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- W2470396719 abstract "La lithiase rénale est une pathologie fréquente (prévalence de 10 % à 12 % en France) et très récidivante. Elle est associée à la maladie rénale chronique et est responsable de 2 à 3 % des cas d’insuffisance rénale terminale surtout si elle s’associe à une néphrocalcinose ou s’inscrit dans le cadre d’une maladie monogénique (1,6 % des lithiases de l’adulte dont 1 % de cystinurie). Afin de comprendre la physiopathologie du processus lithiasique, l’analyse des calculs (morphologique et par spectrophotométrie infrarouge) ainsi qu’une évaluation biologique minimale incluant une cristallurie doivent être réalisées. La lithiase calcique est la forme la plus fréquente (> 80 %). Son traitement médical préventif repose sur des règles hygiéno-diététiques simples : hyperdiurèse non alcaline > 2 litres/jour, normalisation des apports calciques (1 g/jour à répartir sur 3 repas), sodés (6 à 7 g/jour) et protéiques (1 g/kg de poids théorique/jour) et éviction des aliments riches en oxalate. S’il persiste une hypercalciurie de débit (> 0,1 mmol/kg de poids théorique/jour en régime libre), on débutera un traitement par diurétique thiazidique en veillant à prévenir l’hypokaliémie et l’hypocitraturie iatrogènes. Une déminéralisation osseuse doit systématiquement être recherchée en cas d’hypercalciurie de débit. Le traitement de la lithiase urique repose sur une hyperdiurèse alcaline (pH urinaire 6,2 à 6,8). L’allopurinol n’est justifié que si l’uricurie dépasse 4 mmol/jour. Grâce à un traitement médical bien conduit, on peut espérer un arrêt de l’évolutivité lithiasique dans plus de 80 % des lithiases récidivantes, ce qui en fait une des affections rénales les plus accessibles au traitement préventif. Nephrolithiasis is a very common (prevalence around 10 to 12% in France) and recurrent disorder. Nephrolithiasis is associated to chronic kidney disease and is responsible for 2 to 3% of cases of end-stage renal disease, mainly if it is associated to nephrocalcinosis or to a monogenic disorder (1.6% of nephrolithiasis in adults, among them 1% of cystinuria). To understand the underlying pathophysiological processes, stone analysis (morphology and using infrared spectrophotometry) as well as minimal biological assessment including urine crystal research are required. The calcic nephrolithiasis is the more frequent subtype (> 80%). Its medical treatment relies on simple dietary rules: non-alkaline hyperdiuresis > 2 liters/day, calcium intake normalization (1 gram per day divided between the three principal meals), normalization of sodium (6 to 7 grams per day) and protein intake (1 g/kg of theoretical body weight/day), and eviction of foods rich in oxalate. In case of persistent hypercalciuria (> 0.1 mmol/kg of theoretical body weight/day on free diet), a thiazide diuretic can be started while being aware to correct iatrogenic decrease in plasma potassium and urine citrate excretion. Measurement of bone mineral density must systematically be performed in patients with high 24 h-urinary calcium excretion. The medical treatment of uric acid nephrolithiasis relies on alkaline hyperdiuresis (goal of urine pH: 6.2 to 6.8). The use of allopurinol is justified only if urine uric acid is over 4 mmol/day. Thanks to a well-managed preventive medical treatment, one can expect to stop the activity of nephrolithiasis in more than 80% of cases, making it one of the most accessible renal pathologies to preventive medical treatment." @default.
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- W2470396719 date "2017-01-01" @default.
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- W2470396719 title "Lithiase rénale de l’adulte : des mécanismes au traitement médical préventif" @default.
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- W2470396719 doi "https://doi.org/10.1016/j.revmed.2016.05.013" @default.
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