Maalouf Naim M, Langston Joshua P, Van Ness Paul C, Moe Orson W, Sakhaee Khashayar
Department of Internal Medicine, Charles and Jane Pak Center for Mineral Metabolism & Clinical Research, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8885, USA.
Urol Res. 2011 Aug;39(4):303-7. doi: 10.1007/s00240-010-0347-5. Epub 2010 Dec 17.
Topiramate is a neuromodulatory agent increasingly prescribed for a number of neurological and non-neurological indications. Topiramate-treated patients are at risk for nephrolithiasis due to hypocitraturia and high urine pH. However, the prevalence of symptomatic stone disease in TPM users is generally perceived to be low. This study was undertaken to assess in topiramate-treated patients the prevalence of symptomatic nephrolithiasis (by history) and of asymptomatic nephrolithiasis by computed tomography (CT) scan. Topiramate users were identified from a database of patients with neurological disorders at a single university hospital. Among 75 topiramate-treated adult patients with a median daily dose of 300 mg and median treatment duration of 48 months, the prevalence of symptomatic nephrolithiasis was 10.7%. In a subset of topiramate-treated patients and no history of symptomatic stone disease, the prevalence of asymptomatic nephrolithiasis detected by CT scan was 20%. The prevalence of symptomatic nephrolithiasis with long-term topiramate use is higher than reported in short-term studies. Furthermore, clinical prevalence is underestimated due to asymptomatic nephrolithiasis.
托吡酯是一种神经调节药物，越来越多地被用于多种神经和非神经适应症。托吡酯治疗的患者因枸橼酸盐尿减少和尿液pH值升高而有患肾结石的风险。然而，托吡酯使用者中症状性结石病的患病率通常被认为较低。本研究旨在评估托吡酯治疗患者中症状性肾结石（通过病史）的患病率以及通过计算机断层扫描（CT）检测无症状肾结石的患病率。从一家大学医院的神经系统疾病患者数据库中识别出托吡酯使用者。在75名接受托吡酯治疗的成年患者中，每日中位剂量为300毫克，中位治疗持续时间为48个月，症状性肾结石的患病率为10.7%。在一部分接受托吡酯治疗且无症状性结石病病史的患者中，CT扫描检测到的无症状肾结石患病率为20%。长期使用托吡酯的症状性肾结石患病率高于短期研究报告的患病率。此外，由于无症状肾结石的存在，临床患病率被低估。
