title: Pyridoxine and dietary counseling for the management of idiopathic hyperoxaluria in stone-forming patients.
abstract: OBJECTIVE
  To examine the effects of dietary manipulation and pyridoxine medical management for idiopathic hyperoxaluria in patients with nephrolithiasis.
  
  
  METHODS
  A retrospective longitudinal study of the patients treated in our stone clinics from July 2007 to February 2009 was performed. All patients were evaluated with pre- and postintervention 24-hour urine collection and met a registered dietician. Recommendations to keep urine volume above 2 L per day, sodium restriction, protein moderation, increased calcium intake with meals and low oxalate diet combined with oral pyridoxine were given. Initial dosage ranged from 50 to 100 mg per day depending on the baseline oxalate level, and was titrated to a maximum of 200 mg daily. Subjects with at least two 24-hour urine collections were included in the study.
  
  
  RESULTS
  Of 314 patients with complete metabolic and urinary profile evaluation, 95 subjects were identified with idiopathic hyperoxaluria. Mean follow-up was 18.4 ± 14.8 months and mean age was 50.3 ± 12.8 years. In patients treated with the combination of dietary counseling and pyridoxine, there was a significant change in urinary parameters in 75% of patients with a significant decrease in urinary oxalate excretion (58.26 ± 27.05 to 40.61 ± 15.04, P < .0001). In all, 39% of the patients had a decrease from a high urine oxalate levels (>40 mg/d) to a normal range urine oxalate (55.30 ± 22.04 to 33.45 ± 3.93, P = .0004). No peripheral neuropathy was reported.
  
  
  CONCLUSIONS
  Dietary management and medical treatment using pyridoxine may be an effective first-line therapy to decrease hyperoxaluria in patients who form stones.
authors.affiliation: Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Ortiz-Alvarado
authors.forename: Ricardo
authors.initials: R
authors.lastname: Miyaoka
authors.forename: Carly
authors.initials: C
authors.lastname: Kriedberg
authors.forename: Angela
authors.initials: A
authors.lastname: Moeding
authors.forename: Michelle
authors.initials: M
authors.lastname: Stessman
authors.forename: Manoj
authors.initials: M
authors.lastname: Monga
mesh_terms: D003131:Combined Modality Therapy; D037001:Directive Counseling; D005260:Female; D006801:Humans; D006959:Hyperoxaluria / Q000150:complications / Q000178:diet therapy* / Q000188:drug therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011736:Pyridoxine / Q000627:therapeutic use*; D012189:Retrospective Studies; D014545:Urinary Calculi / Q000209:etiology / Q000517:prevention & control*
chemical_list: D011736:Pyridoxine