Effects of non-pharmacological interventions on urinary citrate levels: a systematic review and meta-analysis. Skip to Main Content Sign In Register Advanced Search Online ISSN 1460-2385 Print ISSN 0931-0509 Copyright © 2017 European Renal Association - European Dialysis and Transplant Association Connect Resources Explore Oxford University Press is a department of the University of Oxford.
Medical and alternative therapies in urinary tract stone disease. Nephrolithiasis is a widespread medical problem, with an increased incidence in the last 20 years[1-4].
Its prevalence is expected to rise in the upcoming decades, as has been the case for obesity, diabetes, and metabolic syndrome[2,3]. Another problem related to nephrolithiasis is recurrence. In patients who do not receive prophylaxis following the first attack, recurrence rates are reported as 10% in the first year, 35% in the next 5 years, and 50% in 10 years. If recurrence is not prevented, patients may go through recurrent operations due to nephrolithiasis which, even if said operations are only minimally invasive, still results in hospitalization. This leads to higher monetary costs and loss of manpower, whereas preventing stone formation is far more economic. Numerous reports have revealed that urinary stone disease recurrence rates can be reduced via the correction of environmental and metabolic factors, as well as by the use of certain drugs and diet treatments[6-9].
Update on Nephrolithiasis: Core Curriculum 2016. There are 2 main sources of urinary oxalate in humans: endogenous oxalate production and exogenous oxalate absorption.
The kidney is responsible for oxalate excretion. Oxalate enters the proximal tubule through filtration and secretion. Hyperoxaluria is present in 10% to 50% of calcium stone formers and defined as urinary oxalate excretion > 40 mg/d. Elevated urinary oxalate excretion increases supersaturation, risk for crystal formation, and tubular damage. Primary hyperoxalurias are autosomal recessive disorders that lead to oxalate overproduction in the liver secondary to defects in glyoxylate metabolism. In addition to endogenous oxalate production, dietary oxalate is absorbed by passive and paracellular transport across the tight junctions of the intestine, mainly in the colon. Medical Management to Prevent Recurrent Nephrolithiasis in Adults: A Systematic Review for an American College of Physicians Clinical Guideline. From Minneapolis Veterans Affairs Medical Center, Minnesota Evidence-based Practice Center, University of Minnesota, and Hennepin County Medical Center, Minneapolis, Minnesota; John H.
Stroger Jr. Hospital of Cook County, Chicago, Illinois; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio. Disclaimer: This report is based on research conducted by the Minnesota Evidence-based Practice Center under contract to AHRQ, Rockville, Maryland. The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ, the U.S.
Acknowledgment: The authors thank Marilyn Eells and Maureen Carlyle for technical editing support. Grant Support: By contract HHSA 290 2007 10064 1 from AHRQ to the Minnesota Evidence-based Practice Center. Potential Conflicts of Interest: Dr. Dr. Dr. Dietary and Pharmacologic Management to Prevent Recurrent Nephrolithiasis in Adults: A Clinical Practice Guideline From the American College of PhysiciansDietary and Pharmacologic Management to Prevent Recurrent Nephrolithiasis. From the American College of Physicians and University of Pennsylvania Health System, Philadelphia, Pennsylvania, and Virginia Tech Carilion School of Medicine and Carilion Clinic, Roanoke, Virginia.
Note: Clinical practice guidelines are “guides” only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians’ judgment. All ACP clinical practice guidelines are considered automatically withdrawn or invalid 5 years after publication, or once an update has been issued. Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. Financial Support: Financial support for the development of this guideline comes exclusively from the ACP operating budget. Disclosures: Authors followed the policy regarding conflicts of interest described at www.annals.org/article.aspx?