title: Patient-centered medical therapy for nephrolithiasis.
abstract: OBJECTIVE
  To elucidate the effect of a patient-centered combined nutritional and medical therapy approach on stone disease management, guided by 24-hour urinary stone risk.
  
  
  METHODS
  We retrospectively analyzed the records of patients treated at our multidisciplinary stone clinic from July 2007 to February 2009. Included were adult stone formers who presented with severe urinary abnormalities or whose urinary parameters failed to improve with dietary changes. Urinary risk factors for stone disease were evaluated before and after intervention with 24-hour urine collections. Hypercalciuria was treated with hydrochlorothiazide/indapamide, hypocitraturia with potassium/calcium citrate, and hyperuricosuria with allopurinol. The primary end point was the effect of combined dietary and medical intervention on levels of urinary metabolites. Statistical comparisons of postintervention urine collection values with baseline values were performed using a paired t test. Two-tailed P <.05 was considered statistically significant.
  
  
  RESULTS
  Data for 137 patients with a mean follow-up of 14.39 months were analyzed. Mean age was 47.2 years, and the male-to-female ratio was 1.04. Hypocitraturia was detected in 70 patients (51%), hypercalciuria in 49 (37%) and hyperuricosuria in 18 (13%). A significant improvement was found in 67% of patients with hypocitraturia (urinary citrate levels: 380.28 to 663.96 mg/d; P <.0001), in 82% of patients with hypercalciuria (urinary calcium levels: 337.4 to 183.6 mg/d; P <.0001), and in 72% of patients with hyperuricosuria (urinary citric acid level: 927 to 600 mg/d; P <.0001).
  
  
  CONCLUSIONS
  Medical management of stone disease instituted based on individual risk factors impacts subsequent urinary stone risk, supporting its use for stone disease when patients do not respond to lifestyle and dietary changes.
authors: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors: Giovanni Scala
authors: GS
authors: Marchini
authors: Omar
authors: O
authors: Ortiz-Alvarado
authors: Ricardo
authors: R
authors: Miyaoka
authors: Carly
authors: C
authors: Kriedberg
authors: Angela
authors: A
authors: Moeding
authors: Michelle
authors: M
authors: Stessman
authors: Manoj
authors: M
authors: Monga
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053040:Nephrolithiasis / Q000178:diet therapy* / Q000188:drug therapy* / Q000652:urine; D018802:Patient-Centered Care; D012189:Retrospective Studies