[Nephrolithiasis: metabolic defects and terapeutic implications].

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.

• Authors: Andrea Tasca, Ciro Ammendola
• Journal: Urologia (Urologia) 2014 Jan-Mar Vol. 81 Issue 1 Pg. 1-11 ISSN: 1724-6075 [Electronic] United States
• Vernacular Title: Nefrolitiasi: aspetti metabolici e implicazioni terapeutiche.
• PMID: 24744215 (Publication Type: English Abstract, Journal Article)

Chemical References

• Cathartics
• Organometallic Compounds
• Thiazides
• Vitamin B Complex
• Citric Acid
• Tiopronin
• Pyridoxine
• magnesium citrate

Topics

• Cathartics (therapeutic use)
• Citric Acid (therapeutic use)
• Cystinuria (complications, prevention & control)
• Drug Therapy, Combination
• Humans
• Hypercalciuria (complications, prevention & control)
• Hyperoxaluria (complications, prevention & control)
• Kidney (metabolism)
• Nephrolithiasis (diet therapy, drug therapy, etiology, metabolism, prevention & control, therapy)
• Organometallic Compounds (therapeutic use)
• Pyridoxine (therapeutic use)
• Risk Factors
• Sex Distribution
• Thiazides (therapeutic use)
• Tiopronin (therapeutic use)
• Treatment Outcome
• Vitamin B Complex (therapeutic use)