Thiazide Prophylaxis of Urolithiasis: A Double Blind Study in General Practice

Lærum, E; Larsen, Stig

doi:10.1007/978-1-4684-7272-1_101

Cited by 77 publications

(79 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Chlorthalidone (118) at doses of 25 mg/d or 50 mg/d gave equivalent results that are pooled (Table 5). Hydrochlorothiazide gave therapeutic effects equivalent to chlorthalidone (119), as did indapamide (120).…”

Section: Treatment Trials: Stone Recurrence Outcomesmentioning

confidence: 98%

Kidney stone disease

Coe

Evan

Worcester

2005

Journal of Clinical Investigation

685

527

View full text Add to dashboard Cite

About 5% of American women and 12% of men will develop a kidney stone at some time in their life, and prevalence has been rising in both sexes. Approximately 80% of stones are composed of calcium oxalate (CaOx) and calcium phosphate (CaP); 10% of struvite (magnesium ammonium phosphate produced during infection with bacteria that possess the enzyme urease), 9% of uric acid (UA); and the remaining 1% are composed of cystine or ammonium acid urate or are diagnosed as drug-related stones. Stones ultimately arise because of an unwanted phase change of these substances from liquid to solid state. Here we focus on the mechanisms of pathogenesis involved in CaOx, CaP, UA, and cystine stone formation, including recent developments in our understanding of related changes in human kidney tissue and of underlying genetic causes, in addition to current therapeutics.

show abstract

Section: Treatment Trials: Stone Recurrence Outcomesmentioning

confidence: 98%

Kidney stone disease

Coe

Evan

Worcester

2005

Journal of Clinical Investigation

685

527

View full text Add to dashboard Cite

show abstract

“…There are two placebocontrolled studies with thiazides [45,46], several others with control groups, and follow-up studies of patients with no comparable controls [47][48][49][50][51][52][53][54][55]. In one of the randomized studies thiazide was given together with magnesium and this regimen tended to be more effective than when thiazides were given alone [38].…”

Section: Thiazidementioning

confidence: 99%

Epidemiology and medical management of stone disease

2003

View full text Add to dashboard Cite

SUMMARYRecurrent stone formation in the urinary tract is a common and important problem that must be considered in daily urological practice. With a prevalence of> 10% and an expected recurrence rate of ≈ 50%, stone disease has an important effect on the healthcare system. It is generally agreed that patients with uric acid/urate, cystine or infection stones always should be treated pharmacologically. For calcium stone formers the treatment should be chosen according to the severity of the disease. Recurrence in patients with calcium‐stone disease can be prevented with general or specific dietary and drinking advice, and with pharmacological therapy. For idiopathic calcium stone formers the most convincing therapeutic effects have been reported with thiazide and alkaline citrate.

show abstract

“…Three randomized, placebo-controlled trials have shown that use of a TZ-type drug (hydrochlorothiazide, chlorthalidone, or indapamide in one trial each) can significantly decrease the recurrence of stones compared with placebo over three years (4,13,20). The effect of TZ to reduce stones appears due, at least in part, to their ability to decrease urine Ca excretion (33).…”

mentioning

confidence: 99%

Role of proximal tubule in the hypocalciuric response to thiazide of patients with idiopathic hypercalciuria

Bergsland

Worcester

Coe

2013

American Journal of Physiology-Renal Physiology

View full text Add to dashboard Cite

Bergsland KJ, Worcester EM, Coe FL. Role of proximal tubule in the hypocalciuric response to thiazide of patients with idiopathic hypercalciuria. Am J Physiol Renal Physiol 305: F592-F599, 2013. First published May 29, 2013 doi:10.1152/ajprenal.00116.2013The most common metabolic abnormality found in calcium (Ca) kidney stone formers is idiopathic hypercalciuria (IH). Using endogenous lithium (Li) clearance, we previously showed that in IH, there is decreased proximal tubule sodium absorption, and increased delivery of Ca into the distal nephron. Distal Ca reabsorption may facilitate the formation of Randall's plaque (RP) by washdown of excess Ca through the vasa recta toward the papillary tip. Elevated Ca excretion leads to increased urinary supersaturation (SS) with respect to calcium oxalate (CaOx) and calcium phosphate (CaP), providing the driving force for stone growth on RP. Thiazide (TZ) diuretics reduce Ca excretion and prevent stone recurrence, but the mechanism in humans is unknown. We studied the effect of chronic TZ administration on renal mineral handling in four male IH patients using a fixed three meal day in the General Clinical Research Center. Each subject was studied twice: once before treatment and once after 4 -7 mo of daily chlorthalidone treatment. As expected, urine Ca fell with TZ, along with fraction of filtered Ca excreted. Fraction of filtered Li excreted also fell sharply with TZ, as did distal delivery of Ca. Unexpectedly, TZ lowered urine pH. Together with reduced urine Ca, this led to a marked fall in CaP SS, but not CaOx SS. Since CaOx stone formation begins with an initial CaP overlay on RP, by lowering urine pH and decreasing distal nephron Ca delivery, TZ might diminish stone risk both by reducing CaP SS, as well as slowing progression of RP. calcium oxalate; calcium phosphate; idiopathic hypercalciuria; kidney calculi; thiazide THE MOST COMMON METABOLIC abnormality found in calcium (Ca) stone formers is so-called idiopathic hypercalciuria (IH) (40). Patients with IH absorb more Ca from a given meal than normal people (N), but also have abnormally decreased renal tubule Ca reabsorption, so that they often excrete more Ca than they have absorbed, exhibit decreased bone density, and have a propensity for increased fractures (22,42). Elevated urine Ca excretion leads to increased urinary supersaturation (SS) with respect to both calcium oxalate (CaOx) and calcium phosphate (CaP), providing the driving force for kidney stone formation (36). In addition, urine Ca excretion is correlated with the amount of interstitial apatite deposits (called Randall's plaque) found on the surface of the renal papillae (19). These deposits are the attachment sites for most CaOx stones and appear to be critical for stone formation (14). A plausible mechanism by which increased Ca reaches the deep papillae is via washdown from reabsorption in the thick ascending limb; an increase in delivery of Ca to this site would tend to increase reabsorption and washdown into the papilla and potentially increase...

show abstract

Thiazide Prophylaxis of Urolithiasis: A Double Blind Study in General Practice

Cited by 77 publications

References 5 publications

Kidney stone disease

Kidney stone disease

Epidemiology and medical management of stone disease

Role of proximal tubule in the hypocalciuric response to thiazide of patients with idiopathic hypercalciuria

Contact Info

Product

Resources

About