Nephrolithiasis is a condition in which stones or crystals, termed as calculi are formed within the renal pelvis or tubular lumen of individuals. Internationally, nephrolithiasis occurs in all parts of the world and the prevalence of it is increasing by year, with recurrent rate up to 50% within 5 years and 70% or higher within 10 years.
My father, aged 52, was diagnosed with Nephrolithiasis when he was 37 years old. Later, he had his first ureteroscopy laser surgery to remove the stone, in which it was calcium stone and approximately two centimeters in size. After surgery, he had to do routine follow-up care every six to twelve months and follow dietary therapy recommended by his doctor. 4 years later, he developed the symptoms of acute renal colic attacked. After several lab tests and imaging studies, he was confirmed to have recurrent nephrolithiasis and underwent an endoscope surgery to remove the stone obstruction.
Nephrolithiasis gives a huge impact on the patient, due to pain and discomfort. My father described acute renal colic as “the most painful event in his whole life, worse than being on surgery.” Increase in financial burden can also be seen in term of drug and surgery, which some may not afford for it. Therefore, a better prophylactic treatment should be assessed before raising people’s hope.
Presently, the standard preventive treatment is dietary therapy. In which it includes high water intake to increase urine output, with a target of 2 to 2.5 liters of total urine volume in 24 hours. Plus, low dietary salt and soft drink intake, as well as high dietary of citrus fruit intake. Alternatively, further research found that pharmacological therapy such as diuretic like agents and alkaline citrate could improve the condition and have more potential benefit compared to diet therapy. Despite having a vast line of therapies, little is understood about their efficacy and safety in line to prevent recurrent nephrolithiasis (RN) events.
Therefore, this essay will review several studies on the efficacy of both pharmacological and dietary therapies to prevent recurrent nephrolithiasis. Concise justification will also be given, which would imply that the notion of targeted therapy is extremely viable. Besides, any adverse side effects of the therapies will also be reviewed.
Both of dietary and pharmacological therapies are designed to adjust the concentration of crystal-forming and crystal-inhibiting substances, where it acts either by enhance or inhibit the crystallization process in urine. Focusing on calcium stone, those crystals-forming substances could be calcium, oxalate or phosphate, and crystal-inhibiting substance is the citrate.
27% in second group develop RN. Meanwhile, the mean time for recurrence was 38.7 and 25.1 months respectively for group 1 and 2. These data showed that high water intake really play its role in preventing as well as delaying its occurrence Low urine volume can be due to chronic...