Esra KÖSELER BEYAZ

Nefrolitiaziste Tıbbi Beslenme Tedavisi

Dünya çapında nefrolitiazisin prevalansı ve insidansının giderek arttığı bildirilmektedir. Son yıllarda nefrolitiazis alanında önemli ilerlemeler kaydedilmiştir. Taş oluşum nedenleri ve spesifik moleküler defektler daha kapsamlı olarak ortaya konulmaktadır. İdrar yoğunluğunun yanında idrarda çözünen kristallerin miktarı da böbrek taşı oluşumunda etkilidir. İdrar hacminin azalmasıyla birlikte idrardaki çözünen maddelerin saturasyanu değişir ve taş oluşum riski artar. İdrarda okzalat ve fosfor gibi bazı maddelerin yüksek düzeyi ile böbrek taşları oluşabilmektedir. Genler, metabolik ve çevresel etmenler idrar bileşimini etkileyebilmekte ve taş oluşum riskini arttırabilmektedir. Diyet de böbrek taş oluşumuna neden olabilen ya da taş oluşumunu önleyebilen bir etmendir. Diyet uygulamasındaki değişiklikler ise böbrek taşlarının tedavisinde ve önlenmesinde anahtar bir rol oynayabilmektedir. Böbrek taşlarının ortaya çıkışının ya da yenilenmesinin önlenmesinde idrar süper saturasyonunun azaltılması önemlidir. Bu yüzden idrar hacmi 2-2.5 litre olana kadar sıvı alımının arttırılması hedeflenmelidir. Diyetteki okzalat miktarı arttığında veya kalsiyum düşük olduğunda ortaya çıkabilen hiperoksalüri, kalsiyum okzalat taşı oluşumu için risk etmenidir. Gereksiz diyetsel kalsiyum kısıtlamalarından kaçınmak ve okzalattan zengin besinleri diyette kontrol altına almak böbrek taşının önlenmesi için önemlidir. Artmış diyet sodyum alımı, kalsiyum renal tübüler geri emilimini azaltarak böbrek taşı için risk etmeni olan hiperkalsiüriyi tetikleyebileceği için, diyetle sodyum alımının düzenlemesine gidilebilmektedir. Bu yüzden böbrek taşı oluşumunu ve tekrarlamasını önleyebilmek adına çevresel etmenlerden özellikle beslenmenin de kontrol altına alınması gerekebilmektedir.

Medical Nutrition Therapy in Nephrolithiasis

The prevalence and incidence of nephrolithiasis is reported to be increasing across the world. In recent years, significant progress have been made in the field of nephrolithiasis. The factors and the specific molecular defects leading to stone formation have been revealed extensively. Besides urine concentration, the amount of crystals dissolved in the urine is also effective in the formation of kidney stones. By decreasing urine volume, the solubility of the dissolved substances in the urine changes and the risk of stone formation increases. Kidney stones can be formed when substances in the urine, such as oxalate and phosphorus, become highly concentrated. The genetics, metabolic and environmental factors may affect the urine composition and increase the kidney stone formation. Diet is one of the factors that can promote or inhibit kidney stone formation. Dietary changes can play a key role in the treatment and prevention of kidney stones. Reducing the urinary supersaturation is important for the prevention or the reoccurence of kidney stone formation. Fluid intake should be increased up to 2 to 2.5 L per day. Hypoxaluria, which may occur as a result of high dietary oxalate or low calcium intake, is a risk factor for calcium oxalate stone formation. It is important to avoid unnecessary dietary calcium restrictions, and oxalate-rich foods should be restricted to prevent kidney stones. Dietary sodium intake should also be considered, since increased sodium intake may trigger hypercalciuria, a well-known risk factor for kidney stones, by reducing the renal tubular reabsorption of calcium. Thus, the environmental factors, particularly diet, should be managed for the prevention and reoccurence of kidney stones.

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