Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Urology. 2011 May;77(5):1054-8. doi: 10.1016/j.urology.2010.08.002. Epub 2011 Feb 19.
To examine the effects of dietary manipulation and pyridoxine medical management for idiopathic hyperoxaluria in patients with nephrolithiasis.
A retrospective longitudinal study of the patients treated in our stone clinics from July 2007 to February 2009 was performed. All patients were evaluated with pre- and postintervention 24-hour urine collection and met a registered dietician. Recommendations to keep urine volume above 2 L per day, sodium restriction, protein moderation, increased calcium intake with meals and low oxalate diet combined with oral pyridoxine were given. Initial dosage ranged from 50 to 100 mg per day depending on the baseline oxalate level, and was titrated to a maximum of 200 mg daily. Subjects with at least two 24-hour urine collections were included in the study.
Of 314 patients with complete metabolic and urinary profile evaluation, 95 subjects were identified with idiopathic hyperoxaluria. Mean follow-up was 18.4 ± 14.8 months and mean age was 50.3 ± 12.8 years. In patients treated with the combination of dietary counseling and pyridoxine, there was a significant change in urinary parameters in 75% of patients with a significant decrease in urinary oxalate excretion (58.26 ± 27.05 to 40.61 ± 15.04, P < .0001). In all, 39% of the patients had a decrease from a high urine oxalate levels (>40 mg/d) to a normal range urine oxalate (55.30 ± 22.04 to 33.45 ± 3.93, P = .0004). No peripheral neuropathy was reported.
Dietary management and medical treatment using pyridoxine may be an effective first-line therapy to decrease hyperoxaluria in patients who form stones.
研究饮食干预和吡哆醇医学治疗对肾结石患者特发性高草酸尿症的影响。
对 2007 年 7 月至 2009 年 2 月在我院结石门诊治疗的患者进行回顾性纵向研究。所有患者均进行干预前后 24 小时尿液采集，并接受注册营养师评估。建议患者保持每日尿量超过 2 升，限制钠摄入，适量摄入蛋白质，餐中增加钙摄入，并采用低草酸饮食联合口服吡哆醇。初始剂量根据基线草酸水平而定，范围为 50-100mg/天，最大剂量为 200mg/天。至少有两次 24 小时尿液采集的患者纳入本研究。
在完成完整代谢和尿液分析评估的 314 例患者中，有 95 例患者被诊断为特发性高草酸尿症。平均随访时间为 18.4 ± 14.8 个月，平均年龄为 50.3 ± 12.8 岁。在接受饮食咨询和吡哆醇联合治疗的患者中，75%的患者尿液参数发生显著变化，尿草酸排泄量显著减少（58.26 ± 27.05 降至 40.61 ± 15.04，P <.0001）。共有 39%的患者尿草酸水平（>40mg/d）从高值降至正常值（55.30 ± 22.04 降至 33.45 ± 3.93，P =.0004）。未报告周围神经病。
饮食管理和吡哆醇医学治疗可能是降低结石形成患者高草酸尿症的有效一线治疗方法。
