Pin Huang1,2, Yung-Chin Lee1,2,7, Tsung-Yi Huang2, Jung-Tsung Shen7, Yii-Her Chou1,2, Chun-Nung Huang1,2 , Wen-Jeng Wu1,2, Ming-Tsang Wu5,6,9
1Department of Urology, College of Medicine, Kaohsiung Medical University
2Department of Urology, Kaohsiung Medical University Hospital
3Depratment of Urology, Pingtung Hospital, Ministry of Health and Welfare
4Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University
5Research Center for Environmental Medicine, Kaohsiung Medical University
6Department of Public Health, College of Health Sciences, Kaohsiung Medical University
7Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital
8Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital
9Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University
Purpose: Melamine, a widely used chemical found in many products used daily, is ubiquitously present in our environment. It can increase the precipitation of crystals leading to urolithiasis. However, long-term low dose environmental exposure to melamine could also possibly induce renal tubular injury further increasing the risk of urolithiasis. This study investigated the relationship between the two in adult patients with calcium urolithiasis.
Materials and Methods: We recruited adult patients diagnosed with upper urinary tract calcium urolithiasis at Kaohsiung Medical University-affiliated hospitals, all located in south western Taiwan, between November, 2010 and January, 2015. All participants were interviewed by trained researchers using a structured questionnaire to collect detailed demographic data, medical history, and history of substance use. At that time, each participant provided a one-spot overnight urine sample for biochemical evaluation of urinary melamine level and markers of early renal injury (N-acetyl b-D-glucosaminidase (NAG), ß2-microglobulin (ß2-MG), and microalbumin).
Results: A total of 309 patients (54.7 ± 12.8 years) diagnosed as having calcium urolithiasis were recruited. Their mean urinary melamine level was 3.24 ± 6.66 mg/mmol Cr. It was first stone episode for 159 of the subjects (51.5%). Multivariate regression analyses revealed a significant positive correlation between urinary melamine and urinary NAG, a marker of renal tubular injury, especially in subjects with first stone episodes.
Conclusions: Urinary melamine levels were significantly positive correlated with the marker of renal tubular injury in adult patients with calcium urolithiasis. This finding suggests that besides causing the precipitation of crystals, melamine may also increase the risk of calcium urolithiasis by causing renal tubular injury. Further studies are still needed to detail the underlying mechanisms.