Patient-centered medical therapy for nephrolithiasis.

Area of Science:

• Nephrology
• Urology
• Metabolic Disorders

Background:

• Kidney stone disease management often requires personalized therapeutic strategies.
• Patient-centered approaches integrating nutritional and medical interventions are crucial for complex cases.
• Understanding individual urinary risk factors is key to effective stone disease treatment.

Purpose of the Study:

• To evaluate the efficacy of a combined nutritional and medical therapy for kidney stone disease.
• To assess the impact of this approach on 24-hour urinary stone risk parameters.
• To determine if this strategy benefits patients not responding to dietary changes alone.

Main Methods:

• Retrospective analysis of 137 adult stone formers treated at a multidisciplinary stone clinic.
• Evaluation of 24-hour urine collections for urinary risk factors (hypercalciuria, hypocitraturia, hyperuricosuria) before and after intervention.
• Treatment included hydrochlorothiazide/indapamide, potassium/calcium citrate, and allopurinol based on identified risk factors.
• Paired t-test used for statistical comparison of pre- and post-intervention urinary metabolite levels.

Main Results:

• Significant improvements observed in urinary metabolite levels across different risk profiles.
• 82% of patients with hypercalciuria showed reduced urinary calcium levels (337.4 to 183.6 mg/d).
• 67% of patients with hypocitraturia had increased urinary citrate levels (380.28 to 663.96 mg/d).
• 72% of patients with hyperuricosuria demonstrated improved urinary citric acid levels (927 to 600 mg/d).

Conclusions:

• Individualized medical management based on urinary risk factors effectively impacts subsequent urinary stone risk.
• This combined therapy is a valuable option for stone disease management in patients refractory to lifestyle and dietary modifications.
• Patient-centered, risk-factor-guided interventions improve urinary parameters and support long-term stone disease control.