İdiopatik normokalsiürik rekürren üriner sistem kalsiyum taşlı hastalarda potasyum sitrat’ın kemik mineral yoğunluğu üzerine etkisi

Year 2013, Volume: 8 Issue: 1, 6 - 11, 01.01.2013

Bedi Özbay Bekir Aras Eray Kemahlı Ramazan Kocakaya Volkan Tuğcu Bircan Mutlu Ali İhsan Taşçı

Abstract

Giriş: Bu çalışmada idiopatik normokalsiürik rekürren üriner sistem kalsiyum taşlı hastalarda potasyum sitratın kemik dansitesine etkinliği incelendi.Gereç ve Yöntemler: Çalışmaya daha önce en az 2 kez taş düşüren, yaşları 18 ile 51 yıl arasında değişen, 16’sı kadın ve 14’ü erkek toplam 30 hasta alındı. Tüm hastalarda standart metabolik, endokrinolojik tetkikler ve 24 saatlik idrar analizi incelendi. Çalışma grubuna sadece normokalsiürik rekürren üriner sistem kalsiyum taşlı hastalar dahil edildi. Hastaların hiçbirinde kalsiyum ve kemik metabolizmasını etkileyecek herhangi bir hastalık bulunmuyordu. Her hastanın boyu cm ve vücut ağırlığı kg ölçüldü ve vücut kitle indeksi VKİ hesaplandı. Çalışmaya alınan hastaların diyetle sodyum 100 mEq/gün ve oksalat alımları kısıtlandı. Hastalara 6-18 ay boyunca 60 mEq/gün potasyum sitrat Urocit-K tedavisi verildi ve tedavi öncesi ve sonrasında total femur ve L2-4 vertebra KMY Kemik Mineral Yoğunluğu ve Z-skoru ölçüldü.Bulgular: Çalışmaya alınan erkeklerin yaş ortalaması 34.5 ± 8 yıl, kadınların yaş ortalaması 32.18 ± 6 yıl idi. VKİ; erkeklerde 24.8 ± 1.9 kg/m2, kadınlarda ise 22.6 ± 1.5 kg/m2 idi. Hastaların tedavi öncesi ve sonrasındaki kan biyokimya sonuçları değerlendirildiğinde tedavi sonrası kan parametrelerinde ve idrar kalsiyum değerinde istatistiksel anlamı olan bir değişimin olmadığı ve tüm değerlerin normal sınırlarda olduğu saptandı p > 0.05 . Her iki cinsiyette tedavi sonrasında, tedavi öncesine göre idrar sitrat düzeyinde istatistiksel olarak anlamlı artış oldu p < 0.05 . L2-4 vertebralarda ve femur totalde Z-skoru değerleri tedavi öncesine göre anlamlı olarak daha yüksek bulundu p

Keywords

Potasyum sitrat , normokalsiüri , kemik mineral yoğunluğu

Impact of potassium citrate on bone mineral density in patients with idiopathic normocalciuric recurrent urinary system calcium stones

Abstract

Objective: We investigated the impact of potassium citrate on bone mineral density in patients with idiopathic normocalciuric recurrent urinary system calcium stones. Materials and Methods: A total of 30 patients, aged between 18 and 51 years, including 16 women and 14 men with personel history of at least 2 kidney stones were enrolled in the study. Standard metabolic, endocrine and 24-hour urine tests were performed. Only those with a diagnosis of idiopathic normocalsiuric calsium stone were included in the study group. None of the patients had any disease that may affect calcium and bone metabolism. The body mass index was calculated for each subject. Dietary sodium and oxalate intake were limited during study. Total femur and L2-4 bone mineral density and Z-scores were calculated in patients before and after treatment with 60 mEq/day potassium citrate for 6-18 months. Results: The mean ages of men and women were 34.5±8 and 32.18±6 consecutively. BMI of men was 24.8±1.9kg/m2 and women was 22.6±1.5kg/m2 . There were no statistically significant change in the serum biochemical parameters and urine calcium level after treatment p>0.05 . Urine citrate level was significantly elevated for both genders p

Keywords

Potassium citrate , normocalciuria , bone mineral density

References

• Pietschmann F, Breslau NA, and Pak CYC. Reduced vertebral bone density in hypercalciuric nephrolithiasis. J Bone Miner Res 1992; 7:1383-1388.
• Pak CYC, Peterson RD and Poindexter J. Prevention of spinal bone loss by potassium citrate in cases of calcium urolithiasis. J Urol 2002; 168: 31-34.
• Alhava EM, Juuti M and Karljalainen P. Bone mineral density in patients with urolithiasis Scan J Urol 1976; 10:154-156.
• Ghazali A, Fuentes V, Desaint C, et al. Low bone mineral density and peripheral blood monocyte activation profile in calcium stone formers with idiopathic hypercalciuria. J Clin Endocrinol and Metab 1997; 82:32-38.
• Bataille P, Achard JM, Fournier A, et al. Diet, vitamin D and vertebral mineral density in hypercalciuric calcium stone formers. Kidney Int 1991; 39: 1193-1205.
• Borghi L, Meschi T, Guerra A, et al. Vertebral mineral content in diet- dependent and diet-independent hypercalciuria. J Urol 1991; 146:1334-1338.
• Fuss M, Gillet C, Simon J, et al. Bone mineral content in idiopathic renal stone disease and in primary hyperparathyroidism. Eur Urol. 1983; 9:32-34.
• Pacifici R, Rothstein M, Rifas L, et al. Increased monocyte interleukin-1 activity and decreased vertebral bone density in patients with fasting idiopathic hypercalciuria. J Clin Endocrinol Metab. 1990; 71:138-145
• Tugcu V, Ozbek E, Aras B, et al. Bone mineral density measurement in patients with recurrent normocalciuric calcium stone disease. Urol Res. 2007 Feb;35(1):29-34. Epub 2006 Dec 12.
• Barkin J, Wilson DR, Bayiey A, et al. Bone mineral content in idiopathic calcium nephrolithiasis. Miner Electrolyte Metab 1985; 11:19-24.
• Reed BY, Heler HJ, Gitomer WL, et al. Mapping of common gene defect in absorptive hypercalciuria and idiopathic osteoporosis to chromosome 1q.J Clin Endocrinol Metab 1999; 84:3907-3913.
• Lawoyin S, Sismilich S, Browne R, et al. Bone mineral content in patients with calcium urolithiasis. Metabolism 1979; 28: 1250-1254.
• Pietschmann F, Breslau NA, and Pak CYC. Reduced vertebral bone density in hypercalciuric nephrolithiasis. J Bone Miner Res 1992; 7:1383-1388.
• Fuss M, Pepersack T, Van Geel J, et al. Involvement of low-calcium diet in the reduced bone mineral content of idiopathic renal stone formers. Calcific Tissue Int 1990; 46:9-13.
• Sabry ZI, Shadarevian SB, Cowan JW, Campbell JA. Relationship of dietary intake of sulphur aminoacids to urinary excretion of inorganic sulphate in man. Nature 1965;206:931–933.
• Lemann J Jr, Litzow JR, Lennon EJ. The effects of chronic acid loads in normal man: further evidence for the participation of bone mineral in the defense against chronic metabolic acidosis. J Clin Invest 1966;45:1608–1614.
• Bushinsky DA. Net calcium efflux from live bone during chronic metabolic, but not respiratory acidosis. Amer J Physiol 1989;256:836–842.
• Krieger NS, Sessler NE, Bushinsky DA. Acidosis inhibits osteoblastic and stimulates osteoclastic activity in vitro. Amer J Physiol 1992;262:442–448.
• Arnett TR, Spowage M. Modulation of the resorptive activity of rat osteoclasts by small changes in extracellular pH near the physiological range. Bone 1996;18:277–279.
• Weisinger JR, Alonzo E, Bellorin-Font E, et al. Possible role of cytokines on the bone mineral loss in idiopathic hypercalciuria. Kidney Int 1996; 49:244-250.
• Hess B, Ackerman D, Essig M, et al. Renal mass and serum calcitriol in male idiopathic calcium renal Stone formers: role of protein intake. J Clin Endocrinol Metab 1999; 80:1916.
• Wachman A, Bernstein DS. Diet and osteoporosis. Lancet 1968; 1:958-959..
• Jaeger P, Lippuner K, Casez JP, et al. Low bone mass in idiopathic renal stone formers: magnitude and significance. J Bone Min Res 1994; 9:1525-1532
• Hess B, Casez JP, Takkinen R, et al. Relative hypoparathyroidism and calcitriol up-regulation in hypercalciuric calcium renal stone formers: Impact of nutrition. Am J Nephrol 1993; 13: 18-26.
• Chan JCM. Nutrition and acid-base metabolism. Fed Proc 1981; 40:2423-2428.
• Remer T, Manz F. Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc 1995; 95:791-797.
• Barcelo B, Wuhl O, Servitge E, et al. Randomized double- blind study of potassium citrate in idiopathic hypocitraturic calcium nephrolithiasis. J Urol 1993; 150:1761-1764.
• Hofbauer J, Höbarth K, Szabo N, et al. Alkali citrate prophylaxis in idiopathic recurrent calcium oxalate urolithiasis - a prospective randomized study. Br J Urol 1994;73:362-365.
• Ettinger B, Pak CY, Citron JT, et al. Potassium-magnesium citrate is an effective prophylaxis against recurrent calcium oxalate nephrolithiasis. J Urol 1997; 158:2069-2073.
• Sebastian A, Harris ST, Ottaway JH. Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. N Engl J Med. 1994; 330:1776-1781.
• Green TJ, Whiting SJ. Potassium bicarbonate reduces high protein induced hypercalciuria in adult men. Nutr Res 1994; 14:991-1002.
• Lemann JJ, Pluess JA, Gray RW, et al. Potassium administration reduces and potassium deprivation increases urinary calcium excretion in healthy adults. Kidney Int 1991; 39:973-983.
• Lemann JJ, Gray RW, Pluess JA. Potassium bicarbonate, but not sodium bicarbonate, reduces urinary calcium excretion and improves calcium balance in healthy men. Kidney Int 1989; 35:688.02;11:641-647.
• Bushinsky DA. Metabolic alkalosis decreases bone calcium efflux by suppressing osteoclasts and stimulating osteoblasts. Am J Physiol 1996;271:216–222.
• Marangella M, DiStefano M, Casalis S, et al. Effects of potassium citrate supplementation on bone metabolism. Calcified Tissue International 2004;74:330–335.
• Vescini F, Buffa A, LaManna G, et al. Longterm potassium citrate therapy and bone mineral density in idiopathic calcium stone formers. J Endocrinol Inv 2004;28:218–212.
• Sakhaee K, Maalouf N, Abrams SA, et al. Effects of potassium alkali and calcium supplementation on bone turnover in postmenopausal women. J Clin Endocrinol Metab 2005;90:3528–3533.
• Jehle S, Anetti A, Muser J, et al. Partial neutralization of the acidogenic western diet with potassium citrate increases bone mass in postmenopausal women with osteoporosis. J Amer Soc Nephrol 2006;17:3213–3222.
• Macdonald HM, New SA, Fraser WD, et al. Low dietary potassium intakes and high dietary estimates of net endogenous acid production are associated with low bone mineral density in premenopausal women and increased markers of bone resorption in postmenopausal women. American Journal of Clinical Nutrition 2005;81:923–933.
• New SA, MacDonald HM, Campbell MK, et al. Lower estimates of net endogenous non-carbonic acid production are positively associated with indexes of bone health in premenopausal and perimenopausal women. Am J Clin Nutr 2004;79:131–138.