Urolithiasis associated with topiramate

Abstract

Objective: Topiramate is a sulfamate-substituted monosaccharide anticonvulsant used as adjunctive therapy for intractable refractory seizures. It is report a case of topiramate-induced urolithiasis.Case Report: A 35-year-old man presented with acute, right-sided, colicky flank pain. He denied hematuria or dysuria. He was in use of phenytoin, risperidone, phenobarbital, and topiramate. The total daily dose of topiramate was 375 mg. A CT scan showed a 7 x 1 mm curvilinear density at the right ureterovesical junction with proximal hydrouretronephrosis. He was managed with rigid ureteroscopic stone extraction and the calculus metabolic analysis revealed the stone was composed of carbonate apatite (70%), calcium oxalate dihydrate (20%), and calcium oxalate monohydrate (10%).Comments: The present case typifies many features of topiramate-induced urolithiasis. Those who care for patients with urinary stone disease should be aware of this association.

Risk of urolithiasis due to topiramate as weight loss drug

“…Our study corroborates the same, showing a linear decrease in urinary citrate with time and dose of topiramate which was similar to the study published by Warner BW et al [8] Notably in our study, the stone analysis showed a predominance of Calcium Phosphate in four patients where the stone analysis was done. The same has been shown in other studies as well [9,10] . Topiramate was earlier believed to cause urolithiasis by a similar mechanism as in Type 1 Renal Tubular Acidosis, by inhibiting Carbonic anhydrase at proximal tubule.…”

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“…The development of urolithiasis can be summarized in three pathways [12]: overgrowth on interstitial apatite plaque such as idiopathic calcium oxalate stone, crystal deposits in renal tubules, and free solution crystallization such as cystinuria or hyperoxaluria. Overgrowth on interstitial apatite plaque may be the pathway responsible for the development of urolithiasis in patients receiving topiramate [5,10,[12][13][14][15][16]. In the pathway, the increased urinary oxalate [8,11,14] may deposit on the plaque and increase the sizes of the stones.…”

Nurturing the marriages of urinary liquid biopsies and nano‐diagnostics for precision urinalysis of prostate cancer

“…Prostate cancer (PCa) represents the most frequent solid cancer in males, and it continues to be the primary cause of cancer‐related death in these groups 1,2 . Comprehensive multi‐omics investigations, including genomic, transcriptomic, epigenomic, and proteomic analyses, have been undertaken in the last few years to better understand the heterogeneity of this malignancy 3–6 .…”