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Clinical experience with long-term bendroflumethiazide treatment in calcium oxalate stone formers
Insights
Bendroflumethiazide effectively reduced recurrent calcium oxalate stones in most patients, though some experienced side effects. Higher doses (2.5mg twice daily or 5mg once daily) showed a beneficial effect on stone formation.
Area of Science:
- Nephrology
- Urology
- Pharmacology
Background:
- Recurrent calcium oxalate stones are a common urological condition.
- Effective long-term management strategies are needed to prevent stone recurrence.
Purpose of the Study:
- To evaluate the efficacy and side effects of bendroflumethiazide in patients with recurrent calcium oxalate stones.
- To determine optimal dosing for preventing new stone formation.
Main Methods:
- 85 patients with recurrent calcium oxalate stones were treated with bendroflumethiazide.
- Patients received varying daily doses: 2.5mg (Group A), 2.5mg twice daily (Group B), or 5mg once daily (Group C).
- Treatment duration averaged 3.7 years, with monitoring for stone formation and side effects.
Main Results:
- 31% of patients experienced side effects requiring treatment interruption.
- Groups B and C showed a beneficial effect on stone formation, unlike Group A.
- Patients who failed to respond had higher pre-treatment stone formation rates and lower citrate excretion.
Conclusions:
- Bendroflumethiazide can be effective in managing recurrent calcium oxalate stones, particularly at higher daily doses.
- Monitoring for side effects and individual patient response is crucial.
- Lower citrate excretion may indicate a higher risk of recurrence.
Abstract:
Bendroflumethiazide was administered to 85 patients (62 men, 23 women) with recurrent calcium oxalate stone disease. Side effects leading to interrupted treatment were observed in 26 (31%) of the patients. Fifty-nine (40 men, 19 women) remained on treatment for a mean (+/- SD) period of 3.7 +/- 1.0 years, and 21 reported late side effects. Twenty patients were given 2.5 mg bendroflumethiazide daily (Group A), 27 were given 2.5 mg twice daily (Group B), and 12 were given 5 mg once daily (Group C). Eight patients (14%) formed new stones and another two demonstrated stone growth during treatment. A beneficial effect on stone formation was observed in Groups B and C but not in Group A. Patients who failed to respond to treatment had a pre-treatment stone formation rate of 0.74 stones per year compared with 0.22 in those who did not form new stones. Those with recurrence during treatment had a lower citrate excretion than other patients. No effect on urinary citrate was recorded during treatment, and long-term treatment with bendroflumethiazide did not affect oxalate excretion.