Lamb Edmund J, Stevens Paul E, Nashef Lina
Department of Clinical Biochemistry, East Kent Hospitals NHS Trust, Kent and Canterbury Hospital, Canterbury, CT1 3NG, UK.
Ann Clin Biochem. 2004 Mar;41(Pt 2):166-9. doi: 10.1258/000456304322880104.
The incidence of renal stone disease in patients receiving topiramate (Topamax) is 2-4 times that expected in the background population. This has been attributed to a weak carbonic anhydrase inhibitor effect, but published data are scant. Following three cases of renal stones in patients receiving topiramate, we evaluated biochemical risk for nephrolithiasis in eight further unselected patients. Most patients demonstrated inadequate urinary acidification and hypocitraturia; in some cases citrate was undetectable. Several patients also had other risk factors for nephrolithiasis, including increased urinary sodium, calcium and oxalate excretion. The biochemical changes induced by topiramate appear highly penetrant. Experience with this drug is relatively short-lived and it is being prescribed for long-term use in (often) relatively young patients. This report highlights the significantly increased metabolic risk of stone formation in patients receiving topiramate.
接受托吡酯（妥泰）治疗的患者中肾结石病的发病率是普通人群预期发病率的2至4倍。这归因于其微弱的碳酸酐酶抑制作用，但已发表的数据很少。在3例接受托吡酯治疗的患者出现肾结石后，我们又对另外8例未经挑选的患者评估了肾结石的生化风险。大多数患者表现出尿酸化不足和枸橼酸盐尿过少；在某些情况下，枸橼酸盐检测不到。几名患者还存在其他肾结石风险因素，包括尿钠、钙和草酸盐排泄增加。托吡酯引起的生化变化似乎具有高度渗透性。使用这种药物的经验相对较短，而且它正被用于（通常）相对年轻的患者的长期治疗。本报告强调了接受托吡酯治疗的患者结石形成的代谢风险显著增加。
