Drugs Used in the Therapy of

UROLITHIASIS

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Urolithiasis
1. Calcium stones : (40 75%)
- Ca-oxalate
- Ca-phosphate (hydroxyapatite : Ca5(PO4)3OH, atau
brusite : CaHPO4.H2O)

2. Urate (uric acid) : 5 25%

3. Struvite (MgNH4PO4)
4. Cystine
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 Ca-oxalate

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 Struvite (MgNH4PO4) Brusite Ca-acid phosphate

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Ca-urate Ngatidjan, Cystine
UROLIYHIASIS
Urolithiasis
1. Urine concentration of stone crystaloids
- urine volume (chronic),
- stone constituent excretion (calcium, oxalate, urate),

2. Other factors median time : 7 years

- urinary statics
- pH changes
- forign bodies
- normal protective substances
(Mg, citrate, pyrophasphate
27/08/2017 and glycoptoteins)
Ngatidjan, UROLIYHIASIS
Treatments of urolithiasis
1. Dietary
- drink plenty of water to prevent stone formation
- avoid some food

2. Medication
- to relieve symptoms
- to prevents stone formation
- to stone dissolve

2. Lithotripsy
3. 27/08/2017
Surgery Ngatidjan, UROLIYHIASIS
Drug therapy of Urolithiasis
Depends on
Symptoms analgesics, spasmolytics
Locations surgery, lithotripsy, remedies, diuretics
Type of the stones dietetics, diuretics, remedies herb
Metabolic error dietetics
Infections antibiotics, chemotherapy
27/08/2017 Ngatidjan, UROLIYHIASIS
Analgesics
1. Paracetamol and NSAIDs (diclofenac)

2. Opioid (morphine, pethidine)

masking effect (potent analgesics but may cause

of smooth muscle tone)

have to be accompanied by spasmolytics

27/08/2017 Ngatidjan, UROLIYHIASIS
Spasmolytics
1. Phosphodiesterase inhibitor (papaverine)

2. Muscarinic blockers (hyoscine, atropine)

side effects (constipation, dry mouth,

tachycardia and sandy sensation)

a selective antimuscarinics better

27/08/2017 Ngatidjan, UROLIYHIASIS
Crystalloid therapy
1. Citrates
- for calcium oxalate or uric acid stone
- K-citrate, Mg-citrate, KMg-citrate

2. Phosphates prevent formation

increase dissolution
- Na or K-phosphate of stone
- cellulose phosphate

3. Bicarbonates
- Na-bicarbonate
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 Specific therapy
according to the stone composition

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 Calcium stone

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Idiopathic Hypercalciuria
intestinal hyperabsorption of calcium

postprandial hypercalcemia

parathyroid hormon secretion

tubular calcium reabsorption

hypercalciuria

stone formation
27/08/2017 Ngatidjan, UROLIYHIASIS
Drug use for calcium stones (hypercalciuria)

1. Diuretics (thiazides)
diuresis urine calcium concentration

prevent stone formation

hypokalemia citrate give potasium citrate

2. NaCl intake restriction

3. Sonchus avensis remedies
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Hyperoxaluria
bacterial overgrowth syndromes, chronic disease of
pancreas and biliary tract, jejunoileal bypass, ileal resection

fat malabsorption
calcium is bound to fatty acid

oxalate is free and unabsorbed bile salt

injure the colonic mucosa

oxalate absorption

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hyperoxaluria
Ngatidjan, UROLIYHIASIS
Drug use for oxalate stones (hyperoxaluria)

1. Cholestyramine (oxalate binding resin,

for correction of fat malabsorption)

2. Low fat diet (prevent oxalate-fatty acid binding)

3. Oral calcium lactate (precipitate intestinal

oxalate oxlate absorption )

4. High fluid intake

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 Uric acid stone

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Hyperuricosuria
excessive intake of purine

hyperuricosuria

supersaturation of urine uric acid

crystallization of uric acid in the renal tubules

plugging of renal tubules

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acute renal failure
Ngatidjan, UROLIYHIASIS
Drug use for urate stones (hyperuricosuria)

1. Diuretics (thiazides)
diuresis urine uric acid concentration

prevent stone formation

hypokalemia give potasium citrate / carbonate

2. Purine intake (meat, fish, poultry)

3. Allopurinol 100 mg 2 times a day

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 Cystine stone

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Cystinuria cystine stones

intestinal and tubular amino acid transport defect

cystinuria

formation of cystine stone

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Drug use for cystine stones (cystinuria)
1. High fluid intake (should exceed 3.000ml)

2. Urine alkalinization (sodium bicarbonate,

potasium citrate prevent cystine crystalization)

3. Low methionine diet? (unproved of improving)

4. Penicillamine? ( soluble cystine-penicillamine

prevent stone Ngatidjan,

27/08/2017 formation? unproved)
UROLIYHIASIS
 Remedies
TRADITIONAL HERB

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27/08/2017 Ngatidjan, UROLIYHIASIS Sonchus avensis
27/08/2017 Sonchus avensis
Ngatidjan, UROLIYHIASIS
 Sonchus avensis
The leaf of Sonchus avensis

1. Calcium crystal solubility

prevent stone formation

Lithotryptic (calcium stone aberation)

3. Diuresis prevent stone formation

4. 5 pieces of sonchus leafs boil in 500 ml water

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Clerodendrum calamitosum L.
Orthosiphon itamineus Benth

1. Dissolve existing tone (experimental animal)

2. May cause kidney and heart

damage edema

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27/08/2017 Clerodendrum calamitosum L.
Ngatidjan, UROLIYHIASIS
27/08/2017 Orthosiphon itamineus Benth
Ngatidjan, UROLIYHIASIS
 Orthosiphon itamineus
The leaf ofOrthosiphon itamineus
1. Uricosuria

2. Diuresis prevent stone formation

(if urine pH > 5.5)

3. 25 fress leafs of orthosiphon

(boil in 500 ml 15 minutes, drink everyday)

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 Phylanthus niruri Linn.

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Phyllanthus niruri Linn.
Ngatidjan, UROLIYHIASIS
 Phylanthus niruri Linn
The whole herb of Phyllanthus niruri Linn.
1. Diuretics (20 g herb boil in 500 ml water)

2. ACE-inhibitor

3. Antihepatotoxics (phyllantine and hypophyllantine)

4. Cytostatistics (phyllantostatin A)
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 THANKS

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