title: Kidney stones, carbonic anhydrase inhibitors, and the ketogenic diet.
abstract: OBJECTIVE
  Because carbonic anhydrase inhibitors and the ketogenic diet are each known risk factors for kidney stones, simultaneous use of these therapies has been discouraged. The objective of this study was to establish the prevalence of nephrolithiasis in children in this combination-therapy population.
  
  
  METHODS
  Since 1996, 301 children have been started on the ketogenic diet at our institution. A retrospective cohort study of renal calculi in ketogenic diet patients was performed to evaluate the increased risk with combined use of a carbonic anhydrase inhibitor.
  
  
  RESULTS
  In 15 (6.7%) of 221 children on the ketogenic diet without the use of carbonic anhydrase inhibitors, stones developed. In five (6.3%) of the 80 children on the diet in combination with topiramate or zonisamide, stones developed. There was no difference between these two groups (p = 0.82). No child was treated with either acetazolamide or more than one carbonic anhydrase inhibitor simultaneously. Prior ketogenic diet duration was shorter (10.4 vs. 22.4 months; p = 0.03), and more children had either a family history of renal stones or significant urologic abnormalities (80 vs. 27%; p = 0.04) in the combination-therapy group.
  
  
  CONCLUSIONS
  The combined use of carbonic anhydrase inhibitors and the ketogenic diet does not increase the risk of kidney stones. We recommend that all patients treated with combination therapy should be treated with increased hydration. Urine alkalinization should be considered for children with previous renal abnormalities, family histories of kidney stones, hematuria, or elevated urine calcium-to-creatinine ratios. If renal stones are found, we advocate discontinuation of the carbonic anhydrase inhibitor.
mesh_terms: D002257:Carbonic Anhydrase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004041:Dietary Fats / Q000008:administration & dosage; D004827:Epilepsy / Q000178:diet therapy* / Q000188:drug therapy*; D005260:Female; D005526:Food, Formulated; D006801:Humans; D015994:Incidence; D007223:Infant; D007657:Ketone Bodies / Q000378:metabolism; D007662:Ketosis / Q000209:etiology*; D007669:Kidney Calculi / Q000139:chemically induced / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D002257:Carbonic Anhydrase Inhibitors; D004041:Dietary Fats; D007657:Ketone Bodies