Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2004 / Cilt: 30 - Sayı: 4
Metabolic evaluation and potassium citrate treatmant of stone proflaxy in recurrent calcium oxalate stone patients
- Pages
- 461–469
- DOI
- —
Abstract
Introduction: The role of dietary oxalate in calcium oxalate kidney stone formation remains unclear. However, due to the risk for stone disease that is associated with a low calcium intake, dietary oxalate is believed to be an important contributing factor. Stone formation would therefore ensue from an imbalance between promoters and inhibitors. Several studies in the last two decades have identified many inhibitors of calcium oxalate and calcium phosphate crystallization, which are classified into the ionic and macromolecular. They have been shown to act on kinetics by interfering with nucleation, growth and aggregation of crystals. Unfortunately, except for citrate, none of the newly discovered substances has been definitely characterized in its molecular composition and structure, type and potency of inhibition, differences in concentration and structure between stone forming and non stone-forming subjects. Citrate exhibits a dual action in urine, opposing crystal formation by both thermodynamic and kinetic mechanisms. At present it is the only natural inhibitor, which can be measured in urine, quantitated as to inhibitory activity and used in medical treatment. Materials and Methods: Calcium oxalate, which plays a functional role in plant physiology, is a source of chronic human disease, forming the major inorganic component of kidney stones. In our study, 47 consecutive patients were examined through a study protocol for their stones between April 1999 and June 2003. All patients had recurrent calcium oxalate stones and were randomized divided into 2 groups as control group and treatment group. Randomized group was receiving potassium citrate as the fluid intake was increased in the control group. The mean age of the patients was 36.7 of whom 9 were female and 38 were male. 24 hours urine analysis was studied three times in the study: Before the potassium citrate treatment, one week after a low sodium and calcium diet and after the treatment. According to these parameters post treatment time stone rates were compared with the pretreatment stone rates. Results: No major complication was observed after 12-month follow-up. Before stone metaflaxy in the treatment patient group 26 stones in 23 patients were found to be 4 stones at the end of the potassium citrate treatment. 27 urinary system stones were found to be 24 at the end of the potassium citrate treatment in the control patient group. Recurrence urinary stone was 4 of the 23 patients in the potassium citrate treatment patient group and 11 of the 24 patients in the control patient group. That means the recurrence rate was 17.4% in treatment group and 45.4% control group respectively. Patients receiving potassium citrate treatment had 82.6% urinary stone free rate. Conclusions: Nephrolithiasis is a common disease with a high recurrence rate; however, calcium stone pathogenesis remains unknown because of complex multiple factors. Patients with predominantly stones could be distinguished from those with predominantly calcium oxalate stones by higher urinary saturation with respect to due mainly to hypercalciuria from absorptive hypercalciuria. As a result our study, potassium citrate treatment in urinary recurrent calcium oxalate stone disease is considered as an effective treatment to compare the control patient group.
Özet
Nisan 1999 ile haziran 2003 tarihleri arasında GATA Üroloji kliniğimizde yatarak tedavi gören yada poliklinikte izlenen 47 erişkin taş hastası, bir çalışma protokolü belirlenerek izlenmişlerdir.Hepsi rekürren kalsiyum oksalat taşı olan hastalar rast gele randomize seçim ile tedavi ve kontrol grubu olmak üzere iki gruba ayrıldılar. Tedavi grubu potasyum sitrat ile tedavi edilirken, kontrol grubunun sadece sıvı alımını arttırmaları istenmiştir. Hastaların yaş ortalaması 36.7 olup, 9’u kadın, 38’i erkek hastadır. Çalışma başında bir kez, ikincisi sodyum ve kalsiyumdan kısıtlı diyetle bir hafta sonra, sonuncusu da çalışma bitiminde olmak üzere üç kez 24 saatlik idrar örneği toplanmış, buna göre tedavi sonundaki taş nüksleri, tedavi ve kontrol grubunda karşılaştırıldı. Ortalama 12 aylık takip süresince hiçbir hastada ciddi komplikasyon saptanmamış ve tam bir komplians sağlanmıştır. Metaflaksi öncesinde tedavi grubunda 23 hastada, 26 taş tespit edilmişken, çalışma sonunda 4 taş tespit edilmiştir. Kontrol grubunda çalışma öncesi 27 taş saptanmışken tedavi sonunda 24 taş saptanmıştır. Tekrar oranları hasta sayısına göre tedavi grubunda 23 hastada 4, kontrol grubunda ise 24 hastada 11’dir. Bu tedavi grubunda %17.4, kontrol grubunda ise %45.4’lik bir tekrar oranını ortaya koymaktadır. Bu oran, aynı zamanda potasyum sitrat kullanan hastalarda %82.6’lık bir taşsızlık oranını da vermektedir. Sonuç olarak; rekürren kalsiyum oksalat taşı olan hastalarda potasyum sitrat kullanımı etkili bir tedavi yöntemidir.