Prevention of Stone Formation and Bone Loss In Absorptive Hypercalciuria by Combined Dietary and Pharmacological Interventions

Abstract

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Feb 2003Prevention of Stone Formation and Bone Loss In Absorptive Hypercalciuria by Combined Dietary and Pharmacological Interventions CHARLES Y.C. PAK, HOWARD J. HELLER, MARGARET S. PEARLE, CLARITA V. ODVINA, JOHN R. POINDEXTER, and ROY D. PETERSON CHARLES Y.C. PAKCHARLES Y.C. PAK Principal investigator of the new drug application (NDA) for Urocit-K, with the University of Texas Southwestern Medical Center serving as the sponsor. After the approval of Urocit-K by the Food and Drug Administration in 1985 for the prevention of stone formation, University of Texas Southwestern Medical Center transferred the NDA to the Mission Pharmacal Company (San Antonio, Texas) under a licensing agreement. None of the authors serves as a consultant or owns equity in Mission. No support was obtained from Mission for the conduct of the trial. Requests for reprints: Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas 75390-8885. More articles by this author , HOWARD J. HELLERHOWARD J. HELLER More articles by this author , MARGARET S. PEARLEMARGARET S. PEARLE Financial interest and/or other relationship with Applied Medical, Boston Scientific and Circon. More articles by this author , CLARITA V. ODVINACLARITA V. ODVINA More articles by this author , JOHN R. POINDEXTERJOHN R. POINDEXTER More articles by this author , and ROY D. PETERSONROY D. PETERSON More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)63934-1AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We determined whether dietary restriction of calcium and oxalate, combined with thiazide and potassium citrate treatment, would prevent stone formation and avert bone loss in 18 men and 10 women with type I absorptive hypercalciuria. Materials and Methods: Patients were treated with thiazide (20) or indapamide (8) and potassium citrate (average dose 35 mEq. daily) for 1 to 11 years (mean 3.7) while maintained on low calcium oxalate diet. Serum and urinary chemistry studies and bone mineral density were measured at baseline and at the end of treatment. New stones formed were quantitated during 3 years before and during treatment. Results: During treatment urinary calcium significantly decreased (346 ± 85 to 248 ± 79 mg. daily, p <0.001) but urinary oxalate did not change. Urinary pH and citrate significantly increased, and urinary saturation of calcium oxalate significantly decreased by 46%. Stone formation rate decreased significantly from 2.94 to 0.05 per year (p <0.001). L2-L4 bone mineral density increased significantly by 5.7% compared to normal peak value, and by 7.1% compared with normal age and gender matched value. Femoral neck bone mineral density also increased significantly. Conclusions: Dietary restriction of calcium and oxalate, combined with thiazide and potassium citrate, satisfactorily controlled hypercalciuria, prevented the secondary increase in urinary oxalate, reduced urinary saturation of calcium oxalate, virtually eliminated recurrent stone formation, and increased bone density of the spine and femoral neck. 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Google Scholar From the Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byAssimos D (2018) Re: Comparison of Serum and Urinary Calcium Profile of Immobilized and Ambulant Trauma PatientsJournal of Urology, VOL. 191, NO. 6, (1812-1812), Online publication date: 1-Jun-2014.Pearle M, Goldfarb D, Assimos D, Curhan G, Denu-Ciocca C, Matlaga B, Monga M, Penniston K, Preminger G, Turk T and White J (2018) Medical Management of Kidney Stones: AUA GuidelineJournal of Urology, VOL. 192, NO. 2, (316-324), Online publication date: 1-Aug-2014.Assimos D (2018) Re: Age-Dependent Association between Dickkopf-1 and Calcium-Containing UrolithiasisJournal of Urology, VOL. 192, NO. 2, (440-441), Online publication date: 1-Aug-2014.Assimos D (2018) Re: Effects of Aminobisphosphonates and Thiazides in Patients with Osteopenia/Osteoporosis, Hypercalciuria, and Recurring Renal Calcium LithiasisJournal of Urology, VOL. 190, NO. 2, (570-571), Online publication date: 1-Aug-2013.Pak C, Sakhaee K and Pearle M (2018) Detection of Absorptive Hypercalciuria Type I Without the Oral Calcium Load TestJournal of Urology, VOL. 185, NO. 3, (915-919), Online publication date: 1-Mar-2011.Pak C (2018) Medical Stone Management: 35 Years of AdvancesJournal of Urology, VOL. 180, NO. 3, (813-819), Online publication date: 1-Sep-2008.Matsumoto E, Heller H, Adams-Huet B, Brinkley L, Pak C and Pearle M (2018) Effect of High and Low Calcium Diets on Stone Forming Risk During Liberal Oxalate IntakeJournal of Urology, VOL. 176, NO. 1, (132-136), Online publication date: 1-Jul-2006.MARONI P, KOUL S, CHANDHOKE P, MEACHAM R and KOUL H (2018) OXALATE TOXICITY IN CULTURED MOUSE INNER MEDULLARY COLLECTING DUCT CELLSJournal of Urology, VOL. 174, NO. 2, (757-760), Online publication date: 1-Aug-2005. Volume 169Issue 2February 2003Page: 465-469 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordsdiuretics, thiazidepotassium citrate, bone densitycalcium oxalatecalcium, dietaryMetricsAuthor Information CHARLES Y.C. PAK Principal investigator of the new drug application (NDA) for Urocit-K, with the University of Texas Southwestern Medical Center serving as the sponsor. After the approval of Urocit-K by the Food and Drug Administration in 1985 for the prevention of stone formation, University of Texas Southwestern Medical Center transferred the NDA to the Mission Pharmacal Company (San Antonio, Texas) under a licensing agreement. None of the authors serves as a consultant or owns equity in Mission. No support was obtained from Mission for the conduct of the trial. Requests for reprints: Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas 75390-8885. More articles by this author HOWARD J. HELLER More articles by this author MARGARET S. PEARLE Financial interest and/or other relationship with Applied Medical, Boston Scientific and Circon. More articles by this author CLARITA V. ODVINA More articles by this author JOHN R. POINDEXTER More articles by this author ROY D. PETERSON More articles by this author Expand All Advertisement PDF downloadLoading ...