Sodium Thiosulphate in the Treatment of Renal Tubular Acidosis I with Nephrocalcinosis

Agroyannis, B.; Koutsikos, D.; Tzanatos, H.; Konstadinidou, I

doi:10.3109/00365599409180482

Cited by 14 publications

(11 citation statements)

References 7 publications

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“…The only other report of STS therapy in kidney stone disease was a case report in 1994 of a patient with renal tubular acidosis and nephrocalcinosis, which improved with oral STS therapy. 32 No other studies either supporting or refuting the The mechanism by which thiosulfate reduces pathologic crystallization is not known. Yatzidis suggested that thiosulfate complexed calcium, because calcium thiosulfate is much more soluble than either CaOx or calcium phosphate; however, the solubility of a salt does not indicate the ability of a one molecule to complex another.…”

Section: Discussionmentioning

confidence: 99%

Thiosulfate Reduces Calcium Phosphate Nephrolithiasis

Asplin

Donahue

Lindeman

et al. 2009

Journal of the American Society of Nephrology

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An uncontrolled trial reported that sodium thiosulfate reduces formation of calcium kidney stones in humans, but this has not been established in a controlled human study or animal model. Using the genetic hypercalciuric rat, an animal model of calcium phosphate stone formation, we studied the effect of sodium thiosulfate on urine chemistries and stone formation. We fed genetic hypercalciuric rats normal food with or without sodium thiosulfate for 18 wk and measured urine chemistries, supersaturation, and the upper limit of metastability of urine. Eleven of 12 untreated rats formed stones compared with only three of 12 thiosulfate-treated rats (P Ͻ 0.002). Urine calcium and phosphorus were higher and urine citrate and volume were lower in the thiosulfate-treated rats, changes that would increase calcium phosphate supersaturation. Thiosulfate treatment lowered urine pH, which would lower calcium phosphate supersaturation. Overall, there were no statistically significant differences in calcium phosphate supersaturation or upper limit of metastability between thiosulfate-treated and control rats. In vitro, thiosulfate only minimally affected ionized calcium, suggesting a mechanism of action other than calcium chelation. In summary, sodium thiosulfate reduces calcium phosphate stone formation in the genetic hypercalciuric rat. Controlled trials testing the efficacy and safety of sodium thiosulfate for recurrent kidney stones in humans are needed.

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Section: Discussionmentioning

confidence: 99%

Thiosulfate Reduces Calcium Phosphate Nephrolithiasis

Asplin

Donahue

Lindeman

et al. 2009

Journal of the American Society of Nephrology

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“…Two of the patients had regression of the calcified mass as well as improved motility of the affected joints (20). STS was given for a period of 9 yr to a patient with nephrocalcinosis as a result of renal tubular acidosis type 1 (21). There was no further deterioration of his condition, and the discontinuation of the medication was accompanied by recurrence of renal colic.…”

Section: Discussionmentioning

confidence: 99%

Sodium Thiosulfate Treatment for Calcific Uremic Arteriolopathy in Children and Young Adults

Araya¹,

Fennell²,

Neiberger³

et al. 2006

Clinical Journal of the American Society of Nephrology

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In adult patients with ESRD, calcific uremic arteriolopathy (CUA) is an uncommon but life-threatening complication. No effective therapy exists, although anecdotal case reports highlight the use of sodium thiosulfate (STS), a calcium-chelating agent with antioxidant properties. CUA is rare in children, and STS use has not been reported. The objective of this study was to determine the influence of STS treatment on three patients with CUA in a pediatric chronic dialysis unit. The patients were between 12 and 21 yr of age; two were male; and primary diagnoses were obstructive uropathy, renal dysplasia, and calcineurin nephrotoxicity. Time from ESRD to CUA diagnosis was 1, 9, and 20 yr. Diagnosis was made by tissue biopsy and three-phase bone scan. Pain was the presenting symptom. Initial treatment included discontinuation of calcitriol and use of non-calciumbased phosphate binders and low-calcium dialysate concentration. STS dosage was 25 g/1.73 m 2 per dose intravenously after each hemodialysis session. For optimization of removal of calcium deposits, patient three received a combination of STS and continuous venovenous hemofiltration for the first 10 d. All patients demonstrated rapid pain relief. Within weeks, skin induration and joint mobility of the extremities improved. Radiographic evidence of reduction in the calcium deposits occurred within 3 mo of initiation of STS. The only complication was prolonged QT interval in one patient as a result of hypocalcemia, who was resolved by use of a higher dialysate calcium concentration. STS seems well tolerated in children and young adults with CUA and has mild adverse effects. For determination of its efficacy, optimum dosage, duration of therapy, and dialysis modality, controlled trials are needed.

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“…He reported an 80% reduction in stone rates compared with the patients’ own pretreatment stone formation rate. Oral STS (a dose of 15–20 mmol per day) was used, along with potassium and alkali, to treat a young patient who presented with prolonged history of recurrent renal colic and passage of small kidney stones, due to type I renal tubular acidosis with bilateral nephrocalcinosis and stage III chronic kidney disease [21]. During the 9 years of therapy, the patient did not have any colic, did not develop side effects, and had stable nephrocalcinosis with slight improvement on creatinine clearance.…”

Section: Discussionmentioning

confidence: 99%

Oral Sodium Thiosulfate as Maintenance Therapy for Calcific Uremic Arteriolopathy: A Case Series

AlBugami¹,

Wilson²,

Clarke

et al. 2013

Am J Nephrol

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Background: Calcific uremic arteriolopathy (CUA) is a rare but serious disorder affecting 4% of dialysis patients. Intravenous sodium thiosulfate (IV STS) has been shown as an effective treatment. In Canada, the average cost of IV STS is about CAD 12,000 per month, while the cost of compounded oral STS is CAD 45 per month. Methods: Prospective cohort where all patients diagnosed with CUA during the year 2011 were included. They were treated initially with IV STS. Afterwards, each patient had a baseline bone scan and was started on oral STS for a total of 6 months followed by a repeat bone scan. A single radiologist, blinded to the dates of both scans for a given patient, read all scans. Results: Four patients were studied. The intravenous dose used was 25 g three times a week for an average duration of 131 days. After the maintenance therapy, 2 patients developed further regression of the lesions, 1 had stable lesions, and 1 got worse; however, nonadherence to the drug was confirmed. The oral medication was well tolerated with no reported side effects. Conclusion: Oral STS, after IV STS, seems to stabilize, or even improve CUA lesions, and therefore could be useful as maintenance therapy, especially since its cost is much more reasonable than IV STS and due to the ongoing shortage of the IV formulation.

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Sodium Thiosulphate in the Treatment of Renal Tubular Acidosis I with Nephrocalcinosis

Cited by 14 publications

References 7 publications

Thiosulfate Reduces Calcium Phosphate Nephrolithiasis

Thiosulfate Reduces Calcium Phosphate Nephrolithiasis

Sodium Thiosulfate Treatment for Calcific Uremic Arteriolopathy in Children and Young Adults

Oral Sodium Thiosulfate as Maintenance Therapy for Calcific Uremic Arteriolopathy: A Case Series

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