Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 131
Filtrar
1.
Urologiia ; (2): 113-118, 2019 Jun.
Artigo em Russo | MEDLINE | ID: mdl-31162912

RESUMO

The use of alkaline mineral waters leads to alkalization of urine and an increase in level of urinary citrate, which represent important factor inhibiting the formation of urinary stones. Combination of alkaline mineral waters with citrates facilitates the achievement of target urine pH level not only during dissolution therapy, but also during recurrence prevention. Alkalization of urine and reducing of the influence of alimentary factor dont preclude drug therapy. Patients should be counselled about complex strategies aimed to modifiable risk factors for urinary stone disease.


Assuntos
Cálculos Renais/dietoterapia , Cálculos Renais/prevenção & controle , Águas Minerais/uso terapêutico , Ácido Cítrico/metabolismo , Ácido Cítrico/urina , Ingestão de Líquidos , Humanos , Concentração de Íons de Hidrogênio , Cálculos Renais/química , Recidiva , Fatores de Risco , Prevenção Secundária , Solubilidade , Ácido Úrico/química , Ácido Úrico/metabolismo
2.
EBioMedicine ; 45: 231-250, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31202812

RESUMO

BACKGROUND: Epidemiological evidence of over 9000 people suggests that daily intake of vinegar whose principal bioactive component is acetic acid is associated with a reduced risk of nephrolithiasis. The underlying mechanism, however, remains largely unknown. METHODS: We examined the in vitro and in vivo anti-nephrolithiasis effects of vinegar and acetate. A randomized study was performed to confirm the effects of vinegar in humans. FINDINGS: We found individuals with daily consumption of vinegar compared to those without have a higher citrate and a lower calcium excretion in urine, two critical molecules for calcium oxalate (CaOx) kidney stone in humans. We observed that oral administration of vinegar or 5% acetate increased citrate and reduced calcium in urinary excretion, and finally suppressed renal CaOx crystal formation in a rat model. Mechanism dissection suggested that acetate enhanced acetylation of Histone H3 in renal tubular cells and promoted expression of microRNAs-130a-3p, -148b-3p and -374b-5p by increasing H3K9, H3K27 acetylation at their promoter regions. These miRNAs can suppress the expression of Nadc1 and Cldn14, thus enhancing urinary citrate excretion and reducing urinary calcium excretion. Significantly these mechanistic findings were confirmed in human kidney tissues, suggesting similar mechanistic relationships exist in humans. Results from a pilot clinical study indicated that daily intake of vinegar reduced stone recurrence, increased citrate and reduced calcium in urinary excretion in CaOx stone formers without adverse side effects. INTERPRETATION: Vinegar prevents renal CaOx crystal formation through influencing urinary citrate and calcium excretion via epigenetic regulations. Vinegar consumption is a promising strategy to prevent CaOx nephrolithiasis occurrence and recurrence. FUND: National Natural Science Foundations of China and National Natural Science Foundation of Guangdong Province.


Assuntos
Ácido Acético/administração & dosagem , Epigênese Genética/genética , Cálculos Renais/dietoterapia , Nefrolitíase/dietoterapia , Adulto , Animais , Cálcio/urina , Oxalato de Cálcio/urina , Claudinas/genética , Transportadores de Ácidos Dicarboxílicos/genética , Epigênese Genética/efeitos dos fármacos , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Histonas/genética , Humanos , Cálculos Renais/genética , Cálculos Renais/prevenção & controle , Cálculos Renais/urina , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Nefrolitíase/genética , Nefrolitíase/prevenção & controle , Nefrolitíase/urina , Transportadores de Ânions Orgânicos Dependentes de Sódio/genética , Ratos , Recidiva , Simportadores/genética
3.
Urol Clin North Am ; 46(2): 287-301, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30961861

RESUMO

Nephrolithiasis is an increasingly common condition worldwide and mobile technology is revolutionizing how patients with kidney stone are being diagnosed and managed. Emerging platforms include software applications to increase adherence to stone prevention, mobile compatible hardware, online social media communities, and telemedicine. Applications and hardware specifically relevant to increasing hydration, diet modification, medication adherence, and rapid diagnosis (ie, mobile ultrasound and endoscopy) have the greatest potential to reduce stone recurrence and expedite treatment. Social media and online communities have also been rapidly adopted by patients and providers to promote education and support.


Assuntos
Aplicativos Móveis , Nefrolitíase/terapia , Telemedicina , Dietoterapia , Ingestão de Líquidos , Hidratação/instrumentação , Estilo de Vida Saudável , Humanos , Cálculos Renais/dietoterapia , Cálculos Renais/terapia , Adesão à Medicação , Aplicativos Móveis/tendências , Nefrolitíase/dietoterapia , Educação de Pacientes como Assunto , Mídias Sociais , Telemedicina/instrumentação
4.
Urolithiasis ; 47(4): 311-320, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30915494

RESUMO

Alkali supplements are used to treat calcium kidney stones owing to their ability to increase urine citrate excretion which lowers stone risk by inhibiting crystallization and complexing calcium. However, alkali increases urine pH, which may reduce effectiveness for patients with calcium phosphate stones and alkaline urine. Hydroxycitrate is a structural analog of citrate, widely available as an over-the-counter supplement for weight reduction. In vitro studies show hydroxycitrate has the capacity to complex calcium equivalent to that of citrate and that it is an effective inhibitor of calcium oxalate monohydrate crystallization. In fact, hydroxycitrate was shown to dissolve calcium oxalate crystals in supersaturated solution in vitro. Hydroxycitrate is not known to be metabolized by humans, so it would not be expected to alter urine pH, as opposed to citrate therapy. Preliminary studies have shown orally ingested hydroxycitrate is excreted in urine, making it an excellent candidate as a stone therapeutic. In this article, we detail the crystal inhibition activity of hydroxycitrate, review the current knowledge of hydroxycitrate use in humans, and identify gaps in knowledge that require appropriate research studies before hydroxycitrate can be recommended as a therapy for kidney stones.


Assuntos
Citrato de Cálcio/metabolismo , Citratos/administração & dosagem , Suplementos Nutricionais , Cálculos Renais/dietoterapia , Citrato de Cálcio/química , Humanos , Cálculos Renais/química , Cálculos Renais/urina , Eliminação Renal/efeitos dos fármacos
5.
J Urol ; 201(2): 350-357, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30218763

RESUMO

PURPOSE: We prospectively assessed the efficacy and the predictors of the success of oral dissolution therapy by alkalization for lucent renal calculi. MATERIALS AND METHODS: Patients with radiolucent renal stones were counseled to undergo oral dissolution therapy, which entails oral potassium citrate 20 mEq 3 times daily, 3 L daily fluid intake and a dietary regimen. The study primary end point was the achievement of a 6-month stone-free rate with oral dissolution therapy. The other end point was a change in stone surface area as measured by noncontrast computerized tomography at 3 and 6 months. RESULTS: Between February 2015 and January 2016 only 182 of the 212 eligible patients who agreed to participate were compliant with oral dissolution therapy and included in the final analysis. Mean stone surface area at enrollment was 1.3 cm (range 0.16 to 11.84). At 3 months 97 (53.2%), 65 (35.7%) and 20 (11.1%) patients were oral dissolution therapy responders (stone-free), partial responders and nonresponders, respectively. Oral dissolution therapy achieved a 6-month stone-free rate of 83%, including 97 and 54 patients after 3 and 6 months of oral dissolution therapy, respectively. On regression analysis the initial 3-month response to oral dissolution therapy (p = 0.001), lower stone density (p = 0.03) and higher urine pH 12 weeks after treatment (p = 0.01) independently predicted the oral dissolution therapy response at 6 months. CONCLUSIONS: Regardless of stone size, oral dissolution therapy was an effective treatment approach for lucent renal stones. The initial response to oral dissolution therapy after 3 months was the key factor in determining the potential oral dissolution therapy response after 6 months. In addition, treatment compliance in achieving the targeted urine pH and low stone density has an independent role in the oral dissolution therapy response.


Assuntos
Diuréticos/uso terapêutico , Cálculos Renais/tratamento farmacológico , Citrato de Potássio/uso terapêutico , Adulto , Feminino , Humanos , Concentração de Íons de Hidrogênio , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/dietoterapia , Cálculos Renais/urina , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Prognóstico , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
J Urol ; 200(5): 1082-1087, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29940247

RESUMO

PURPOSE: Kidney stone disease is characterized by a relatively high rate of recurrence. In our study we analyzed the association between relative supersaturation and the risk of stone recurrence. Additionally, we examined the association between the risk of recurrence and changes in relative supersaturation and urinary composition after 1 week of medical treatment. MATERIALS AND METHODS: We performed a post hoc analysis of data from a previously published randomized controlled trial comparing the effect of 2 diets in 120 men with recurrent calcium oxalate stones and hypercalciuria. Baseline and followup 24-hour urine parameters were used to calculate the relative supersaturation of calcium oxalate, calcium phosphate and uric acid using the EQUIL2, JESS and LithoRisk computer programs. Cox models were used to calculate the estimated association between each baseline relative supersaturation, and 1-week changes and the risk of recurrence during followup. RESULTS: During a 5-year followup 35 patients (34%) experienced recurrence. A reduction in calcium oxalate relative supersaturation at 1 week was significantly associated with a lower risk of recurrence using the EQUIL2 calculation (for every 10% reduction from baseline HR 0.92, 95% CI 0.86-1.00, p = 0.044). However, there was no association for relative supersaturation calculated by other methods or for the relative supersaturation of other salts. Changes in the 24-hour urine excretion of citrate, potassium and magnesium were significantly associated with a risk of recurrence. CONCLUSIONS: In recurrent stone formers with hypercalciuria baseline values and changes in the relative supersaturation of calcium oxalate may be associated with the risk of recurrence. Changes in urinary citrate, potassium and magnesium following dietary intervention may also be predictive.


Assuntos
Oxalato de Cálcio/urina , Hipercalciúria/diagnóstico , Cálculos Renais/diagnóstico , Prevenção Secundária/métodos , Adulto , Fosfatos de Cálcio/urina , Ácido Cítrico/urina , Feminino , Seguimentos , Humanos , Hipercalciúria/dietoterapia , Hipercalciúria/prevenção & controle , Hipercalciúria/urina , Cálculos Renais/dietoterapia , Cálculos Renais/prevenção & controle , Cálculos Renais/urina , Magnésio/urina , Masculino , Pessoa de Meia-Idade , Potássio/urina , Valor Preditivo dos Testes , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Medição de Risco/métodos , Fatores de Tempo , Ácido Úrico/urina
7.
Curr Urol Rep ; 19(6): 41, 2018 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-29663088

RESUMO

PURPOSE OF REVIEW: Urinary risk factors, such as hypercalciuria, hypocitraturia, and hyperoxaluria, either in combination or alone, are associated with calcium stones. Dietary habits as well as underlying medical conditions can influence urinary risk factors. Evaluation of the conglomerate of patients' stone risks provides evidence for individualized medical management, an effective and patient-supported approach to prevention. RECENT FINDINGS: Many patients with stones desire prevention to avoid repeated surgical interventions. Yet, recent practice pattern assessments and health care utilization data show that many patients are rarely referred for metabolic evaluation or management. Innovations in metabolic management over the past decade have improved its effectiveness in reducing risk and preventing calcium stones. Although no new pharmacologic agents for calcium stone prevention have recently become available, there is relatively new thinking about some diet-based approaches. This review will synthesize current evidence to support individualized metabolic management of calcium stones.


Assuntos
Dieta , Cálculos Renais/etiologia , Cálculos Renais/terapia , Prevenção Secundária/métodos , Cálcio/análise , Humanos , Cálculos Renais/química , Cálculos Renais/dietoterapia , Recidiva , Medição de Risco , Fatores de Risco
8.
BMC Nephrol ; 18(1): 349, 2017 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-29202723

RESUMO

BACKGROUND: Kidney stone disease is common in industrialized countries. Recently, it has attracted growing attention, because of its significant association with adverse renal outcomes, including end stage renal disease. Calcium-containing kidney stones are frequent with high recurrence rates. While hypercalciuria is a well-known risk factor, restricted intake of animal protein and sodium, combined with normal dietary calcium, has been shown to be more effective in stone prevention compared with a low-calcium diet. Notably, the average sodium intake in Switzerland is twice as high as the WHO recommendation, while the intake of milk and dairy products is low. METHODS: We retrospectively analyzed Swiss recurrent kidney stone formers (rKSF) to test the impact of a low-sodium in combination with a low-calcium diet on the urinary risk profile. In patients with recurrent calcium oxalate containing stones, we investigated both, the consequence of a low-sodium diet on urinary volume and calcium excretion, and the influence of a low-sodium low-calcium diet on urinary oxalate excretion. RESULTS: Of the 169 patients with CaOx stones, 49 presented with hypercalciuria at baseline. The diet resulted in a highly significant reduction in 24-h urinary sodium and calcium excretion: from 201 ± 89 at baseline to 128 ± 88 mmol/d for sodium (p < 0.0001), and from 5.67 ± 3.01 to 4.06 ± 2.46 mmol/d (p < 0.0001) for calcium, respectively. Urine volume remained unchanged. Notably, no increase in oxalate excretion occurred on the restricted diet (0.39 ± 0.26 vs 0.39 ± 0.19 mmol/d, p = 0.277). Calculated Psf (probability of stone formation) values were only predictive for the risk of calcium phosphate stones. CONCLUSION: A diet low in sodium and calcium in recurrent calcium oxalate stone formers resulted in a significant reduction of urinary calcium excretion, but no change in urine volume. In this population with apparently low intake of dairy products, calcium restriction does not necessarily result in increased urinary oxalate excretion. However, based on previous studies, we recommend a normal dietary calcium intake to avoid a potential increase in urinary oxalate excretion and unfavorable effects on bone metabolism in hypercalciuric KSFs.


Assuntos
Cálcio na Dieta/urina , Cálcio/urina , Dieta Hipossódica/métodos , Cálculos Renais/dietoterapia , Cálculos Renais/urina , Adulto , Cálcio/deficiência , Cálcio na Dieta/efeitos adversos , Feminino , Humanos , Cálculos Renais/epidemiologia , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Suíça/epidemiologia , Fatores de Tempo
10.
J Endourol ; 31(6): 605-610, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28318298

RESUMO

OBJECTIVE: Increasing fluid intake to achieve a urine volume (UV) of >2.5 L/day decreases stone events. We assessed compliance rates and demographic and clinical variables associated with increased fluid intake and UV in patients with urolithiasis following dietary counseling. MATERIALS AND METHODS: In a retrospective study, patients with a low baseline UV (<2.5 L/day) on an initial 24-hour urine collection during metabolic stone evaluation were identified between 2010 and 2015. Patients received detailed standardized dietary counseling, including increasing fluid intake to >3 L/day and titrating it to achieve UV >2.5 L/day. A follow-up 24-hour urine collection was performed at 6 months (FU1) and 18 months (FU2) to assess compliance (UV >2.5 L/day) and predictors associated with it. RESULTS: Our cohort contained 363 patients, 53.4% men and 46.6% women. The mean UV of baseline, FU1, and FU2 urine collections was 1.63, 2.52, and 2.48 L, respectively. The compliance rate of obtaining UV of >2.5 L was 50.1% at 6 months. On logistic regression, male sex (odds ratio [OR] 3.27, 95% confidence interval [CI] 1.94, 5.52, p < 0.001), urolithiasis-related procedures such as ureteroscopy (OR 2.31, 95% CI 1.20, 4.42, p = 0.01) or percutaneous nephrolithotomy (OR 3.48, 95% CI 1.58, 7.63, p = 0.002), and baseline 24-hour UV >1 L (OR 3.00, 95% CI 1.02, 8.76, p = 0.04) were associated with greater odds of compliance. Age >58 years (OR 0.39, 95% CI 0.20, 0.75, p = 0.005) and presence of lower urinary tract symptoms (OR 0.50, 95% CI 0.26, 0.95, p = 0.03) were associated with lower odds of compliance. Ethnicity, body mass index, renal function, marital status, renal stone burden, stone type, and household income were not associated with compliance. CONCLUSIONS: In stone formers, compliance to fluid intake recommendations as measured by 24-hour UV is roughly 50%. Understanding risk factors for noncompliance, especially in at risk patients, can be used for quality improvement initiatives and reducing stone events.


Assuntos
Dieta , Cálculos Renais/dietoterapia , Cooperação do Paciente , Adulto , Estudos de Coortes , Aconselhamento , Feminino , Humanos , Cálculos Renais/urina , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Coleta de Urina
11.
World J Urol ; 35(9): 1331-1340, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28160089

RESUMO

PURPOSE: The aim of this review was to provide current best evidence for evaluation, dietary, and medical management of patients with urolithiasis. METHODS: Literature addressing evaluation, dietary, and medical management of urolithiasis was searched. Papers were analyzed and rated according to level of evidence (LOE), whereupon a synthesis of the evidence was made. Grade of recommendation (GOR) was judged from individual clinical experience and knowledge of the evidence according to the Oxford Centre for Evidence-based Medicine. RESULTS: It is obvious that different stone diseases influence the life of stone-forming individuals very differently, and that evaluation and medical management should be personalized according to risk of recurrence, severity of stone disease, presence of associated medical conditions, and patient's motivation. With regard to evaluation, dietary and medical management of patients with urolithiasis evidence from the literature suggest that selective metabolic evaluation may lead to rational dietary and medical management. Statements based on LOE and GOR are provided to guide clinical practice. CONCLUSION: The provided evidence for evaluation of patients with urolithiasis aims at defining patients at high risk for recurrent/complicated stone disease. Based on this approach, evidence-based dietary and medical management regimes are suggested.


Assuntos
Dietoterapia/métodos , Hidratação/métodos , Supressores da Gota/uso terapêutico , Inibidores de Simportadores de Cloreto de Sódio/uso terapêutico , Urolitíase/terapia , Alopurinol/uso terapêutico , Gerenciamento Clínico , Diuréticos/uso terapêutico , Medicina Baseada em Evidências , Humanos , Raios Infravermelhos , Cálculos Renais/diagnóstico , Cálculos Renais/dietoterapia , Cálculos Renais/tratamento farmacológico , Citrato de Potássio/uso terapêutico , Guias de Prática Clínica como Assunto , Análise Espectral , Tomografia Computadorizada por Raios X , Ultrassonografia , Urinálise , Urolitíase/diagnóstico , Difração de Raios X
12.
Eur Rev Med Pharmacol Sci ; 20(3): 414-25, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26914114

RESUMO

Urinary stones have been recognized as a human disease since dawn of history and treatment of this condition is reported by Egyptian medical writings. Also, pears have a very long history, being one of the earliest cultivated fruit trees and also known for medicinal use. Urinary tract stone formation represents a common condition and also a significant burden for health care service, due also to possible frequent relapses. Furthermore, urinary stones have been reported to have relationship with different metabolic derangements, and appropriate diet could contribute to avoid or reduce urinary stone formation. Citrate is an inhibitor of crystal growth in the urinary system, and hypocitraturia represents a main therapeutical target in stone formers. Pears contain a significant amount of malic acid, a precursor of citrate, and have antioxidant activity as well. A diet supplemented with pears, and associated with low consumption of meat and salt could impact positively cardiometabolic risk and urinary tract stone formation. However, very few studies evaluated the impact of pears utilization on health, and none on urinary tract stone formation in particular. High content in malate could warrant protection against stone formation, avoiding patients at high risk to be compelled to assume a considerable and expensive amount of pills.


Assuntos
Citratos/metabolismo , Frutas , Fitoterapia , Pyrus , Cálculos Urinários/prevenção & controle , Suplementos Nutricionais , Egito , Humanos , Cálculos Renais/dietoterapia , Cálculos Renais/prevenção & controle , Recidiva , Cálculos Urinários/dietoterapia , Armas
13.
Arch Ital Urol Androl ; 87(2): 105-20, 2015 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-26150027

RESUMO

OBJECTIVE: Diet interventions may reduce the risk of urinary stone formation and its recurrence, but there is no conclusive consensus in the literature regarding the effectiveness of dietary interventions and recommendations about specific diets for patients with urinary calculi. The aim of this study was to review the studies reporting the effects of different dietary interventions for the modification of urinary risk factors in patients with urinary stone disease. MATERIALS AND METHODS: A systematic search of the Pubmed database literature up to July 1, 2014 for studies on dietary treatment of urinary risk factors for urinary stone formation was conducted according to a methodology developed a priori. Studies were screened by titles and abstracts for eligibility. Data were extracted using a standardized form and the quality of evidence was assessed. RESULTS: Evidence from the selected studies were used to form evidence-based guideline statements. In the absence of sufficient evidence, additional statements were developed as expert opinions. CONCLUSIONS: General measures: Each patient with nephrolithiasis should undertake appropriate evaluation according to the knowledge of the calculus composition. Regardless of the underlying cause of the stone disease, a mainstay of conservative management is the forced increase in fluid intake to achieve a daily urine output of 2 liters. HYPERCALCIURIA: Dietary calcium restriction is not recommended for stone formers with nephrolithiasis. Diets with a calcium content ≥ 1 g/day (and low protein-low sodium) could be protective against the risk of stone formation in hypercalciuric stone forming adults. Moderate dietary salt restriction is useful in limiting urinary calcium excretion and thus may be helpful for primary and secondary prevention of nephrolithiasis. A low-normal protein intake decrease calciuria and could be useful in stone prevention and preservation of bone mass. Omega-3 fatty acids and bran of different origin decreases calciuria, but their impact on the urinary stone risk profile is uncertain. Sports beverage do not affect the urinary stone risk profile. HYPEROXALURIA: A diet low in oxalate and/or a calcium intake normal to high (800-1200 mg/day for adults) reduce the urinary excretion of oxalate, conversely a diet rich in oxalates and/or a diet low in calcium increase urinary oxalate. A restriction in protein intake may reduce the urinary excretion of oxalate although a vegetarian diet may lead to an increase in urinary oxalate. Adding bran to a diet low in oxalate cancels its effect of reducing urinary oxalate. Conversely, the addition of supplements of fruit and vegetables to a mixed diet does not involve an increased excretion of oxalate in the urine. The intake of pyridoxine reduces the excretion of oxalate. HYPERURICOSURIA: In patients with renal calcium stones the decrease of the urinary excretion of uric acid after restriction of dietary protein and purine is suggested although not clearly demonstrated. HYPOCITRATURIA: The administration of alkaline-citrates salts is recommended for the medical treatment of renal stone-formers with hypocitraturia, although compliance to this treatment is limited by gastrointestinal side effects and costs. Increased intake of fruit and vegetables (excluding those with high oxalate content) increases citrate excretion and involves a significant protection against the risk of stone formation. Citrus (lemons, oranges, grapefruit, and lime) and non citrus fruits (melon) are natural sources of dietary citrate, and several studies have shown the potential of these fruits and/or their juices in raising urine citrate levels. CHILDREN: There are enought basis to advice an adequate fluid intake also in children. Moderate dietary salt restriction and implementation of potassium intake are useful in limiting urinary calcium excretion whereas dietary calcium restriction is not recommended for children with nephrolithiasis. It seems reasonable to advice a balanced consumption of fruit and vegetables and a low consumption of chocolate and cola according to general nutritional guidelines, although no studies have assessed in pediatric stone formers the effect of fruit and vegetables supplementation on urinary citrate and the effects of chocolate and cola restriction on urinary oxalate in pediatric stone formers. Despite the low level of scientific evidence, a low-protein (< 20 g/day) low-salt (< 2 g/day) diet with high hydration (> 3 liters/day) is strongly advised in children with cystinuria. ELDERLY: In older patients dietary counseling for renal stone prevention has to consider some particular aspects of aging. A restriction of sodium intake in association with a higher intake of potassium, magnesium and citrate is advisable in order to reduce urinary risk factors for stone formation but also to prevent the loss of bone mass and the incidence of hypertension, although more hemodynamic sensitivity to sodium intake and decreased renal function of the elderly have to be considered. A diet rich in calcium (1200 mg/day) is useful to maintain skeletal wellness and to prevent kidney stones although an higher supplementation could involve an increase of risk for both the formation of kidney stones and cardiovascular diseases. A lower content of animal protein in association to an higher intake of plant products decrease the acid load and the excretion of uric acid has no particular contraindications in the elderly patients, although overall nutritional status has to be preserved.


Assuntos
Cálcio na Dieta/administração & dosagem , Proteínas na Dieta/administração & dosagem , Água Potável/administração & dosagem , Cálculos Renais/dietoterapia , Cálculos Renais/prevenção & controle , Sódio na Dieta/administração & dosagem , Adulto , Idoso , Oxalato de Cálcio/metabolismo , Oxalato de Cálcio/urina , Criança , Ácido Cítrico/metabolismo , Suplementos Nutricionais , Medicina Baseada em Evidências , Humanos , Cálculos Renais/etiologia , Cálculos Renais/metabolismo , Cálculos Renais/urina , Nefrologia , Educação de Pacientes como Assunto , Fatores de Risco , Sociedades Médicas , Resultado do Tratamento
14.
Curr Urol Rep ; 16(7): 47, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26025494

RESUMO

Diet is implicated in stone formation and growth. Whether alone or in concert with pharmacologics, dietary changes may be useful in reducing recurrence but only when they correct dietary stone-forming risks. Patients benefit from recommendations individualized to their food preferences as well as to lifestyle, age, food knowledge and access, preparation skills, and cultural and ethnic identities. Urologists can provide general dietary recommendations but often lack the time to provide the full complement of individualized nutrition care offered by a registered dietitian nutritionist (RDN). Urologists can partner with and refer patients to a RDN for any component of the nutrition care process: assessment of diet, diagnosis of dietary factors that contribute to stone risk factors, intervention formulation and implementation, and monitoring the effectiveness of the intervention and modifying it as needed to maintain suitably low dietary risk for stone recurrence.


Assuntos
Comportamento Alimentar , Cálculos Renais/etiologia , Animais , Aconselhamento , Humanos , Cálculos Renais/dietoterapia , Recidiva , Fatores de Risco
16.
J Endourol ; 28(9): 1127-31, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24846196

RESUMO

OBJECTIVE: To assess urologists' practice patterns and beliefs about dietary therapy for stone prevention. Dietary therapy is offered to stone formers (SFs) by a subset of urologists. While some may involve a registered dietitian (RD) to provide medical nutrition therapy (MNT), most do not as MNT is Medicare-covered only for diabetes and chronic kidney disease. MATERIALS AND METHODS: An investigator-created survey was distributed to assess Endourological Society members' opinions, confidence, and practices regarding nutrition therapy. RESULTS: Respondents (n=217) practice largely in academic, hospital/clinic, and private settings. Most (82%) felt dietary therapy should be provided regardless of the number of stone events. Most (90%) said the urologist should provide dietary recommendations and more than half (52%) do so for ≥75% of patients (10% provide it for <25%). Time spent with SFs for nutrition varied from ≤4 to ≥10 minutes (31% and 23%) with 64% feeling this to be insufficient time. Of urologists providing counseling, 58% assess their patients' diets. Self-confidence in determining dietary contributors to risk factors and in quantifying intake of foods/nutrients varied (range 45%-82%). Most (76%) said they would like another provider to give recommendations; 23% partner with an RD to do so. CONCLUSIONS: Urologists are interested in dietary stone prevention, despite the fact that the majority have inadequate time to provide it. We identified areas of educational need, specifically, quantifying patients' intake of certain foods/nutrients and identifying whether stone risk factors are diet related. Urologists' skill gaps are precisely the strengths of RDs, and thus, a partnership between RDs and urologists could be beneficial.


Assuntos
Cálculos Renais/dietoterapia , Cálculos Renais/prevenção & controle , Política Nutricional , Educação de Pacientes como Assunto , Padrões de Prática Médica , Urologia , Adulto , Aconselhamento , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Medicare , Estados Unidos
18.
J Endourol ; 28(2): 248-51, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24032438

RESUMO

INTRODUCTION: Obese patients have an increased risk of kidney stones, and several studies have identified specific urinary derangements on 24-hour collections. The objective of this study was to assess obese and super-obese stone formers, and their compliance with dietary modifications over time, based on 24-hour urine outcomes. PATIENTS AND METHODS: A retrospective review was performed searching for all stone formers who completed a 24-hour urine collection before and after dietary counseling for stone prevention. Patients were excluded if placed on medical therapy in addition to dietary therapy. Patients were divided in three main groups according to their body mass index (BMI): 30, 30-40, and >40 kg/m(2). Demographic data and 24-hour urine stone risk parameters (volume, sodium, uric acid, citrate, and oxalate) were assessed. Initial 24-hour urine results were compared to follow-up results after dietary counseling. Then, the outcomes from each group were compared to each other. RESULTS: Two hundred and fourteen stone formers (67% male) were identified with a mean age of 49.5±15.0 years. One hundred twenty-eight (59.8%) patients had BMI <30 kg/m(2), 61 (28.5%) between 30-40 kg/m(2), and 25 (11.7%) >40 kg/m(2). Among patients with BMI <30 kg/m(2), there were significant improvements in all urinary parameters (p<0.001) as well as in the group with BMI between 30 to 40 kg/m(2) (p=0.02 for oxalate, p<0.001 for other parameters). Among super-obese patients, there were significant improvements in the urinary volume (p=0.03), sodium (p<0.001), uric acid (p=0.001), and oxalate (p<0.001). There were no significant differences in the improvements observed in the urinary volume (p=0.69), sodium (p=0.08), uric acid (p=0.17), and citrate levels (p=0.97) between the groups. CONCLUSION: Dietary recommendations can be an equally effective strategy in decreasing the risk or stone recurrence in obese and super-obese kidney stone formers as it is in those who are not obese.


Assuntos
Suplementos Nutricionais , Cálculos Renais/dietoterapia , Obesidade/complicações , Adulto , Índice de Massa Corporal , Ácido Cítrico/urina , Feminino , Seguimentos , Humanos , Cálculos Renais/etiologia , Cálculos Renais/urina , Masculino , Pessoa de Meia-Idade , Obesidade/urina , Oxalatos/urina , Estudos Retrospectivos , Sódio/urina , Ácido Úrico/urina
19.
Actas Fund. Puigvert ; 32(4): 137-142, dic. 2013. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-119102

RESUMO

La dieta puede afectar a los enfermos con litiasis oxálica, aumentando los factores de riesgo para la formación. Una vez completado el estudio metabólico se deben dar algunas normas dietéticas basadas en los datos científicos disponibles. Existen pocos trabajos que hayan analizado de forma completa el contenido de oxalatos en los alimentos de la dieta humana. Se debe insistir en la ingesta hídrica abundante, la reducción de sal y de proteínas animales, manteniendo un correcto aporte de calcio. En el presente trabajo se adjuntan algunas tablas de contenidos de oxalato en diversos alimentos. Los más ricos en oxalato (acelgas, espinacas, coliflor, té, cacao, kiwis) deben ser restringidos


Diet affect oxalic lithiasis patients, increasing the risk factors for stone formation. Upon completion of the metabolic study should give some dietary guidelines based on scientific data. Few studies have analyzed completely the oxalate content in foods of the human diet. It must be emphatized abundant fluid intake, reducing salt and animal protein, maintaining proper calcium intake. In this paper, some tables about oxalate content in various foods are attached. Most rich in oxalate (chard, spinach, cauliflower, tea, cocoa, kiwis) must be restricted


Assuntos
Humanos , Oxalato de Cálcio/efeitos adversos , Cálculos Renais/dietoterapia , Hiperoxalúria/dietoterapia , Dieta com Restrição de Proteínas , Dieta Hipossódica , Comportamento Alimentar
20.
Kaohsiung J Med Sci ; 29(2): 88-92, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23347810

RESUMO

The aim of this study is to investigate the effects of dietary factors on 24-hour urine parameters in patients with idiopathic recurrent calcium oxalate stones. A total of 108 of idiopathic recurrent calcium oxalate stones were included in the study. A 24-hour urinalysis was performed and metabolic abnormalities were measured for all of the patients. All of the patients were given specialized diets for their 24-hour urine abnormalities. At the end of first month, the same parameters were examined in another 24-hour urinalysis. Hyperoxaluria, hypernatruria, and hypercalciuria were found in 84 (77%), 43 (39.8%), and 38 (35.5%) of the patients, respectively. The differences between the oxalate, sodium, volume, uric acid, and citrate parameters before and after the dietary intervention were significant (p < 0.05). The calcium parameters were not significantly different before and after the intervention. We found that oxalate, sodium, volume, uric acid, and citrate-but not calcium-abnormalities in patients with recurrent calcium oxalate stones can be corrected by diet. The metabolic profiles of idiopathic calcium oxalate stone patients should be evaluated and the appropriate dietary interventions should be implemented to decrease stone recurrence.


Assuntos
Oxalato de Cálcio/química , Dieta , Hipercalciúria/dietoterapia , Hiperoxalúria/dietoterapia , Cálculos Renais/dietoterapia , Adulto , Cálcio/urina , Ácido Cítrico/urina , Feminino , Humanos , Hipercalciúria/complicações , Hipercalciúria/urina , Hiperoxalúria/complicações , Hiperoxalúria/urina , Cálculos Renais/complicações , Cálculos Renais/urina , Masculino , Pessoa de Meia-Idade , Recidiva , Sódio/urina , Ácido Úrico/urina
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA