Influence of clinical therapy and nutritional counseling on the recurrence of urolithiasis

PURPOSE: To evaluate the influence of combined clinical therapy and nutritional guidance on the recurrence of urolithiasis. METHODS: From our registry of patients with recurrent urolithiasis we selected 57 who had at least 5-years of follow-up. We collected 24h urine samples in order to analyze Ca, Na, uric acid, citrate, oxalate, and Mg concentrations and to assess urine volume. Patients filled out a clinical questionnaire before treatment, and abdominal radiographs and/or ultrasound were performed both before treatment and during the follow-up period. During follow-up, specific and individualized dietary advice was given based on the individual's metabolic disorders. Patients also received specific pharmacological treatment for their metabolic alterations. Outcome measures were metabolites in urine and the urolith recurrence rate. Pre- and post- intervention values were compared using tests as appropriate. RESULTS: Fifty six of the patients were male and the majority of patients were overweight. The mean BMI was 27 kg/m2. Urinary excretion of calcium, uric acid and sodium decreased significantly over the five year follow-up period. The number of uroliths that formed during the 5-year follow-up also decreased significantly compared to pre-treatment values. CONCLUSION: Individualized dietary advice combined with pharmacological treatment significantly reduces long-term urolithiasis recurrence. .

Avaliação da influência da orientação nutricional e do tratamento medicamentoso na recorrência da litíase urinária / Evaluation of the influence of nutritional guidance and drug therapy recurrence of urolithiasis

A litíase urinária é a terceira causa mais comum de afeção do trato urinário. A orientação dietética e o tratamento medicamentoso específico são importantes na recorrência da litíase e, portanto, mudar a dieta e seguir o tratamento farmacológico específico pode prevenir a sua recorrência. Avaliar a influência da orientação nutricional e do tratamento medicamentoso na recorrência da litíase urinária. A partir do nosso registro de pacientes com litíase recorrente foram selecionados 57 que tiveram pelo menos 5 anos de seguimento. Intervenção: Durante o acompanhamento dos pacientes foram avaliados os seguintes parâmetros: questionário clínico, investigação metabólica e avaliação por imagem (ultra-sonografia e/ou raio-X simples de abdome). Todos os pacientes foram orientados a controlar a ingestão de proteína (entre 0,8 a 1g/Kg peso corporal/dia) e adequar a ingestão de cálcio (entre 800 a 1000 mg/dia), levando-se em consideração o registro alimentar de 3 dias. A restrição de sal (menor que 5 g/dia) foi realizada tendo como referência a variação do sódio excretado na urina de 24h. Durante o acompanhamento os pacientes receberam ainda orientações dietéticas e farmacológicas específicas de acordo com o distúrbio metabólico identificado. 56% dos pacientes eram sexo masculino e a média do IMC no pré-tratamento foi de 27,8 kg/m², observando-se uma correlação positiva entre o número médio de cálculos formados por ano no pré-tratamento e IMC (p=0,012) Notamos uma diminuição significativa do cálcio, sódio e ácido úrico na urina de 24 horas no pós tratamento em comparação ao período inicial. Observamos um aumento significativo do citrato na urina de 24 horas no pós-tratamento. O nº de cálculos formados durante seguimento de 5 anos, diminuiu significativamente em relação ao pré tratamento...

Urinary tract lithiasis is the third most common cause of urinary tract affection. Dietary factors have great importance in the formation of urolithiasis; therefore, changing the diet and specific pharmacological treatment can prevent its recurrence. Evaluate the influence of clinical therapy associated to nutritional orientation in the recurrence of urolithiasis. From our registry of patients with recurrent lithiasis we selected 57 who had at least 5-years of follow-up. We used the protocol composed by 2 non-consecutive urine samples of 24h and was performed: Ca, Na, uric acid, citrate, oxalate, Mg and urinary volume assessments. In the pre treatment the lithiasis clinical questionary and after five years was care out using abdomen x-ray and/or ultrasound. Individualized dietary orientation consisted of: to increase fluid intake (enough to form ≥ 2 L / day); sodium ingestion <5 g / day and protein intake range between 0.8 - 1 g / kg body weight / day, and the adequate calcium intake (800 to 1000 mg / day). During the follow-up of patients, specific and individualized dietary orientation was performed according to the diagnosed metabolic disorder. Patients received specific pharmacological treatment according to the metabolic alteration. 54% were male. In average the BMI was 27 kg / m2. It was observed that according to BMI classification, the patients were overweight. Urinary excretion of calcium, uric acid and sodium decreased significantly after 5 years of follow-up. The number of stones formed in the 5- year follow-up decreased significantly compare to pre treatment. Individualized dietary orientation and pharmacological...

Urinary lithiasis and idiopathic hypercalciuria: the importance of dietary intake evaluation

PUSPOSE: To evaluate food intake of patients with urinary lithiasis and idiopathic hypercalciuria (IH). MATERIALS AND METHODS: Between August 2007 and June 2008, 105 patients with lithiasis were distributed into 2 groups: Group 1 (n = 55) - patients with IH (urinary calcium excretion > 250 mg in women and 300 mg in men with normal serum calcium); Group 2 (n = 50) - normocalciuria (NC) patients . Inclusion criteria were: age over 18, normal renal function (creatinine clearance = 60 mL/min), absent proteinuria and negative urinary culture. Pregnant women, patients with some intestinal pathology, chronic diarrhea or using corticoids were excluded. The protocol of metabolic investigation was based on non-consecutive collection of two 24-hour samples for dosages of: calcium, sodium, uric acid, citrate, oxalate, magnesium and urinary volume. Food intake was evaluated through the quantitative method of Dietary Register of three days. RESULTS: Urinary excretion of calcium (433.33 ± 141.92 vs. 188.93 ± 53.09), sodium (280.08 ± 100.94 vs. 200.44.93 ± 65.81), uric acid (880.63 ± 281.50 vs. 646.74 ± 182.76) and magnesium (88.78 ± 37.53 vs. 64.34 ± 31.84) was significantly higher in the IH group in comparison to the NC group (p < 0.05). As regards the nutritional composition of food intake of IH and NC groups, there was no statistical significant difference in any nutrient evaluated. CONCLUSION: In our study, no difference was observed in the food intake of patients with urinary lithiasis and IH or NC.

Metabolic investigation of patients with staghorn calculus: is it necessary?

Objective: To evaluate the prevalence of metabolic disorders in patients with staghorn calculi treated at the Regional Center of Lithiasis Metabolic Studies in central region of São Paulo State, Brazil. Materials and methods: Between February 2000 and February 2008, 630 patients with urinary calculi were evaluated in the lithiasis outpatient clinic. Thirty-seven of them had staghorn calculi (35 women and 2 men). The inclusion criteria for the metabolic investigation included the absence of urological manipulation 30 days before the examination, negative urine culture and creatinine clearance > 60 mL/min. The protocol for metabolic investigation consisted of qualitative search for cystinuria. Two non-consecutive 24-hour urine samples collected to measure calcium, phosphorus, uric acid, sodium, potassium, magnesium, oxalate and citrate, and serum calcium levels , phosphorus, uric acid, sodium, potassium, magnesium, chloride, parathormone and urine pH. Results: Among patients with lithiasis, 5.9 percent (37/ 630) had staghorn calculus and in 48.6 percent (18/37) were diagnosed with urinary infection. The females were predominant for 94.5 percent of cases. The calculi were unilateral in 31 of cases and bilateral in six. Metabolic abnormalities were found in 68.2 percent of patients with hypercalciuria (64.2 percent) and hypocitraturia (53.3 percent) being the most common disorders. Conclusions: The presence of metabolic disorders in nearly 70 percent of patients with staghorn calculus reinforces the necessity for evaluation of these patients. The diagnosis and treatment of identified metabolic abnormalities can contribute to the prevention of recurrent staghorn calculi.