Abu-Ghanem Yasmin, Kleinmann Nir, Erlich Tomer, Winkler Harry Z, Zilberman Dorit E
Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr Med Assoc J. 2021 Jan;23(1):12-16.
Dietary modifications and patient-tailored medical management are significant in controlling renal stone disease. Nevertheless, the literature regarding effectiveness is sparse.
To explore the impact of dietary modifications and medical management on 24-hour urinary metabolic profiles (UMP) and renal stone status in recurrent kidney stone formers.
We reviewed our prospective registry database of patients treated for nephrolithiasis. Data included age, sex, 24-hour UMP, and stone burden before treatment. Under individual treatment, patients were followed at 6-8 month intervals with repeat 24-hour UMP and radiographic images. Nephrolithiasis-related events (e.g., surgery, renal colic) were also recorded. We included patients with established long-term follow-up prior to the initiation of designated treatment, comparing individual nephrolithiasis status before and after treatment initiation.
Inclusion criteria were met by 44 patients. Median age at treatment start was 60.5 (50.2-70.2) years. Male:Female ratio was 3.9:1. Median follow-up was 10 (6-25) years and 5 (3-6) years before and after initiation of medical and dietary treatment, respectively. Metabolic abnormalities detected included: hypocitraturia (95.5%), low urine volume (56.8%), hypercalciuria (45.5%), hyperoxaluria (40.9%), and hyperuricosuria (13.6%). Repeat 24-hour UMP under appropriate diet and medical treatment revealed a progressive increase in citrate levels compared to baseline and significantly decreased calcium levels (P = 0.001 and 0.03, respectively). A significant decrease was observed in stone burden (P = 0.001) and overall nephrolithiasis-related events.
Dietary modifications and medical management significantly aid in correcting urinary metabolic abnormalities. Consequently, reduced nehprolithiasis-related events and better stone burden control is expected.
饮食调整和针对患者的个性化医疗管理对控制肾结石病至关重要。然而，关于其有效性的文献较少。
探讨饮食调整和医疗管理对复发性肾结石患者24小时尿代谢谱（UMP）和肾结石状况的影响。
我们回顾了接受肾结石治疗的患者的前瞻性登记数据库。数据包括年龄、性别、24小时UMP以及治疗前的结石负荷。在个体化治疗下，患者每隔6 - 8个月接受随访，复查24小时UMP和影像学检查。还记录了与肾结石相关的事件（如手术、肾绞痛）。我们纳入了在开始指定治疗前有长期随访记录的患者，比较治疗开始前后个体的肾结石状况。
44例患者符合纳入标准。开始治疗时的中位年龄为60.5（50.2 - 70.2）岁。男女比例为3.9:1。医疗和饮食治疗开始前和后的中位随访时间分别为10（6 - 25）年和5（3 - 6）年。检测到的代谢异常包括：低枸橼酸尿（95.5%）、低尿量（56.8%）、高钙尿（45.5%）、高草酸尿（40.9%）和高尿酸尿（13.6%）。在适当的饮食和医疗治疗下复查24小时UMP显示，与基线相比，枸橼酸盐水平逐渐升高，钙水平显著降低（分别为P = 0.001和0.03）。结石负荷显著降低（P = 0.001），总体与肾结石相关的事件也显著减少。
饮食调整和医疗管理显著有助于纠正尿代谢异常。因此，预计与肾结石相关的事件会减少，结石负荷控制得更好。
