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[Nephrolithiasis: metabolic defects and terapeutic implications].
- Source :
-
Urologia [Urologia] 2014 Jan-Mar; Vol. 81 (1), pp. 1-11. Date of Electronic Publication: 2014 Apr 17. - Publication Year :
- 2014
-
Abstract
- Over the past 10 years, major progress has been made in the knowledge of urinary lithogenesis, including the potential pathogenetic role of Randall's plaques and renal tubular crystal retention. Urine supersaturation is the driving force of this process and can be induced by some risk factors, including low urine volume, high urinary excretion of calcium oxalate and uric acid and low urinary excretion of citrate. Primary hypercalciuria can be due to intestinal overabsorption renal leak and bone reabsorption of calcium. Prophilaxis is mainly conducted with thiazides and low calcium diet which is indicated only in the intestinal form. Primary hyperoxaluria is treated with pyridoxine and may require in the severe forms simultaneous renal and liver transplantation. Enteric hyperoxaluria is secondary to fatty acids malabsorption and requires diet, oral calcium and cholestiramine. Hyperuricosuria is caused by diet endogenous overproduction, mainly due to enzymatic defects or high renal excretion of uric acid. Urine alkalinization with K or K and Mg citrate can prevent stone formation even in idiopathic uric acid nephrolithiasis, in which a defect of urine acidification is supposed to be the main abnormality, and in hypocitraturic patients. Cystinuria is a rare inherited defect with an intense clinical impact. It can be classified in three forms and urinary stone formation is the role. Increased solubility and conversion of cystine in a more soluble form are the main goals of the prophylaxis which includes K citrate and thiol agents administration. Tiopronin is preferred to D-penicillamine due to its lower side effects.
- Subjects :
- Cathartics therapeutic use
Citric Acid therapeutic use
Cystinuria complications
Drug Therapy, Combination
Humans
Hypercalciuria complications
Hyperoxaluria complications
Nephrolithiasis diet therapy
Nephrolithiasis drug therapy
Nephrolithiasis etiology
Nephrolithiasis prevention & control
Organometallic Compounds therapeutic use
Pyridoxine therapeutic use
Risk Factors
Sex Distribution
Thiazides therapeutic use
Tiopronin therapeutic use
Treatment Outcome
Vitamin B Complex therapeutic use
Cystinuria prevention & control
Hypercalciuria prevention & control
Hyperoxaluria prevention & control
Kidney metabolism
Nephrolithiasis metabolism
Nephrolithiasis therapy
Subjects
Details
- Language :
- Italian
- ISSN :
- 1724-6075
- Volume :
- 81
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Urologia
- Publication Type :
- Academic Journal
- Accession number :
- 24744215
- Full Text :
- https://doi.org/10.5301/uro.5000058