Treatment of calcium nephrolithiasis in the patient with hyperuricosuria.
Treatment of calcium nephrolithiasis in the patient with hyperuricosuria.
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DOI：
10.1007/s40620-014-0084-x
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发表时间：
2014-12
影响因子：
3.4
通讯作者：
Goldfarb DS
中科院分区：
文献类型：
--
作者：
Arowojolu O;Goldfarb DS
近三分之一的钙结石患者患有高尿酸尿。体外研究和临床试验已经研究了尿酸与钙结石之间的关系，但高尿酸尿与患者钙结石形成之间的关联仍存在争议。尿酸似乎会导致人尿液中草酸钙盐析。然而，横断面观察研究并不支持这种体外现象对所提出的关联的重要性。一项小型安慰剂对照随机临床试验表明，别嘌呤醇可降低高尿酸尿症和正常钙尿症患者的草酸钙结石复发率。别嘌呤醇与吲达帕胺联合治疗的效果评估显示没有相加效应。别嘌呤醇可能具有抗氧化作用，可减少钙结石的形成，而钙结石的形成与黄嘌呤氧化酶的抑制无关。此外，一种新型黄嘌呤氧化还原酶抑制剂非布索坦也可能有效预防钙结石，因为它可以减少尿中尿酸的排泄。
Nearly one-third of patients with calcium stones have hyperuricosuria. In vitro studies and clinical trials have investigated the relationship between uric acid and calcium stones, but the association between hyperuricosuria and calcium stone formation in patients is still being debated. Uric acid appears to cause salting out of calcium oxalate in human urine. However, the importance of this in vitro phenomenon to the proposed association is not supported in cross-sectional observational studies. A small placebo-controlled randomized clinical trial showed that allopurinol decreased the rate of recurrent calcium oxalate calculi in patients with hyperuricosuria and normocalciuria. An assessment of the effect of combination therapy of allopurinol with indapamide showed no additive effect. Allopurinol may have antioxidant effects that are responsible for its reducing calcium stone formation, which are independent of xanthine oxidase inhibition. In addition, a newer xanthine oxidoreductase inhibitor, febuxostat, may also be effective in the prevention of calcium stones, as it reduces urinary uric acid excretion.