Taş Hastalığında İlaç Tedavilerinin Güncel Yeri: Alkalinizasyon, İnhibitörler ve Yeni Ajanlar
Özet
Bu bölümde, üriner sistem taş hastalığına bağlı olarak gelişebilecek üç kritik acil durum – sepsis, obstrüksiyon ve akut böbrek hasarı – güncel literatür ve kılavuzlar ışığında ele alınmaktadır. Taş hastalığı çoğunlukla elektif koşullarda tedavi edilebilse de enfeksiyon, bilateral obstrüksiyon veya tek böbrekli hastalarda ortaya çıkan komplikasyonlar hızlı ilerleyerek yaşamı tehdit edebilir. Bölümde patofizyolojik mekanizmalar, klinik bulgular, tanı yöntemleri, laboratuvar ve görüntüleme yaklaşımları kapsamlı biçimde değerlendirilmiştir. Ayrıca acil drenaj yöntemleri (üreteral stent, perkütan nefrostomi), antibiyotik tedavisi ve sepsis yönetiminde multidisipliner yaklaşım vurgulanmıştır. Amaç, ürologlara ve klinisyenlere bu komplikasyonların erken tanınması, etkin tedavi edilmesi ve mortalite ile morbiditenin azaltılmasına yönelik pratik bir yol haritası sunmaktır.
Referanslar
Fink HA, Wilt TJ, Eidman KE, et al. Medical management to prevent recurrent nephrolithiasis in adults: A systematic review for an American College of Physicians Clinical Guideline. Annals of Internal Medicine. 2013;158(7):535–543. doi: 10.7326/0003-4819-158-7-201304020-00005.
EAU Guidelines on Urolithiasis – Uroweb [Internet]. European Association of Urology; [cited 2025 Aug 13]. Available from: https://uroweb.org/guidelines/urolithiasis/chapter/metabolic-evaluation-and-recurrence-prevention
Worcester EM, Coe FL. New insights into the pathogenesis of idiopathic hypercalciuria. Seminars in Nephrology. 2008;28(2):120–132. doi: 10.1016/j.semnephrol.2008.01.005.
Jahrreiss V, Seitz C, Quhal F. Medical management of urolithiasis: great efforts and limited progress. Asian Journal of Urology. 2024;11(2):149–155. doi: 10.1016/j.ajur.2023.05.001.
Papatsoris A, Geavlete B, Radavoi GD, et al. Management of urinary stones by experts in stone disease (ESD 2025). Archivio Italiano di Urologia e Andrologia. 2025;97(2):14085. doi: 10.4081/aiua.2025.14085.
Mousavi A, Takele R, Limbrick B, et al. Oral dissolution therapy of uric acid stones: a systematic review. Société Internationale d’Urologie Journal. 2024;5(4):284–299. doi: 10.3390/siuj5040047.
Domrongkitchaiporn S, Khositseth S, Stitchantrakul W, et al. Dosage of potassium citrate in the correction of urinary abnormalities in pediatric distal renal tubular acidosis patients. American Journal of Kidney Diseases. 2002;39(2):383–391. doi: 10.1053/ajkd.2002.30560.
Zeng G, Zhu W, Robertson WG, et al. International Alliance of Urolithiasis (IAU) guidelines on the metabolic evaluation and medical management of urolithiasis. Urolithiasis. 2023;51(1). doi: 10.1007/s00240-022-01387-2.
Dhayat NA, Bonny O, Roth B, et al. Hydrochlorothiazide and prevention of kidney-stone recurrence. New England Journal of Medicine. 2023;388(9):781–791. doi: 10.1056/NEJMoa2209275.
Barry KA. Citrate salts for preventing and treating calcium-containing kidney stones in adults. American Family Physician. 2017;95(9):552–553. (Cochrane for Clinicians synopsis).
Segall M, Mousavi A, Eisner BH, et al. Pharmacologic treatment of kidney stones: current medication and pH monitoring. Actas Urológicas Españolas (English Edition). 2024;48(1):11–18. doi: 10.1016/j.acuroe.2023.11.008.
Sharbaugh AJ, Ayyash OM, Riley JM, et al. Timing of magnesium supplementation in patients with nephrolithiasis: a randomized controlled trial. Clinical Nephrology. 2025;103(5):312–317. doi: 10.5414/CN111168.
Ettinger B, Tang A, Citron JT, et al. Randomized trial of allopurinol in the prevention of calcium oxalate calculi. New England Journal of Medicine. 1986;315(22):1386–1389. doi: 10.1056/NEJM198611273152204.
Zhang H, Zhou L. Study of febuxostat and allopurinol placebo in patients with high uric acid excretion and calcium stones. Panminerva Medica. 2024;66(2):198–199. doi: 10.23736/S0031-0808.23.04953-4.
Bhatt NP, Deshpande AV, Starkey MR. Pharmacological interventions for the management of cystinuria: a systematic review. Journal of Nephrology. 2024;37(2):293–308. doi: 10.1007/s40620-023-01795-6.
Rogers A, Kalakish S, Desai RA, et al. Management of cystinuria. Urologic Clinics of North America. 2007;34(3):347–362. doi: 10.1016/j.ucl.2007.04.006.
Goldfarb DS, MacDonald PA, Gunawardhana L, et al. Randomized controlled trial of febuxostat versus allopurinol or placebo in individuals with higher urinary uric acid excretion and calcium stones. Clinical Journal of the American Society of Nephrology. 2013;8(11):1960–1967. doi: 10.2215/CJN.01760213.
Garrelfs SF, Frishberg Y, Hulton SA, et al. Lumasiran, an RNAi therapeutic for primary hyperoxaluria type 1. New England Journal of Medicine. 2021;384(13):1216–1226. doi: 10.1056/NEJMoa2021712.
Griffith DP, Gleeson MJ, Lee H, et al. Randomized, double-blind trial of Lithostat™ (acetohydroxamic acid) in the palliative treatment of infection-induced urinary calculi. European Urology. 1991;20(3):243–247. doi: 10.1159/000471707.
