Category: Clinical Stones: Medical Management

MP10-22 - The Impact Of Dietary Modifications And Medical Management On 24 Hour Urinary Metabolic Profiles And The Status Of Renal Stone Disease In Recurrent Stone Formers

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective :

We aimed to explore the impact of dietary modifications and medical management on 24-hour urinary metabolic profiles (UMP) and renal stone status in recurrent kidney stone formers.


Methods :

We reviewed our prospective registry database of patients treated for nephrolithiasis. Data included patients' age, sex, 24-hour UMP and stone burden before treatment. Under individual treatment, patients were followed up in 6-8 months intervals with repeat 24-hour UMP and radiographic images.  Nephrolithiasis-related events (surgery, colic) were also recorded.


We elected to concentrate on patients with established medical records prior to the initiation of designated treatment, thus comparing their nephrolithiasis status before and after.  Changes comparison from baseline   was carried out using Student t-test (2-tailed, paired). Analysis of variance with repeat measures was implemented for multiple comparisons.


Results :

44 patients met inclusion criteria.  Median age at treatment start was 60.5 years (50.2-70.2 years).  Male:Female ratio was 3.9:1. Median follow-up was 10 (6-25 years); and 5 years (3-6 years) before and after initiation of medical and dietary treatment, respectively. Metabolic abnormalities detected were as follows:


hypocitraturia (95.5%), low urine volume (56.8%), hypercalciuria (45.5%), hyperoxaluria (40.9%), hyperuricosuria (13.6%). Repeat 24-hour UMP under appropriate diet and medical treatment revealed a progressive increase in citrate levels compared to baseline and significantly decreased calcium levels (P=0.001, 0.03, respectively).  A significant decrease has been observed in stone burden (P=0.001) and overall nephrolithiasis-related events.


Conclusions :

Dietary modifications and medical management significantly aid in correcting urinary metabolic abnormalities. Consequently, reduced nehprolithiasis-related events and better stone burden control is expected.

Yasmin Abu-Ghanem

Resident
Department of Urology, Chaim Sheba Medical Center, Ramat Gan, Israel. Affiliated with Tel Aviv University.
Ramat Gan, HaMerkaz, Israel

Tomer Erlich


Ramat Gan, HaMerkaz, Israel

Harry Winkler

Department of Urology, Chaim Sheba Medical Center, Ramat Gan, Israel. Affiliated with Tel Aviv University.
Ramat Gan, HaMerkaz, Israel

Nir Kleinmann

Department of Urology, Chaim Sheba Medical Center, Ramat Gan, Israel. Affiliated with Tel Aviv University.
Ramat Gan, HaMerkaz, Israel

Dorit E. Zilberman

Associate Professor
Chaim Sheba Medical Center
Ramat Gan, HaMerkaz, Israel

Dorit E Zilberman, MD
Associate Professor of Urology
Chaim Sheba Medical Center, Tel-Hashomer,
Ramat-Gan, 52621, Israel


Academic Degrees:
MD, Sackler School of Medicine Tel Aviv University, Tel-Aviv, 2001
MU (Master in Urology) Magna Cum Laude, Sackler School of Medicine Tel Aviv University, Tel-Aviv, 2007

Residency:
Urology, Chaim Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv, Israel, 2001-2007

Fellowship:
Endourology, Laparoscopic and Robotic Surgery, Division of Urology, Duke University Medical Center, Durham, NC, USA, 2008-2010

Clinical Interests:
Robotic laparoscopic and endoscopic approaches for benign and malignant urologic conditions; medical and surgical management of stone disease