目的:目前推荐的胱氨酸结石形成者的治疗策略是基于从最保守的措施开始的渐进方法。在胱氨酸尿症患者中,患者对饮食管理和药物治疗的依从性增加与结石干预减少相关.在这个基于案例的审查中,在循证医学的指导下,对胱氨酸结石前患者的饮食管理进行了综述。
方法:13岁的胱氨酸尿症患者的饮食管理,他接受了18次泌尿结石干预,根据循证医学进行了审查。在Pubmed中进行了文献检索,MEDLINE,Embase,和Cochrane图书馆数据库,根据1993年至2022年9月发布的PRISMA指南。本文共收录304篇文章。
结果:在处理有胱氨酸尿症的患者时,过度水合,通过药物治疗使尿液碱化,考虑到个别情况,合理使用与胱氨酸结合的药物已经成为现实。一项有限的研究认为,素食是有效的,因为水果和蔬菜的碱性负荷可以减少达到pH7.5以上的尿碱化所需的碱化物质的量,使其特别适合于胱氨酸结石的饮食治疗。
结论:饮食调整的终身随访,过度水合,个性化药物治疗(碱化和胱氨酸结合药物)对于预防慢性肾病和胱氨酸尿症的肾衰竭至关重要。
OBJECTIVE: The currently recommended treatment strategy for cystine stone formers is based on a progressive approach that starts with the most conservative measures. In patients with cystinuria, increased patient compliance with dietary management and medical treatment is associated with fewer stone interventions. In this
case-based review, the dietary management of cystine stone former was reviewed under the guidance of evidence-based medicine.
METHODS: The dietary management of the 13-year-old cystinuria patient, who underwent 18 endourological stone interventions, was reviewed in the light of evidence-based medicine. A literature search was performed in Pubmed, MEDLINE, Embase, and Cochrane Library databases according to PRISMA guidelines published from 1993 to September 2022. A total of 304 articles were included in this paper.
RESULTS: In managing patients with cystinuria, hyperhydration, and alkalinization of the urine with medical treatment, the rational use of cystine-binding drugs by taking into account individual situations has come to the fore. A limited study has argued that a vegetarian diet is effective as the alkaline load from fruits and vegetables can reduce the amount of alkalizing substances required to achieve urinary alkalinization above pH 7.5, making it particularly suitable for the dietary treatment of cystine stone disease.
CONCLUSIONS: Life-long follow-up with dietary modification, hyperhydration, and personalized medical therapy (alkalinization and cystine-binding drugs) are critical in preventing chronic kidney disease and kidney failure in cystinuria.