Medications for Kidney Stone Disease with Dr. Amy E. Krambeck, MD скачать в хорошем качестве

Medications for Kidney Stone Disease with Dr. Amy E. Krambeck, MD

Amy E. Krambeck, MD, Professor of Urology at Northwestern University Feinberg School of Medicine, Chicago, Illinois, discusses the metabolic management of kidney stones and provides a comprehensive overview of pharmacologic treatments. In this 23-minute presentation, Dr. Krambeck explains that while guideline recommendations have remained unchanged for over a decade, certain medications remain underutilized despite strong clinical evidence. She highlights current pharmacological options for treating different patient types: For struvite stones, acetohydroxamic acid, a urease inhibitor, can significantly reduce stone growth but is poorly tolerated, limiting its use to patients unable to undergo surgery. Similarly, renacidin, used to dissolve struvite stones through nephrostomy tube instillation, is rarely utilized due to risks of hypermagnesemia and sepsis. In cystine stones, cheating agents such as tiopronin offer better tolerability than older treatments like d-penicillamine. They reduce recurrence while requiring careful monitoring for nephrotic syndrome. Uric acid stones can be prevented by raising urinary pH with potassium citrate, a first-line therapy that outperforms allopurinol except in cases of hyperuricosuria with normal urinary calcium. For hypercalciuria, the role of thiazide diuretics in this condition is emphasized, particularly in combination with potassium citrate to prevent citrate depletion. For enteric hyperoxaluria, calcium supplementation, particularly calcium citrate, is effective. It counteracts excessive oxalate absorption in patients with bowel disorders. Lumisaran (Oxlumo) is a novel RNA-targeting therapy for primary hyperoxaluria type 1. It offers significant reductions in oxalate levels and is a potential alternative to liver-kidney transplantation. Dr. Krambeck asserts that all patients require strict monitoring, frequent renal function checks, and a low-sodium diet. Personalized treatment based on each patient's needs is paramount. Don't forget to join the GRU Community: https://grandroundsinurology.com/regi... Follow us on Twitter/X: https://x.com/GRUrology And like and subscribe to us here on YouTube!