Impacto de la profilaxis secundaria en el manejo de pacientes con urolitiasis de alto riesgo de recidiva

Junio 2016

ARTÍCULOS DE INVESTIGACIÓN 710 Rev Med Chile 2016; 144: 710-715 Impacto de la profilaxis secundaria en el manejo de pacientes con urolitiasis de alto riesgo de recidiva Enrique Ossandón S., Francisco Sepúlveda T., Cristián Acevedo C. Impact of secondary prophylaxis in the management of patients with high recurrence risk of urolithiasis Background: In a previous study, we showed our experience in a group of 54 patients with a high risk of urolithiasis recurrence, who were subjected to a complete metabolic evaluation. Aim: To report the evolution of these patients after 5 years of follow-up. Patients and Methods: All patients underwent a general management of urolithiasis plus specific treatments for underlying metabolic disorders. Each patient had an annual medical assessment including a clinical examination, urinalysis and imaging studies (non-enhanced computed tomography scan, ultrasonography and plain abdominal Rx rays). In every case, the underlying metabolic disorder, treatment adherence, stones on imaging studies and symptomatology were evaluated. Adherence of general and specific measures were evaluated subjectively. Failure of secondary prevention was defined as the recurrence of clinical or imaging urolithiasis (increase of the number of lithiasis) despite a correct treatment of the metabolic disorders. Results: Twenty nine patients completed the follow-up. Mean age was 45 years old. Nineteen patients (65%) had only one metabolic disorder, three patients (10%) two disorders, one patient (3%) four disorders, and six patients (21%) a normal metabolic study. The median of follow-up was 54 months (45-60). During that period, twenty-three patients (79%) kept the treatment as it was indicated. In this subgroup, 21 had no clinical or imaging recurrence of urolithiasis during follow-up (91%). Total adherence to treatment and follow-up was 42% (23/54) of the initial group of patients. Conclusions: A complete metabolic study allows to identify patients with a high risk of urolithiasis recurrence, enabling a specific treatment of the metabolic disorder. Our experience shows that 75% (21/29) of patients remain free of recurrence at five years of follow-up. (Rev Med Chile 2016; 144: 710-715) Key words: Recurrence; Secondary Prevention; Urolithiasis. Unidad de Litiasis. Servicio de Urología. Hospital Clínico Universidad de Chile (HCUCH). Santiago, Chile. Recibido el 16 de agosto de 2015, aceptado el 1 de abril de 2016. Correspondencia a: Dr. Enrique Ossandón Salas Santos Dumont 999, Independencia, Santiago, Chile. enriqueossandon@mi.cl La litiasis de vía urinaria es una patología de alta prevalencia, alcanzando hasta en 15% de la población y puede variar de gran manera de acuerdo al lugar geográfico estudiado1,2. Se han descrito diversos factores asociados a un mayor riesgo de presentar esta patología, entre los que destacan una baja ingesta de líquidos, y una elevada ingesta de proteínas de origen animal y sodio3. El riesgo de recurrencia después de un episodio de urolitiasis puede llegar a 45% a 5 años y 75% a 20 años4, porcentaje no menor, considerando la morbilidad y costos que puede significar


Junio 2016
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