Title :

Adverse Effects of Currently Used Medical Treatments for Cystinuria and Treatment Goals: Results from a French Series of 442 Patients.

Author(s) :

Prot-Bertoye, Caroline [Auteur]
Lebbah, Said [Auteur]
Daudon, Michel [Auteur]
Tostivint, Isabelle [Auteur]
Jais, Jean-Philippe [Auteur]
Lillo-Le Louet, Agnes [Auteur]
Pontoizeau, Clement [Auteur]
Cochat, Pierre [Auteur]
Bataille, Pierre [Auteur]
Bridoux, Franck [Auteur]
Brignon, Pierre [Auteur]
Choquenet, Christian [Auteur]
Combe, Christian [Auteur]
Conort, Pierre [Auteur]
Decramer, Stephane [Auteur]
Dore, Bertrand [Auteur]
Dussol, Bertrand [Auteur]
Essig, Marie [Auteur]
Frimat, Marie [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Gaunez, Nicolas [Auteur]
Joly, Dominique [Auteur]
Le Toquin-Bernard, Sophie [Auteur]
Mejean, Arnaud [Auteur]
Meria, Paul [Auteur]
Morin, Denis [Auteur]
N''''guyen, Hung V [Auteur]
Normand, Michel [Auteur]
Pietak, Michel [Auteur]
Ronco, Pierre [Auteur]
Christian, Saussine [Auteur]
Tsimaratos, Michel [Auteur]
Friedlander, Gerard [Auteur]
Traxer, Olivier [Auteur]
Knebelmann, Bertrand [Auteur]
Courbebaisse, Marie [Auteur]

Journal title :

BJU international

Abbreviated title :

BJU Int.

Publication date :

2019-02-24

ISSN :

1464-410X

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

OBJECTIVE: To evaluate medical treatments, in terms of adverse events (AEs) and therapeutic goals, in a large series of patients with cystinuria. METHODS: Data from 442 patients with cystinuria were recorded retrospectively. ...
Show more >OBJECTIVE: To evaluate medical treatments, in terms of adverse events (AEs) and therapeutic goals, in a large series of patients with cystinuria. METHODS: Data from 442 patients with cystinuria were recorded retrospectively. Crystalluria was studied in 89 patients. A mixed-effects logistic regression model was used to estimate how urine pH, specific gravity and cysteine-binding thiols (CBT) correlate with risk of cystine crystalluria. RESULTS: Alkalizing agents and CBT agents were given to 88.8% (n = 381) and 55.3% (n = 238) of patients, respectively. Gastrointestinal AEs were reported in 12.3%, 10.4% and 2.6% of patients treated with potassium bicarbonate, potassium citrate and sodium bicarbonate, respectively (P = 0.008). The percentages of patients who experienced at least one AE with tiopronin (24.6%) and with D-penicillamine (29.5%) were similar (P = 0.45). Increasing urine pH and decreasing urine specific gravity significantly reduced the risk of cystine crystalluria, whereas D-penicillamine and tiopronin treatments did not reduce this risk (odds ratio [OR] 1 for pH ≤6.5; OR 0.52 [95% confidence interval {95% CI} 0.28-0.95] for 7.0 <pH ≤7.5, P = 0.03; OR 0.26 [95% CI 0.13-0.53] for 7.5 < pH ≤8.0, P <0.001; OR 1 for specific gravity ≤1.005 OR 5.76 [95% CI 1.45-22.85] for 1.006 ≤ specific gravity ≤1.010, P = 0.01; and OR 11.06 [95% CI 2.76-44.26] for 1.011 ≤ specific gravity ≤ 1.014, P < 0.001). Increased urine pH significantly increased the risk of calcium phosphate crystalluria (OR 1 for pH≤ 6.5; OR 6.09 [95% CI 2.15-17.25] for pH >8.0, P <0.001). CONCLUSIONS: Adverse events were frequent with D-penicillamine and tiopronin. Alkaline hyperdiuresis was well tolerated and reduced cystine crystalluria. Urine specific gravity ≤1.005 and urine pH >7.5, while warning about calcium-phosphate crystallization, should be the goals of medical therapy.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

CHU Lille
Inserm
Université de Lille

Collections :

• Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286

Submission date :

2019-10-22T08:09:08Z