Efficacy of standard and low dose hydrochlorothiazide in the recurrence prevention of calcium nephrolithiasis (NOSTONE trial): protocol for a randomized double-blind placebo-controlled trial.

Nephrolithiasis is a global healthcare problem with a current lifetime risk of 18.8% in men and 9.4% in women. Given the high cost of medical treatments and surgical interventions as well as the morbidity related to symptomatic stone disease, medical prophylaxis for stone recurrence is an attractive approach. Thiazide diuretics have been the cornerstone of pharmacologic metaphylaxis for more than 40 years. However, evidence for benefits and harms of thiazides in the prevention of calcium containing kidney stones in general remains unclear. In addition, the efficacy of the currently employed low dose thiazide regimens to prevent stone recurrence is not known. The NOSTONE trial is an investigator-initiated 3-year prospective, multicenter, double-blind, placebo-controlled trial to assess the efficacy of standard and low dose hydrochlorothiazide treatment in the recurrence prevention of calcium containing kidney stones. We plan to include 416 adult (≥ 18 years) patients with recurrent (≥ 2 stone episodes in the last 10 years) calcium containing kidney stones (containing ≥50% of calcium oxalate, calcium phosphate or a mixture of both). Patients will be randomly allocated to 50 mg or 25 mg or 12.5 mg hydrochlorothiazide or placebo. The primary outcome will be incidence of stone recurrence (a composite of symptomatic or radiologic recurrence). Secondary outcomes will be individual components of the composite primary outcome, safety and tolerability of hydrochlorothiazide treatment, changes in urinary biochemistry elicited by hydrochlorothiazide treatment and impact of baseline disease severity, biochemical abnormalities and stone composition on treatment response. The NOSTONE study will provide long-sought information on the efficacy of hydrochlorothiazide in the recurrence prevention of calcium containing kidney stones. Strengths of the study include the randomized, double-blind and placebo-controlled design, the large amount of patients studied, the employment of high sensitivity and high specificity imaging and the exclusive public funding support. ClinicalTrials.gov, NCT03057431 . Registered on February 20 2017

L'infarctus rénal : un diagnostic méconnu

L'infarctus rénal, le plus souvent segmentalre, reste un diagnostic difficile et souvent méconnu. La présentation clinique est peu spécifique mais la triade douleurs du flanc, abdominales ou dorso-lombaires, élévation des LDH et hématurie microscopique, survenant sur un terrain à risque thrombo-embolique, doit faire rechercher ce diagnostic. La lithiase urinaire, la pyélonéphrite aiguë et les pathologies intra-abdominales aiguës sont les principaux diagnostics différentiels. Une étiologie cardiaque (FA, anévrismes septaux, valvulopathies mitrales et endocardites) est présente dans la majorité des cas. Le CT-scan avec injection de produit de contraste représente l'examen diagnostique de choix. L'anticoagulatlon ou la fibrinolyse constituent le traitement de première intention quelle que soit la gravité de l'occlusion vasculaire

Approche pratique de la lithiase rénale: duo entre généralistes et spécialistes [Renal stone disease: collaborative management between primary care and specialized physicians].

Nephrolithiasis is a highly prevalent pathology with a 10% lifetime risk in the Western population. Although it is often minimized and qualified as "idiopathic" significant comorbidities are frequently observed, e.g. the metabolic syndrome, type 2 diabetes mellitus, hypertension and bone fragility. Therefore nephrolithiasis can be regarded as a systemic disorder. A specialized diagnostic and therapeutic approach should be offered to such patients with active kidney stone disease in order to prevent stone recurrence and favor early diagnosis of said comorbidities

Prise en charge du patient insuffisant rénale:intérêt d'une approche éducative complémentaire au suivi médical

Chronic kidney disease (CKD) is complex to manage, especially when a substitutive treatment has to be implemented. Strict medical follow-up is mandatory but not sufficient to provide optimal care to the CKD patients. Educational intervention gives more skills to the patients to cope with this chronic disease. In this approach, physicians and nurses help patients to have a greater acceptance of their illness and make their treatment their own. Therapeutic education is part of this patient-centred approach. Peer counselling is also used in our program as well as an educative journal

Evaluation of 24-h urine collection quality in the Swiss Kidney Stone Cohort-NCCR Kidney.CH

Background Kidney stone affect one in ten adults in Switzerland. Diet plays a key role in the development and management of kidney stones. We collected data on the dietary habits of stone formers and controls using two consecutive 24-h dietary recalls and 24-h urine collections as well as blood chemistry. We explored the quality and completeness of 24-hour urine collections of participants prior to using 24-h urinary electrolytes and urea excretions as biomarkers of dietary intakes. Methods The Swiss Kidney Stone Cohort (SKSC) is a multicentric cohort of stone formers. A control group, free of kidney stone on CT-scan, was recruited in the general adult population. The SKSC includes 803 kidney stones formers and 207 controls (table 1). We evaluated the quality of the 24-h urine collection at baseline using urinary creatinine excretion (μmol/kg/24h). We also used a multiple linear regression model, including age, sex, BMI and linguistic region as covariates, to explore whether urinary volume and creatinine excretion differed between cases and controls. Results Of the 1882 urinary collections available, 631(33,5%) were outside the 10th-90th percentiles of the expected urinary creatinine excretion values. Mean 24-h urinary volume (day 1) was 1809±786ml (SKSC) and 2078±827ml (controls). After adjusting for age, sex, BMI and linguistic region, controls have a higher urinary volume than cases (+263±66ml, p <0.001). Swiss Germans have higher urinary volumes (+153±52ml, p <0.01). Adjusted mean 24-h urinary creatinine excretion (day 1) was similar in cases (164±52μmol/kg/24h) and controls (166±43μmol/kg/24h, p = 0.6). Conclusions The percentage of inadequate collections falls within a range previously described in the literature. Patients have lower 24-h urinary volume, but similar creatinine excretion than controls. Swiss Germans have higher urinary volumes. Further analysis will be conducted using 24-h urinary electrolytes (sodium, potassium) and urea excretions to assess the dietary intake of the participants. (Table Presented)

Dietary consumption in the Swiss Kidney Stone Cohort-NCCR Kidney.CH

Background: Kidney stones are a frequent condition, with a prevalence around 5-10% in Europe. Previous studies showed associations between kidney stones and diet. Thus, studying kidney stone formers' diet is of key importance to establish efficient dietary measures for the prevention and management of kidney stones. Methods: The Swiss Kidney Stone Cohort (SKSC) is a multicentric cohort of stone formers. Participants were seen at baseline, 3 months, 1 year and once a year during 3 years. A control group of non-stone formers was recruited in the general adult population. Repeated consecutive 24-h dietary recalls and 24-h urines were collected. We used two consecutive 24-h dietary recalls at baseline to describe the diet in the stone and non-stone former groups. For each participant, we used the average consumption of 19 food groups from the two recalls as response variables in two-part models that estimate separately the kidney stone status influence on the probability of consumption (logistic regression) and on the amount reported by consumers (linear regression). The covariables in the models were kidney stone status, age, sex, BMI, linguistic region and education level. Results: The characteristics of the 458 participants with two 24-h dietary recalls at baseline are summarized in Table 1. The sex-specific mean consumed amounts for each food group were similar between the two groups, except for vegetables and alcoholic beverages (Table 2). In the two-part model (Table 3), the kidney stone status was significantly associated with the probability of consuming nuts and seeds, cakes and biscuits as well as alcoholic beverages. Among consumers, kidney stone formers reported smaller amounts of vegetables and alcoholic beverages than non-formers. Conclusions: Overall, the diets of kidney stone formers and non-formers are similar. We observed associations of kidney stone status with vegetables and alcoholic beverages consumption. This data helps guiding food recommendations in stone formers in Switzerland

Hydrochlorothiazide and Prevention of Kidney-Stone Recurrence.

Nephrolithiasis is one of the most common conditions affecting the kidney and is characterized by a high risk of recurrence. Thiazide diuretic agents are widely used for prevention of the recurrence of kidney stones, but data regarding the efficacy of such agents as compared with placebo are limited. Furthermore, dose-response data are also limited. In this double-blind trial, we randomly assigned patients with recurrent calcium-containing kidney stones to receive hydrochlorothiazide at a dose of 12.5 mg, 25 mg, or 50 mg once daily or placebo once daily. The main objective was to investigate the dose-response effect for the primary end point, a composite of symptomatic or radiologic recurrence of kidney stones. Radiologic recurrence was defined as the appearance of new stones on imaging or the enlargement of preexisting stones that had been observed on the baseline image. Safety was also assessed. In all, 416 patients underwent randomization and were followed for a median of 2.9 years. A primary end-point event occurred in 60 of 102 patients (59%) in the placebo group, in 62 of 105 patients (59%) in the 12.5-mg hydrochlorothiazide group (rate ratio vs. placebo, 1.33; 95% confidence interval [CI], 0.92 to 1.93), in 61 of 108 patients (56%) in the 25-mg group (rate ratio, 1.24; 95% CI, 0.86 to 1.79), and in 49 of 101 patients (49%) in the 50-mg group (rate ratio, 0.92; 95% CI, 0.63 to 1.36). There was no relation between the hydrochlorothiazide dose and the occurrence of a primary end-point event (P = 0.66). Hypokalemia, gout, new-onset diabetes mellitus, skin allergy, and a plasma creatinine level exceeding 150% of the baseline level were more common among patients who received hydrochlorothiazide than among those who received placebo. Among patients with recurrent kidney stones, the incidence of recurrence did not appear to differ substantially among patients receiving hydrochlorothiazide once daily at a dose of 12.5 mg, 25 mg, or 50 mg or placebo once daily. (Funded by the Swiss National Science Foundation and Inselspital; NOSTONE ClinicalTrials.gov number, NCT03057431.)