Double-Blind Study with Thiazide in Recurrent Calcium Lithiasis

Scholz, D.; Schwille, P. O.; Sigel, A.

doi:10.1016/s0022-5347(17)53269-3

Cited by 102 publications

(50 citation statements)

References 9 publications

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“…Again, there was no change in oxalate excretion in the control group. Scholze et al (62) reported no decrease in urine oxalate in patients who received hydrochlorothiazide after 1 yr of therapy but did find a reduction in oxalate excretion in the placebo group. Martins et al (63) performed a prospective crossover trial comparing the biochemical effects of hydrochlorothiazide and indapamide.…”

Section: Discussionmentioning

confidence: 95%

Thiazides Reduce Brushite, but not Calcium Oxalate, Supersaturation, and Stone Formation in Genetic Hypercalciuric Stone–Forming Rats

Bushinsky¹,

Asplin²

2005

Journal of the American Society of Nephrology

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Over 59 generations, a strain of rats has been inbred to maximize urine calcium excretion. The rats now excrete eight to 10 times as much calcium as controls. These rats uniformly form calcium phosphate (apatite) kidney stones and have been termed genetic hypercalciuric stone-forming (GHS) rats. The addition of a common amino acid and oxalate precursor, hydroxyproline, to the diet of the GHS rats leads to formation of calcium oxalate (CaOx) kidney stones. Hydroxyproline-supplemented GHS rats were used to test the hypothesis that the thiazide diuretic chlorthalidone would decrease urine calcium excretion, supersaturation, and perhaps stone formation. All GHS rats received a fixed amount of a standard 1.2% calcium diet with 5% trans-4-hydroxy-L-proline (hydroxyproline) so that the rats would exclusively form CaOx stones. Half of the rats had chlorthalidone (Thz; 4 to 5 mg/kg per d) added to their diets. Urine was collected weekly, and at the conclusion of the study, the kidneys, ureters, and bladders were radiographed for the presence of stones. Compared with control, the addition of Thz led to a significant reduction of urine calcium and phosphorus excretion, whereas urine oxalate excretion increased. Supersaturation with respect to the calcium hydrogen phosphate fell, whereas supersaturation with respect to CaOx was unchanged. Rats that were fed Thz had fewer stones. As calcium phosphate seems to be the preferred initial solid phase in patients with CaOx kidney stones, the reduction in supersaturation with respect to the calcium phosphate solid phase may be the mechanism by which thiazides reduce CaOx stone formation.

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Section: Discussionmentioning

confidence: 95%

Thiazides Reduce Brushite, but not Calcium Oxalate, Supersaturation, and Stone Formation in Genetic Hypercalciuric Stone–Forming Rats

Bushinsky¹,

Asplin²

2005

Journal of the American Society of Nephrology

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“…Seven of the ten RCTs reported a reduction in recurrence rate in treated patients (9 -12,14 -16). Two trials that showed no difference in outcome were limited by their short follow-up duration of Ͻ2 years (17,18). A consistent finding in these trials is that stone-forma-tion rate between treated and control groups did not begin to diverge until after at least 1 year of therapy.…”

Section: Thiazide Diuretics and Nephrolithiasismentioning

confidence: 93%

The Evidence-Based Use of Thiazide Diuretics in Hypertension and Nephrolithiasis

Reilly¹,

Peixoto²,

Desir³

2010

Clinical Journal of the American Society of Nephrology

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Thiazide-type diuretics are commonly used in the treatment of hypertension and nephrolithiasis. Evidence from randomized clinical trials needs to be considered in decisions about agent choice and dose. In nephrolithiasis, one of the major limitations of the literature is a paucity of data on the dose-response effect of hydrochlorothiazide (HCTZ) on urinary calcium excretion. The best available evidence for prevention of stone recurrence suggests the use of indapamide at 2.5 mg/d, chlorthalidone at 25 to 50 mg daily, or HCTZ 25 mg twice a day or 50 mg daily. In hypertension, chlorthalidone (12.5 to 30 mg daily) may be the best choice when a diuretic is used for initial therapy, with indapamide (1.5 mg daily) being a valuable alternative for older patients. When adding a thiazide to other drug classes, indapamide (2.5 mg daily) has demonstrated value in hypertensive patients who have had a stroke, and HCTZ (12.5 to 25 mg daily) has a safe track record in several patient groups. Although chlorthalidone has not been tested as add-on therapy, the authors believe it is a safe option in such cases.

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“…Stone specific diagnostic and therapeutic algorithms Figure 2 [31][32][33][34][35][36][37][38][39][40][41][42][43][44]. Elevated levels of ionized calcium in serum (or total calcium and albumin) require assessment of intact PTH to confirm or exclude suspected hyperparathyroidism (HPT) [60].…”

Section: 3mentioning

confidence: 99%

Metabolic Evaluation and Recurrence Prevention for Urinary Stone Patients: EAU Guidelines

Skolarikos¹,

Straub²,

Knoll³

et al. 2015

European Urology

260

173

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Double-Blind Study with Thiazide in Recurrent Calcium Lithiasis

Cited by 102 publications

References 9 publications

Thiazides Reduce Brushite, but not Calcium Oxalate, Supersaturation, and Stone Formation in Genetic Hypercalciuric Stone–Forming Rats

Thiazides Reduce Brushite, but not Calcium Oxalate, Supersaturation, and Stone Formation in Genetic Hypercalciuric Stone–Forming Rats

The Evidence-Based Use of Thiazide Diuretics in Hypertension and Nephrolithiasis

Metabolic Evaluation and Recurrence Prevention for Urinary Stone Patients: EAU Guidelines

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