PowerPointPrsentation

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Effect of a bicabonate-rich mineral water in
patients with recurrent renal stone formation a
controlled double-blind study Chr.
Gutenbrunner, U. Smorag, O. Karagülle, F. Candir,
H. Becker, U. Jonas Professor Christoph
Gutenbrunner, MD, PhD, Clinic for Physical
Medicine and Rehabilitation Hanover Medical
School Carl-Neuberg-Str. 1 D-30625
Hannover gutenbrunner.christoph_at_mh-hannover.de
Institut BMK
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Introduction
? In the industrialised countries urolithiasis is
a frequent disease ? Prevalence in Germany
4.7 ? Incidence 1.47 ? The rate of relapses
is high 50-60 ? The extra-corporal shock-wave
therapy is not free of complications ? For that
reason an effective metaphylaxis is of major
importance
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Introduction
? A basic principle of the metaphylaxis of
urolitioasis is the dilution of the urine by an
increase of the fluid intake ? Additional
principles are ? the reduction of the excretion
of stone forming substances in the urine
calcium, oxalate, uric acid and others ? the
enhancement of the excretion of inhibitors
magnesium, citrate and others ? the reduction
of the crystallisation risk by influencing the
pH of the urine (dependent on the type of
renal stones)
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Introduction
? From experimental studies it is known that ?
bicarbonate waters increase the urinary pH and
the citrate excretion ? magnesium-rich
waters increase the urinary excretion of
magnesium ? the increase of
calcium-excretion is over- compensated by the
increase of diuresis ? Only a few studies were
performed in patients ? Most studies dealt with
the problem of calcium-waters ? Therefore we
studied the effect of a magnesium- and
bicarbonate-rich mineral water
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Material and Methods
? Design of the Study - double-blind
controlled study - cross-over-design ?
Patients - Patients with multi-episodic
CaOx-urolithiasis (n34) - males/females
30/4 - number of stone episodes 3.0 1.6 ?
Setting - Everyday activities - no
standardisation of the diet - nutrition protocol
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Material and Methods
? Interventions - 1.5 l/d bicarbonated water
(2,673 mg HCO3-/l 175 mg Mg/l 116 mg
Ca/l) - 1.5 l/d low-mineralized water (98
mg HCO3-/l 8 mg Mg/l 38 mg Ca/l) -
1.400 ml of each water for three consecutive
days - all waters in the same type of bottles,
colour code - distance between drinking
periods one week ? Main Outcome Parameters
- 24-h-urine samples before drinking, 3rd day
of drinking - urinary pH (24-h-urine) -
magnesium- and citrate-excretion -
supersaturation CaOx and of other types of
urinary stones
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Results
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Results
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Results
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Patients with high risk
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p1 Significance between verum and controls p2
Significance between baseline and drinking
period
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Conclusion
? Both waters significantly reduce the renal
stone formation risk in patients with relapsing
CaOx-urolithiasis ? The mineral water
additionally increases the urinary pH as well as
the excretion of magnesium and citrate ? The
mineral water is effective even in cases with
high risk of stone formation (hypercalciuria,
hyperoxaluria) ? Bicarbonated waters should be
used in patients with combined stones containing
CaOx and uric acid or in uric acid stones but
not in in patients with phosphate stones
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