Treatment of Cystine Nephrolithiasis with Alpha-Mercapto-Propionylglycine

During the last 2 decades in Germany, only minor efforts were expended for the prevention of urinary stones. Substantial technical progress simplified the treatment of existing calculi; thus, it was more convenient to treat a new stone than to prevent its recurrence. But times change! In these days of financial squeeze in the medical system, prevention becomes more attractive. Nevertheless, strategies for kidney stone prevention developed. Established concepts for dietary advice were rejected due to the results of new randomized studies. Moreover, new pharmacological substances were introduced for metaphyalxis. The new concepts are feasible for the daily routine. For some treatment modalities in stone prevention, there is valid evidence from the literature, which should encourage us to adopt these modalities in the future. A number of drugs are used as "good common practice" without any proof from a randomized trial. Often prospective and valid studies are not available. The present paper intends to describe the status quo of nephrolithiasis prevention in Germany, focussing on confirmed data and unsolved problems.

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“…Der allgemein verbreitete Einsatz dieser Substanzen gründet sich letztlich auf eine Vielzahl positiver Fallberichte [5,26,43,48].…”

Section: Tiopronin/α-mercaptopropionylglycinunclassified

Pr�vention der Nephrolithiasis

Straub

Hautmann

2004

Der Urologe A

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Evidenzbasierte Pharmakologische Harnsteinmetaphylaxe

Straub

Hautmann

2006

Urologe

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Approximately one-fourth of urolithiasis patients are at high risk for recurrent stone formation or severe metabolic disturbances. These patients need specific metaphylaxis for effective stone prevention, adjusted to their individual metabolic risk. Recent recommendations for the pharmacological treatment of stone diseases are summarized in this article. For the different treatment options, evidence from the literature was assessed. In addition, a follow-up concept for pharmacologically treated high-risk stone formers is discussed.

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Diagnosis and metaphylaxis of stone disease

Straub

Strohmaier

Berg³

et al. 2005

World J Urol

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This review draws the recent state of the art in metabolic diagnosis and metaphylaxis of stone disease. It is the basis for the consensus approval with the other medical societies and institutions in Germany involved in the guideline process of the new "Urolithiasis Guideline". The German Working Committee on Stone Disease reviewed critically the current literature in the field of urolithiasis-including the existing German and EAU-Guidelines as well as the Conference Book of the First International Consultation on Stone Disease. As far as possible the references were rated according to the EBM criteria. On this basis the expert group discussed all pathways and statements regarding the management of stone disease. The present review coincides with the consented guideline draft of the German Working Committee on Stone Disease. Occurrence of stone disease in the western world increases seriously. Modern lifestyle, dietary habits and overweight-problems of the affluent societies-emerge to be the important promoters of the "stone-boom" in the new millennium. This even affects children, whose stone prevalence is otherwise significantly less than that of adults. Criteria for the high risk group of stone formers were clearly defined. A diagnostic standard is formulated for the basic and the elaborate metabolic evaluation of a stone patient. Approximately 75% of all stone patients could anticipate stone recurrence with elementary reorientation of their lifestyle and dietary habits, summarized as general metaphylaxis. About 25% of the stone formers require additional pharmacological intervention to normalize their individual biochemical risk, precisely compiled for each stone type as specific metaphylaxis.

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Treatment of Cystine Nephrolithiasis with Alpha-Mercapto-Propionylglycine

Cited by 3 publications

References 6 publications

Pr�vention der Nephrolithiasis

Pr�vention der Nephrolithiasis

Evidenzbasierte Pharmakologische Harnsteinmetaphylaxe

Diagnosis and metaphylaxis of stone disease

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