SUCCESSFUL MANAGEMENT OF URIC-ACID NEPHROLITHIASIS WITH POTASSIUM CITRATE
SUCCESSFUL MANAGEMENT OF URIC-ACID NEPHROLITHIASIS WITH POTASSIUM CITRATE
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DOI：
10.1038/ki.1986.201
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发表时间：
1986-09-01
影响因子：
19.6
通讯作者：
FULLER, C
中科院分区：
文献类型：
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作者：
PAK, CYC;SAKHAEE, K;FULLER, C
18例尿酸肾结石患者(单纯尿酸结石6例，尿酸钙结石12例)采用柠檬酸钾(30~80mEq/d，通常为60mEq/d)长期治疗，疗程1~5.33年，平均2.78年。尿液pH由低(5.30±-)升高。0.31 SD)至正常(6.19~6.46)。尿中游离尿酸含量，开始高达204。+-。82 mg/d，治疗后降至正常范围(至108 mg/d)。尿柠檬酸从503。+-上升。225毫克/天至852至998毫克/天。用柠檬酸钾治疗后，尿草酸钙饱和度显著降低。新结石形成率从1.20±-下降。1.68石/年至0.01+-0.04石/年(P<；0.001 x卡方)。94.4%的患者获得缓解，成石率下降99.2%。在5例患者中获得了详细的病例报告，显示了钠碱治疗和钾碱治疗的不同反应。所有5名患者都有持续性的低尿酸(典型的尿酸为5.5)和正常的尿酸，4名患者有高尿酸血症。在治疗之前，他们通过手术取出或自发排出结石，这些结石的成分是纯尿酸。当给予碱(如碳酸氢钠或柠檬酸盐，每天60至118mEq)时，4名患者继续形成新的结石，其余患者的放射透明(尿酸)结石变为“钙化”。结石分析显示，5名患者有草酸钙，3名患者有磷酸钙。用柠檬酸钾(4例)或碳酸氢钾(1例)治疗1~3.5年(剂量60~80mEq/d)，未见新结石形成。这些结果提供了生理和物理化学的理论基础，以及柠檬酸钾治疗尿酸结石合并/不合并钙结石的疗效。
Eighteen patients with uric acid nephrolithiasis (six with uric acid stones alone and 12 with both uric acid and calcium stones) underwent long-term treatment (1 to 5.33 years, mean of 2.78 years) with potassium citrate (30 to 80 mEq/day, usually 60 mEq/day). Urinary pH increased from low (5.30 .+-. 0.31 SD) to normal (6.19 to 6.46) during treatment. Urinary content of undissociated uric acid, which was high to begin with at 204 .+-. 82 mg/day, decreased to the normal range (64 to 108 mg/day) following treatment. Urinary citrate rose from 503 .+-. 225 mg/day to 852 to 998 mg/day. Urinary saturation of calcium oxalate significantly declined with potassium citrate treatment. New stone formation rate declined from 1.20 .+-. 1.68 stones/year to 0.01 .+-. 0.04 stones/year (P < 0.001 by chi square). Remission was experienced in 94.4% of patients, and the group stone formation rate declined by 99.2%. Detailed case reports were obtained in five patients showing different responses between sodium alkali and potassium alkali treatment. All five patients had persistently low urinary pH (typically < 5.5) and normouricosuria, and four had hyperuricemia. Before treatment, they had stones surgically removed or spontaneously passed, which were pure uric acid in composition. When sodium alkali was give (as bicarbonate or citrate, 60 to 118 mEq/day), new stone formation continued in four patients, and a radiolucent (uric acid) calculus become "calcified" in the remaining patient. The stone analysis disclosed calcium oxalate in five patients and calicum phosphate in three patients. When potassium citrate (in four cases) or potassium bicarbonate (in one case) was offered instead over 1 to 3.5 years (at a dosage of 60 to 80 mEq/day), no new stones were formed. The results provide physiological and physicochemical rationale, as well as therapeutic efficacy for potassium citrate treatment in the management of uric acid lithiasis presenting with/without calcium stones.