Pharmacological Therapy for Calcium Phosphate Urolithiasis

描述（由申请人提供）：磷酸钙（CaP）肾结石疾病的发病率在过去三十年中显著增加。尽管进行了药物干预，但患有CaP尿石症的患者通常会经历结石复发，这表明当前医疗方案的次优性质。导致CaP结石形成的主要代谢危险因素是高钙尿、高尿液pH和低柠檬酸尿。柠檬酸钾（KCit）经常被开给钙结石形成者，因为它会增加尿柠檬酸盐并降低尿钙。然而，令人担忧的是，在CaP结石形成者中，这些有益作用可能会被KCit诱导的尿液pH值进一步升高所抵消，并且KCit在CaP结石形成者中的净效应仍有待确定。一种基于生理学但未经临床试验的替代策略是柠檬酸（CitA）给药，它可能会增加尿柠檬酸盐，而不会提高尿pH值。基于上述知识和原理以及我们的初步研究，我们假设KCit和/或柠檬酸是降低CaP结石形成者复发性结石形成风险的潜在对策。为了验证这一假设，我们将在短期安慰剂对照交叉代谢研究中检查CitA或KCit是否可以降低CaP结石形成者尿液中的CaP饱和度（作为透钙磷石）。除了基于计算机的结石风险预测程序外，还将应用物理化学分析来评估结石复发的风险。这项小规模的临床试点研究将使用替代措施来测试两种简单的方案。它解决了一个最重要的临床问题，因为我们迫切需要一种有效的治疗复发性CaP结石患者的方法，这是一组在过去的临床试验中没有专门评估的结石形成者。结果 从这个试点研究很可能导致全面的随机临床试验的临床结果，预防和治疗复发性CaP尿石症，越来越多的情况下，在临床实践中。 公共卫生相关性：磷酸钙肾结石在临床实践中越来越多地遇到，并且高度复发且难以治疗。本提案将测试柠檬酸钾或柠檬酸的药物治疗是否降低磷酸钙结石形成者复发结石形成的风险。这项初步研究的结果可能会导致全面的随机临床试验，用于预防和治疗复发性磷酸钙肾结石。

DESCRIPTION (provided by applicant): The incidence of calcium phosphate (CaP) kidney stone disease has increased significantly over the last three decades. Patients suffering from CaP urolithiasis often experience stone recurrence despite pharmacological interventions, an indication to the suboptimal nature of the current medical regimen. The major metabolic risk factors predisposing to CaP stone formation are hypercalciuria, high urine pH, and hypocitraturia. Potassium citrate (KCit) is frequently prescribed to calcium stone formers because it increases urine citrate and lowers urine calcium. However, a concern is that, in CaP stone formers, these beneficial effects may be negated by a further rise in urine pH induced by KCit, and the net effect of KCit in CaP stone formers remains to be determined. An alternative strategy that is physiologically-based but not clinically-tested is citric acid (CitA) administratin that can potentially increase urine citrate without raising urine pH. Based on the knowledge and rationale stated above and our preliminary studies, we hypothesize that KCit and/or citric acid are potential countermeasures that attenuate the risk of recurrent stone formation in CaP stone formers. To test this hypothesis, we will examine in a short-term placebo-controlled cross-over metabolic study whether CitA or KCit can reduce CaP saturation (as brushite) in urine of CaP stone formers. Physicochemical assays will be applied in addition to computer-based stone risk prediction programs to assess risk of stone recurrence. This small scale clinical pilot study will use surrogate measures to test two simple regimens. It addresses a clinical question of utmost importance as we are in dire need of an effective therapy for patients with recurrent CaP stones, a group of stone formers that have not been specifically evaluated in past clinical trials. Results from this pilot study are likely to lead to full-scale randomized clinical trials with clinical outcomes for the prevention and treatment of recurrent CaP urolithiasis, an increasingly encountered condition in clinical practice. PUBLIC HEALTH RELEVANCE: Calcium phosphate kidney stones are increasingly encountered in clinical practice, and are highly recurrent and difficult to treat. This proposal wil test whether pharmacological therapy with potassium citrate or citric acid reduces the risk of recurrent stone formation in calcium phosphate stone formers. Results from this pilot study are likely to lead to full-scale randomized clinical trials for the prevention and treatment of recurret calcium phosphate kidney stones.