Is selective therapy of recurrent nephrolithiasis possible?

Pak, Charles Y.C.; Peters, Paul C.; Hurt, George; Kadesky, M.C.; Fine, Myron G.; Reisman, David D.; Splann, Frank; Caramela, Calvin; Freeman, Alan; Britton, Faye; Sakhaee, K.; Breslau, Neil A.

doi:10.1016/0002-9343(81)90214-x

Cited by 124 publications

(18 citation statements)

References 25 publications

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“…The same responses have been documented by Yendt and Cohanim (36), Pak et al (37), and Maschio et al (38). The probable mechanism is a reduction of calcium oxalate supersaturation.…”

Section: Thiazide Diuretic Agentssupporting

confidence: 82%

Nephrolithiasis and Nephrocalcinosis

Parks¹,

Coe²

1998

Suki and Massry’s THERAPY OF RENAL DISEASES AND RELATED DISORDERS

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“…The same responses have been documented by Yendt and Cohanim (36), Pak et al (37), and Maschio et al (38). The probable mechanism is a reduction of calcium oxalate supersaturation.…”

Section: Thiazide Diuretic Agentssupporting

confidence: 82%

Nephrolithiasis and Nephrocalcinosis

Parks¹,

Coe²

1998

Suki and Massry’s THERAPY OF RENAL DISEASES AND RELATED DISORDERS

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“…Over 88 patient-years, bendroflumethiazide (2.5 mg/day) reduced new stone formation compared with the pre-treatment phase 25. Pak et al segregated hypercalciuria into predominantly intestinal hyperabsorption or renal leak and noted a decline in stone formation rate from 2.1 to 0.40 in both groups of patients 23. In a 5-year experience with hydrochlorothiazide (50 mg/day) and amiloride (5 mg/day) in 519 patients with recurrent calcium nephrolithiasis, where 65% of which were classified as hypercalciuric, 53 new stones were formed in the treated group in contrast to the predicted 916 stones 22.…”

Section: Hypercalciuriamentioning

confidence: 99%

Pharmacotherapy of urolithiasis: evidence from clinical trials

Moe

Pearle

Sakhaee

2011

Kidney International

105

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Urolithiasis is a worldwide problem with significant health and economic burdens. Medical therapy that alters the course of stone disease has enormous medical and financial impact. Urolithiasis is a final manifestation of a broad range of etiologies and pathogenesis. The modest progress in understanding the pathophysiology has hampered successful development of targeted therapy. Current regimens are based mostly on rational alteration of urinary biochemistry and physical chemistry to lower the risk of precipitation. In terms of pharmacotherapy, there are drugs to successfully improve hypercalciuria, hypocitraturia, aciduria, hyperuricosuria, and hypercystinuria. These agents have been proven to be effective in randomized controlled trials in improving urinary biochemical and physicochemical risk factors, as well as clinical outcomes. Although our current regimens have clearly improved the management and lives of stone formers, there are still clearly identifiable immense voids in the knowledge of pathophysiology of stone disease that can be filled with combined basic science and clinical studies.

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“…In selective therapy [15], a specific drug is chosen for each disorder, based on its ability to correct the underlying metabolic derangements. Thus, thiazide is indicated in renal hypercalciuria, since it corrects the ‘renal leak’ of calcium and restores normal parathyroid function, intestinal calcium absorption and urinary calcium.…”

Section: Relative Merits Of Selective Versus Nonselective Drug Treatmentmentioning

confidence: 99%

Medical Prevention of Renal Stone Disease

Pak

1998

Nephron

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Medical treatment designed to prevent stone formation is important in idiopathic calcium oxalate nephrolithiasis, because of the high rate of stone recurrence. Several randomized trials have established the values of conservative and drug treatments. A high fluid intake alone has been reported to inhibit the recurrence of stone formation in single stone formers. In patients with recurrent disease, a significant reduction in stone formation rate from pretreatment was found in the placebo group maintained on a conservative program, underscoring the importance of increased fluid intake and dietary modification. In patients with active recurrent stone disease, treatment with drugs along with a conservative program is necessary. Allopurinol, thiazide, potassium citrate and potassium-magnesium citrate have been shown to inhibit stone formation compared with placebo. It has not been clearly established that a selective treatment is more effective than a more randomly chosen drug treatment. Another advantage of medical approach is its ability to correct nonrenal complications of stone disease, such as bone loss that sometimes accompanies stone disease.

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Is selective therapy of recurrent nephrolithiasis possible?

Cited by 124 publications

References 25 publications

Nephrolithiasis and Nephrocalcinosis

Nephrolithiasis and Nephrocalcinosis

Pharmacotherapy of urolithiasis: evidence from clinical trials

Medical Prevention of Renal Stone Disease

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