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Treatment of calcium urolithiasis with diphosphonate: efficacy and hazards
Abstract:
The effect of treatment of renal stone formation with 5 to 20 mg./kg. per day oral disodium ethane-1-hydroxy-1,1-diphosphonate for up to 30 months was examined in 12 patients with active renal (calcium) stone disease. The over-all incidence of stone passage decreased from 17.8 stones per year per patient before treatment to 7.7 stones per year per patient during therapy. Of the 12 patients 7 passed fewer stones or no stones during treatment. However, the incidence of stone passage was not changed substantially by disodium ethane-1-hydroxy-1,1-diphosphonate in 5 patients. Symptoms of muscle weakness and pain in the back, hips and shoulders occurred in 3 patients during treatment, 2 patients had an increase in serum alkaline phosphatase and 1 patient had a decrease in bone density. Although disodium ethane-1-hydroxy-1,1-diphosphonate may be clinically useful to manage calcium urolithasis in certain patients its over-all use is limited because of its ineffectiveness in some patients and owing to its potential to induce osteomalacia.
Insights
Disodium ethane-1-hydroxy-1,1-diphosphonate reduced renal (calcium) stone passage in some patients. However, effectiveness varied, and potential side effects like osteomalacia limit its use in calcium urolithiasis management.
Area of Science:
- Nephrology
- Pharmacology
- Biochemistry
Background:
- Renal stone disease, particularly calcium urolithiasis, affects a significant patient population.
- Current management strategies for active renal stone disease require effective therapeutic options.
Purpose of the Study:
- To evaluate the efficacy and safety of oral disodium ethane-1-hydroxy-1,1-diphosphonate in patients with active renal calcium stone disease.
Main Methods:
- A study involving 12 patients with active renal (calcium) stone disease.
- Treatment administered: 5 to 20 mg/kg/day oral disodium ethane-1-hydroxy-1,1-diphosphonate for up to 30 months.
- Outcomes assessed: Incidence of stone passage, patient-reported symptoms, and biochemical/bone density markers.
Main Results:
- The overall incidence of stone passage decreased from 17.8 to 7.7 stones per year per patient.
- Seven out of 12 patients experienced a reduction in stone passage or cessation of stones.
- Five patients showed no substantial change in stone passage incidence.
- Adverse effects included muscle weakness, pain, elevated serum alkaline phosphatase, and decreased bone density in some patients.
Conclusions:
- Disodium ethane-1-hydroxy-1,1-diphosphonate demonstrates potential clinical utility in managing calcium urolithiasis for select patients.
- Treatment effectiveness is variable, with some patients not responding.
- Potential adverse effects, including osteomalacia, necessitate careful consideration and limit widespread application.