Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Urology. 2013 Dec;82(6):1220-5. doi: 10.1016/j.urology.2013.08.002. Epub 2013 Sep 17.
To assess the efficacy of dietary management for the treatment of idiopathic hyperoxaluria in a large tertiary care center and examine the influence of patient factors, compliance, and follow-up on oxalate reduction, which has not been previously investigated.
Retrospectively, 149 patients with kidney stones with idiopathic hyperoxaluria who received dietary management at our stone clinic were evaluated. Changes in urinary parameters on 24-hour urine collections were calculated for all patients and those with abnormal values in the overall short-term (30-240 days) and long-term (>240 days) time periods. Changes in urinary oxalate were evaluated with respect to patient characteristics and compliance measures.
Urine oxalate and supersaturation of calcium oxalate were significantly (P < .001) reduced by 8.9 ± 19.2 mg/d and 1.7 ± 4.3, respectively. A total of 48.3% of the patients reduced their urinary oxalate to normal. Urine oxalate reductions were similar in the short-term and long-term periods. Women lowered urine oxalate nearly twice as much as men (12.7 ± 2.0 mg/d vs 6.7 ± 2.2 mg/d, P = .022) and body mass index (BMI) negatively correlated with oxalate reduction (Pearson's r = -0.213). Reported noncompliance and keeping follow-up appointments did not affect oxalate, however, there was a significant correlation between increasing urine volume and reducing oxalate (Pearson's r = -0.21).
This study confirms that meaningful reductions of urine oxalate and supersaturation of calcium oxalate can be achieved with dietary management of hyperoxaluria on a larger clinical scale. Furthermore, we identified that women and patients with low BMIs had greater urine oxalate reductions and urine volume may also be used by clinicians as a measure of dietary compliance.
评估在大型三级医疗机构中通过饮食管理治疗特发性高草酸尿症的疗效，并研究患者因素、依从性和随访对草酸降低的影响，此前尚未对此进行研究。
回顾性分析了在我院结石门诊接受饮食管理的 149 例肾结石伴特发性高草酸尿症患者。对所有患者和在短期（30-240 天）和长期（>240 天）时间段内尿参数异常的患者进行 24 小时尿液收集的变化计算。根据患者特征和依从性措施评估尿草酸的变化。
尿草酸和草酸钙过饱和度分别显著降低了 8.9±19.2mg/d 和 1.7±4.3（P<0.001）。共有 48.3%的患者将尿草酸降低至正常水平。短期和长期的尿草酸降低相似。女性降低尿草酸的幅度几乎是男性的两倍（12.7±2.0mg/d 与 6.7±2.2mg/d，P=0.022），体重指数（BMI）与草酸降低呈负相关（Pearson r=-0.213）。报告的不依从和随访预约并未影响草酸，但尿液量与降低草酸之间存在显著相关性（Pearson r=-0.21）。
本研究证实，通过饮食管理可以在更大的临床范围内实现有意义的尿草酸和草酸钙过饱和度降低。此外，我们发现女性和 BMI 较低的患者尿草酸降低幅度更大，并且尿液量也可被临床医生用作饮食依从性的衡量标准。
