Platelet aggregation during the administration of non-selective nsaids in women with nephrolithiasis

Aim: to evaluate the effect of adrenergic and purinergic signaling in platelets (PLT) during COX inhibition on the severity of hematuria in women with nephrolithiasis (NLT). Material and Methods. The study was prospective and included 60 patients with imaging evidence of urinary tract stones, who were treated with high doses of non-selective non-steroidal anti-inflammatory drugs (NSAIDs) as part of lithokinetic therapy (LKT) for analgesia. The study included 30 women who had reproducible TP-receptor hyporeactivity (<45%) after 72h of LKT with non-selective NSAIDs. The severity of hematuria was assessed at the time of hospitalization and for 7 days of LCT. The activity of the TP receptor, α2-adrenergic receptor, purine P2X1- and P2Y-receptors (P2Y1, P2Y12) was studied by turbidimetric method on a ChronoLog analyzer (USA). Agonists (arachidonic acid, epinephrine, ATP and ADP) were used at EC50 and EC10 concentrations. Statistical analysis was performed using the MedCalc package. Results. After 72 hours of LCT, the activity of the TP receptor, α2-adrenergic receptor and purine P2-receptors of PLT decreased and reached the level of hyporeactivity. Recovery of the activity of P2X1- and P2Y-receptors to the level of normoreactivity was registered after 5 days, while the activity of the α2-adrenergic receptor remained in the range of hyporeactivity. On day 7, α2-adrenergic receptor and P2X1-receptor hyperreactivity developed and P2Y- receptor normoreactivity remained. The effectiveness of compensatory reactions of PLT aimed at limiting hematuria depended on the synergism of functionally active receptors. Conclusion. In women with nephrolithiasis during the administration of non-selective NSAIDs, the spontaneous increase in α2- adrenoreceptor activity is indicative of the lability of the sympathoadrenal system caused by the trafficking of stones in the urinary tract. The limitation of hematuria observed in this case is associated with increased pro- aggregation activity of platelet hemostasis due to synergism of α2-adrenoreceptor and P2-receptors.

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