Tekrarlayan üriner sistem kalsiyum taşlarının metabolik değerlendirilmesi ve medikal yaklaşımlar

Üriner traktus’ta tekrarlayan taşların oluşumu önemli ve yaygın bir problemdir. Taşların medikal tedavisindeki en önemli faktör, doğru metabolik tanının konmasıdır. Maalesef, tekrarlayan taş hastalarının önemli bir kısmında uygun metabolik değerlendirme yapılmamaktadır. Diyet düzenlemeleri, halen tedavinin en önemli kısımlarından birini oluşturmaktadır. Son yapılan çalışmalar, tekrarlayan kalsiyum taşı olan hastalarda kalsiyum kısıtlamasının faydalı olmadığını belirtmektedir. Yeni çalışmalar, tekrarlayan kalsiyum taşlarının önlenmesinde oksalat, tuz ve hayvansal proteinlerin kıstlanmasının önemine dikkat çekmektedir. Diyet düzenlemeleri ile taş oluşumu kontrol altına alınamadığında veya şiddetli metabolik düzensizlik bulunduğunda farmakolojik tedavi gerekli olabilmektedir.

Anahtar Kelimeler:

Kalsiyum okzalat, Üriner taş

Methabolic evaluation and medical aspects of recurrent urinary tract calcium stones

Recurrent Stone formation in the urinary tract is a common and important problem. The most important component in the medical treatment of stones is establishing the correct metabolic diagnosis. Unfortunately a significant proportion of patients with recurrent stones do not undergo proper metabolic evaluation. Dietary modification still remains one of the most important strategies for therapy. Recent studies suggest that severe calcium restriction is not useful in patients with recurrent calcium nephrolithiasis. New studies imply the significant role of oxalate, salt and animal protein dietary restrictions in the prevention of calcium stone recurrence. When dietary modification is unsuccessful in controlling stone formation or in the presence of severe metabolic derangements, a pharmacologic treatment may be necessary.

Keywords:

Calcium Oxalate, Urinary Calculi,

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1. Menon M, Resnick MI. Urinary lithiasis: etiology, diagnosis, and medical management. In: WalshPC, RetikAB, Vaughan ED, editors. Campbell's Urology Philadelphia: WB Saunders; p: 2002;3229-3305
2. Clinical approach. In: Coe FL, Parks JH, eds. Nephrolithiasis: pathogenesis and treatment (2nd edn), Chicago: Year Book Medical, p: 1998;1-37
3. Bihl G, Meyers A. Recurrent renal stone disease-advances in pathogenesis and clinical management. Lancet, 2001; 25;358 (9282): 651-656
4. Goldfarb DS., Coe FL. Prevention of recurrent nephrolithiasis. Am Fam Physician, 1999; 15;60:2269-2276
5. Mitch WE, Walser M. Nutritional therapy of the uremic patient. In Brenner BM, Rector FC Jr eds. The Kidney. Vol II. Third edn. Philadelphia: WB Saunders, 1986;1759-90.
6. Borghi L, Meschi T, Amato F, et al. Urinary volume, water and recurrence in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol 1996;155:839-843.
7. Borghi L, Meschi T, Schianchi T, et al. Urine volume: stone risk factor and preventive measure. Nephron , 1999;81:31-37.
8. Curhan GC, Willett WC, Speizer FE, et al. Beverage use and risk for kidney stones in women. Ann Intern Med , 1998;128:534-540.
9. Soucie JM., Thun MJ., Coates RJ., et al. Demographic and geographic variability of kidney stones in the United States. Kidney Int , 1994;46:893-899.
10. Prince CL, Scardino PL, Wolan TC. The effect of temperature, humidity, and dehydration on the formation of renal calculi. J Urol, 1956;75:209-212.
11. Curhan GC, Rimm EB, Willett WC, et al. Regional variation in nephrolithiasis incidence and prevalence among United States men. J Urol , 1994;151:838-841.
12. Curhan GC, Willett WC, Rimm EB, et al. A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med , 1993;328:833-838
13. Borghi L, Schianchi T, Meschi T, et al. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med, 2002;346:77-84.
14. Curhan GC, Willett WC, Speizer FE, et al. Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann Intern Med, 1997;126:497-504.
15. Pak CY, Peterson RD, Poindexter J. Prevention of spinal bone loss by potassium citrate in cases of calcium urolithiasis. J Urol, 2002;168:31-34.
16. Asplin JR, Bauer KA, Kinder J, et al. Bone mineral density and urine calcium excretion among subjects with and without nephrolithiasis. Kidney Int, 2003;63:662-669.
17. Parivar F, Low RK, Stoller ML. The influence of diet on urinary stone disease. J Urol, 1996; 155:432-440.
18. Sakhaee K, Harvey JA, Padalino PK, et al. The potential role of salt abuse on the risk for kidney stone formation. J Urol, 1993;150:310-312
19. Assimos DG, Holmes RP. Role of diet in the therapy of urolithiasis. Urol Clin North Am, 2000;27:255-268.
20. Holmes RP, Goodman HO, Assimos DG. Contribution of dietary oxalate to urinary oxalate excretion. Kidney Int, 2001;59:270-276
21. Siener R, Ebert D, Nicolay C, et al. Dietary risk factors for hyperoxaluria in calcium oxalate stone formers. Kidney Int, 2003;63:1037-1043. al. Intake of vitamins B6 and C and the risk of kidney stones in women. J Am Soc Nephrol, 1999;10:840- 5.
23. Nordenvall C, Backman L, Larsson L, Tiselius HG. Effects of calcium, aluminium, magnesium and cholestyramine on hyperoxaluria in patients with jejunoileal by pass. Acta Chir Scand, 1983; 149: 938
24. Barcelo P, Wuhl O, Servitge E, et al. Randomized double blind study of potassium citrate in idiopathic hypocitraturic calcium nephrolithiasis. J Urol, 1993;150:1761-1764
25. Ettinger B, Pak CYC, Citron JT, et al. Potassium-magnesium citrate is an effective prophylaxis against recurrent calcium oxalate nephrolithiasis. J Urol, 1997; 158:2069-2073.
26. Heyburn PJ, Robertson WG, Peacock M. Phosphate treatment of recurrent calcium stone disease. Nephron, 1982;32: 3149.
27. Lagrue G, Hioco D, Kazandjian M, Cattaneo A, Cassagnol M. Lithiase rénale cacique et phosphothérapie. Etud à long term (65 cas). Semain Des Hopitau Paris, 1980;50: 10438
28. Laerum E, Larsen S. Thiazide prophylaxis of urolithiasis. A double-blind study in general practice. Acta Med Scan, 1984;215: 3839
29. Borghi L, Meschi T, Guerra A, Novarini A. Randomized prospective study of a nonthiazide diuretic, indapamide, in preventing calcium stone recurrences. J Cardiovascular Pharmacol, 1993;22 (Suppl. 6): S7886, 1993
30. Tiselius HG, Larsson L, Hellgren E. Clinical results of allopurinol treatment in prevention of calcium oxalate stone formation. J Urol, 1986;136: 503