Üriner Sistem Taş Hastalığında Metaflaksi

Nihat Karabacak; Ali Atan; Fazlı Polat

doi:10.54233/endourolbull-1681427

Derleme

Metaphlyxia in Urinary System Stone Disease

Yıl 2025, Cilt: 17 Sayı: 2, 97 - 104, 30.05.2025

Nihat Karabacak , Ali Atan , Fazlı Polat

Öz

Urolithiasis should not be considered merely an acute condition requiring episodic treatment, but rather a chronic and multifactorial disease with increasing global prevalence and a high recurrence rate. Metaphylaxis, encompassing secondary preventive strategies to prevent stone recurrence, has become a central component of modern stone management. This review outlines the definition and scope of metaphylaxis in stone disease, patient risk stratification, protocols for metabolic evaluation, dietary and lifestyle interventions, and pharmacological treatment options in line with current clinical guidelines and recent literature. Evidence from randomized controlled trials demonstrates that personalized treatment strategies targeting metabolic abnormalities such as hypercalciuria, hypocitraturia, and hyperuricosuria can reduce recurrence rates by more than 50%. Furthermore, lifestyle modifications combined with pharmacological agents such as potassium citrate, thiazide diuretics, and allopurinol have shown long-term clinical benefits. The success of metaphylaxis is closely tied to structured patient education, regular metabolic monitoring, and radiological follow-up. Effectively implemented metaphylaxis programs not only prevent new stone formation but also reduce the need for surgical interventions and stone-related complications. In conclusion, individualized, guideline-based metaphylaxis strategies have become indispensable in prolonging stone-free intervals in the management of urolithiasis.

Anahtar Kelimeler

urolithiasis, metaphylaxis, stone recurrence, metabolic evaluation, diet, pharmacotherapy

Kaynakça

1. Scales Jr CD, Smith AC, Hanley JM, Saigal CS, Project UDiA. Prevalence of kidney stones in the United States. European urology. 2012;62(1):160-5. https://doi.org/10.1016/j.eururo.2012.03.052.
2. Rule AD, Lieske JC, Li X, Melton III LJ, Krambeck AE, Bergstralh EJ. The ROKS nomogram for predicting a second symptomatic stone episode. Journal of the American Society of Nephrology. 2014;25(12):2878-86. https://doi.org/10.1681/ASN.2013091011.
3. Şahin A, Ürkmez A, Yıldırım Ç, Akan S, Güner D, Yüksel ÖH. Correlation of renal colic incidences with the season, gender and age: cross-sectional study. Haydarpaşa Numune Med J. 2020;60(1):10-5. https://doi.org/10.14744/ hnhj.2018.33254.
4. Kang DE, Maloney MM, Haleblian GE, Springhart WP, Honeycutt EF, Eisenstein EL, et al. Effect of medical management on recurrent stone formation following percutaneous nephrolithotomy. The Journal of urology. 2007;177(5):1785-9. https://doi.org/10.1016/j.juro.2007.01.061.
5. Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. The Journal of urology. 1996;155(3):839-43.
6. Geraghty RM, Davis NF, Tzelves L, Lombardo R, Yuan C, Thomas K, et al. Best practice in interventional management of urolithiasis: an update from the European Association of Urology Guidelines Panel for Urolithiasis 2022. European urology focus. 2023;9(1):199-208. https://doi.org/10.1016/j.euf.2022.06.014.
7. Alelign T, Petros B. Kidney stone disease: an update on current concepts. Advances in urology. 2018;2018(1):3068365. https://doi.org/10.1155/2018/3068365.
8. Kok DJ. Metaphylaxis, diet and lifestyle in stone disease. Arab Journal of Urology. 2012;10(3):240-9. https://doi. org/10.1016/j.aju.2012.03.003.
9. Fritsche H-M, Dötzer K. Improving the compliance of the recurrent stone-former. Arab Journal of Urology. 2012;10(3):342-6. https://doi.org/10.1016/j.aju.2012.07.003.
10. Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, et al. Medical management of kidney stones: AUA guideline. The Journal of urology. 2014;192(2):316-24. https://doi.org/10.1016/j.juro.2014.05.006.
11. Lombardo R, Tzelves L, Geraghty R, Davis NF, Neisius A, Petřík A, et al. Follow-up of urolithiasis patients after treatment: An algorithm from the EAU Urolithiasis Panel. World Journal of Urology. 2024;42(1):202. https://doi. org/10.1007/s00345-024-04872-y.
12. Montgomery TA, Nair HR, Phadke M, Morhardt E, Ludvigson A, Motamedinia P, et al. Protein Intake and High Uric Acid Stone Risk. Kidney Medicine. 2024;6(9):100878. https://doi.org/10.1016/j.xkme.2024.100878.
13. Kang DE, Sur RL, Haleblian GE, Fitzsimons NJ, Borawski KM, Preminger GM. Long-term lemonade based dietary manipulation in patients with hypocitraturic nephrolithiasis. The Journal of urology. 2007;177(4):1358-62. https:// doi.org/10.1016/j.juro.2006.11.058.
14. Skolarikos A, Somani B, Neisius A, Jung H, Petřík A, Tailly T, et al. Metabolic evaluation and recurrence prevention for urinary stone patients: an EAU guidelines update. European Urology. 2024. https://doi.org/10.1016/j. eururo.2024.05.029.
15. Tiselius H-G. Metabolic risk-evaluation and prevention of recurrence in stone disease: does it make sense? Urolithiasis. 2016;44(1):91-100. https://doi.org/10.1007/s00240-015-0840-y.
16. Finger M, Finger E, Bellucci A, Malieckal DA. Medical management for the prevention of kidney stones. Postgraduate medical journal. 2023;99(1169):112-8. https://doi.org/10.1136/postgradmedj-2021-140971.
17. Sakhaee K, Maalouf NM, Sinnott B. Kidney stones 2012: pathogenesis, diagnosis, and management. The Journal of Clinical Endocrinology & Metabolism. 2012;97(6):1847-60. https://doi.org/10.1210/jc.2011-3492.
18. Ferraro PM, Taylor EN, Curhan GC. 24-Hour urinary chemistries and kidney stone risk. American Journal of Kidney Diseases. 2024;84(2):164-9. https://doi.org/10.1053/j.ajkd.2024.02.010.
19. Ferraro PM, Taylor EN, Gambaro G, Curhan GC. Soda and other beverages and the risk of kidney stones. Clinical Journal of the American Society of Nephrology. 2013;8(8):1389-95. https://doi.org/10.2215/CJN.11661112.
20. Ferraro PM, Bargagli M. Dietetic and lifestyle recommendations for stone formers. Archivos espanoles deurologia. 2021;74(1):112-22.
21. Liu Kot K, Labagnara K, Kim JI, Loloi J, Gupta K, Agalliu I, et al. Evaluating the American Urologic Association (AUA) dietary recommendations for kidney stone management using the National Health And Nutritional Examination Survey (NHANES). Urolithiasis. 2023;51(1):60. https://doi.org/10.1007/s00240-023-01423-9.
22. Coe FL, Evan A, Worcester E. Kidney stone disease. The Journal of clinical investigation. 2005;115(10):2598-608. https://doi.org/10.1172/JCI26662.
23. Siener R. Nutrition and kidney stone disease. Nutrients. 2021;13(6):1917. https://doi.org/10.3390/nu13061917.
24. Meschi T, Maggiore U, Fiaccadori E, Schianchi T, Bosi S, Adorni G, et al. The effect of fruits and vegetables on urinary stone risk factors. Kidney international. 2004;66(6):2402-10. https://doi.org/10.1111/j.1523-1755.2004.66029.x.
25. Rodriguez A, Curhan GC, Gambaro G, Taylor EN, Ferraro PM. Mediterranean diet adherence and risk of incident kidney stones. The American journal of clinical nutrition. 2020;111(5):1100-6. https://doi.org/10.1093/ajcn/ nqaa066.
26. Arivoli K, Valicevic AN, Oerline MK, Hsi RS, Patel SR, Hollingsworth JM, et al. Preventive pharmacological therapy and risk of recurrent urinary stone disease. Clinical Journal of the American Society of Nephrology. 2024:10.2215. https://doi.org/10.2215/CJN.0000000000000428.
27. Curhan GC, Goldfarb DS. Thiazide use for the prevention of recurrent calcium kidney stones. Clinical Journal of the American Society of Nephrology. 2023:10.2215. https://doi.org/10.2215/CJN.0000000000000399.
28. Ghazaani MZ, Rizi FSD, Malekpour E, Momeni E, Abbasi F. Hydrochlorothiazide and kidney stone recurrence; an in-depth analysis of the NOSTONE trial. Journal of Renal Injury Prevention. 2024;13(3):e32279-e. https://doi. org/10.34172/jrip.2024.32279.
29. Li D-f, Gao Y-l, Liu H-c, Huang X-c, Zhu R-f, Zhu C-t. Use of thiazide diuretics for the prevention of recurrent kidney calculi: a systematic review and meta-analysis. Journal of Translational Medicine. 2020;18:1-12. https://doi. org/10.1186/s12967-020-02270-7.
30. Goldfarb DS, Modersitzki F, Asplin JR, Nazzal L. Effect of a high-citrate beverage on urine chemistry in patients with calcium kidney stones. Urolithiasis. 2023;51(1):96. https://doi.org/10.1007/s00240-023-01468-w.
31. Moe OW, Xu LHR. Hyperuricosuric calcium urolithiasis. Journal of Nephrology. 2018;31(2):189-96. https://doi.org/10.1007/s40620-018-0469-3.
32. Arowojolu O, Goldfarb DS. Treatment of calcium nephrolithiasis in the patient with hyperuricosuria. Journal of nephrology. 2014;27:601-5. https://doi.org/10.1007/s40620-014-0084-x.
33. Sfoungaristos S, Gofrit ON, Yutkin V, Pode D, Duvdevani M. Prevention of renal stone disease recurrence. A systematic review of contemporary pharmaceutical options. Expert opinion on pharmacotherapy. 2015;16(8):1209- 18. https://doi.org/10.1517/14656566.2015.1037740.
34. Das P, Gupta G, Velu V, Awasthi R, Dua K, Malipeddi H. Formation of struvite urinary stones and approaches towards the inhibition—A review. Biomedicine & pharmacotherapy. 2017;96:361-70. https://doi.org/10.1016/j. biopha.2017.10.015.
35. Türkmen MA, Kavukçu S. Primer Hiperokzalüri. Turkiye Klinikleri Pediatric Nephrology-Special Topics. 2024;5(2):37- 45.
36. Roberson D, Sperling C, Shah A, Ziemba J. Economic considerations in the management of nephrolithiasis. Current urology reports. 2020;21:1-9. https://doi.org/10.1007/s11934-020-00971-6.
37. Kianian R, Carter M, Finkelshtein I, Eleswarapu SV, Kachroo N. Application of artificial intelligence to patient-targeted health information on kidney stone disease. Journal of Renal Nutrition. 2024;34(2):170-6. https://doi.org/10.1053/j.jrn.2023.10.002.

Üriner Sistem Taş Hastalığında Metaflaksi

Yıl 2025, Cilt: 17 Sayı: 2, 97 - 104, 30.05.2025

Nihat Karabacak , Ali Atan , Fazlı Polat

Öz

Ürolitiyazis, dünya genelinde artan prevalansı ve yüksek tekrarlama eğilimi nedeniyle sadece akut dönemde tedavi edilmesi gereken bir tablo değil, aynı zamanda uzun dönem takip gerektiren çok yönlü bir hastalık olarak değerlendirilmelidir. Taş nüksünün önlenmesine yönelik sekonder profilaksi stratejileri içeren metaflaksi, üriner taş hastalığı yönetiminin merkezinde yer almaktadır. Bu derlemede taş hastalığında metaflaksinin tanımı, kapsamı, risk temelli hasta sınıflandırması, metabolik değerlendirme yöntemleri, diyet ve yaşam tarzı modifikasyonları ile farmakolojik tedavi yaklaşımları güncel kılavuzlar ve literatür doğrultusunda ele alınmıştır. Metabolik analizlere dayalı bireyselleştirilmiş tedavi stratejilerinin hiperkalsiüri, hipositratüri ve hiperürikozüri gibi patolojilerde taş rekürrensini %50’nin üzerinde azaltabildiği gösterilmiştir. Ayrıca yaşam tarzı değişiklikleri ile birlikte potasyum sitrat, tiyazid diüretikler ve allopurinol gibi ajanların uzun dönem faydaları randomize kontrollü çalışmalarda ortaya konmuştur. Metaflaksinin başarısı hasta eğitimi, düzenli metabolik ve radyolojik takip ile doğrudan ilişkilidir. Etkin yürütülen metaflaksi programları, yeni taş oluşumunu engellemenin yanında cerrahi müdahale ihtiyacını ve taş ilişkili komplikasyonları da azaltmaktadır. Sonuç olarak, ürolitiyazis tedavisinde bireyselleştirilmiş güncel kılavuz temelli metaflaksi stratejileri, taşsız kalma süresinin uzatılmasında vazgeçilmez bir yaklaşım haline gelmiştir.

Anahtar Kelimeler

ürolitiyazis, metaflaksi, taş rekürrensi, metabolik değerlendirme, diyet, farmakoterapi

Etik Beyan

Destekleyen Kurum

Yazarlar olarak bu çalışmanın finansal destek almadığını beyan ediyoruz.

Kaynakça

1. Scales Jr CD, Smith AC, Hanley JM, Saigal CS, Project UDiA. Prevalence of kidney stones in the United States. European urology. 2012;62(1):160-5. https://doi.org/10.1016/j.eururo.2012.03.052.
2. Rule AD, Lieske JC, Li X, Melton III LJ, Krambeck AE, Bergstralh EJ. The ROKS nomogram for predicting a second symptomatic stone episode. Journal of the American Society of Nephrology. 2014;25(12):2878-86. https://doi.org/10.1681/ASN.2013091011.
3. Şahin A, Ürkmez A, Yıldırım Ç, Akan S, Güner D, Yüksel ÖH. Correlation of renal colic incidences with the season, gender and age: cross-sectional study. Haydarpaşa Numune Med J. 2020;60(1):10-5. https://doi.org/10.14744/ hnhj.2018.33254.
4. Kang DE, Maloney MM, Haleblian GE, Springhart WP, Honeycutt EF, Eisenstein EL, et al. Effect of medical management on recurrent stone formation following percutaneous nephrolithotomy. The Journal of urology. 2007;177(5):1785-9. https://doi.org/10.1016/j.juro.2007.01.061.
5. Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. The Journal of urology. 1996;155(3):839-43.
6. Geraghty RM, Davis NF, Tzelves L, Lombardo R, Yuan C, Thomas K, et al. Best practice in interventional management of urolithiasis: an update from the European Association of Urology Guidelines Panel for Urolithiasis 2022. European urology focus. 2023;9(1):199-208. https://doi.org/10.1016/j.euf.2022.06.014.
7. Alelign T, Petros B. Kidney stone disease: an update on current concepts. Advances in urology. 2018;2018(1):3068365. https://doi.org/10.1155/2018/3068365.
8. Kok DJ. Metaphylaxis, diet and lifestyle in stone disease. Arab Journal of Urology. 2012;10(3):240-9. https://doi. org/10.1016/j.aju.2012.03.003.
9. Fritsche H-M, Dötzer K. Improving the compliance of the recurrent stone-former. Arab Journal of Urology. 2012;10(3):342-6. https://doi.org/10.1016/j.aju.2012.07.003.
10. Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, et al. Medical management of kidney stones: AUA guideline. The Journal of urology. 2014;192(2):316-24. https://doi.org/10.1016/j.juro.2014.05.006.
11. Lombardo R, Tzelves L, Geraghty R, Davis NF, Neisius A, Petřík A, et al. Follow-up of urolithiasis patients after treatment: An algorithm from the EAU Urolithiasis Panel. World Journal of Urology. 2024;42(1):202. https://doi. org/10.1007/s00345-024-04872-y.
12. Montgomery TA, Nair HR, Phadke M, Morhardt E, Ludvigson A, Motamedinia P, et al. Protein Intake and High Uric Acid Stone Risk. Kidney Medicine. 2024;6(9):100878. https://doi.org/10.1016/j.xkme.2024.100878.
13. Kang DE, Sur RL, Haleblian GE, Fitzsimons NJ, Borawski KM, Preminger GM. Long-term lemonade based dietary manipulation in patients with hypocitraturic nephrolithiasis. The Journal of urology. 2007;177(4):1358-62. https:// doi.org/10.1016/j.juro.2006.11.058.
14. Skolarikos A, Somani B, Neisius A, Jung H, Petřík A, Tailly T, et al. Metabolic evaluation and recurrence prevention for urinary stone patients: an EAU guidelines update. European Urology. 2024. https://doi.org/10.1016/j. eururo.2024.05.029.
15. Tiselius H-G. Metabolic risk-evaluation and prevention of recurrence in stone disease: does it make sense? Urolithiasis. 2016;44(1):91-100. https://doi.org/10.1007/s00240-015-0840-y.
16. Finger M, Finger E, Bellucci A, Malieckal DA. Medical management for the prevention of kidney stones. Postgraduate medical journal. 2023;99(1169):112-8. https://doi.org/10.1136/postgradmedj-2021-140971.
17. Sakhaee K, Maalouf NM, Sinnott B. Kidney stones 2012: pathogenesis, diagnosis, and management. The Journal of Clinical Endocrinology & Metabolism. 2012;97(6):1847-60. https://doi.org/10.1210/jc.2011-3492.
18. Ferraro PM, Taylor EN, Curhan GC. 24-Hour urinary chemistries and kidney stone risk. American Journal of Kidney Diseases. 2024;84(2):164-9. https://doi.org/10.1053/j.ajkd.2024.02.010.
19. Ferraro PM, Taylor EN, Gambaro G, Curhan GC. Soda and other beverages and the risk of kidney stones. Clinical Journal of the American Society of Nephrology. 2013;8(8):1389-95. https://doi.org/10.2215/CJN.11661112.
20. Ferraro PM, Bargagli M. Dietetic and lifestyle recommendations for stone formers. Archivos espanoles deurologia. 2021;74(1):112-22.
21. Liu Kot K, Labagnara K, Kim JI, Loloi J, Gupta K, Agalliu I, et al. Evaluating the American Urologic Association (AUA) dietary recommendations for kidney stone management using the National Health And Nutritional Examination Survey (NHANES). Urolithiasis. 2023;51(1):60. https://doi.org/10.1007/s00240-023-01423-9.
22. Coe FL, Evan A, Worcester E. Kidney stone disease. The Journal of clinical investigation. 2005;115(10):2598-608. https://doi.org/10.1172/JCI26662.
23. Siener R. Nutrition and kidney stone disease. Nutrients. 2021;13(6):1917. https://doi.org/10.3390/nu13061917.
24. Meschi T, Maggiore U, Fiaccadori E, Schianchi T, Bosi S, Adorni G, et al. The effect of fruits and vegetables on urinary stone risk factors. Kidney international. 2004;66(6):2402-10. https://doi.org/10.1111/j.1523-1755.2004.66029.x.
25. Rodriguez A, Curhan GC, Gambaro G, Taylor EN, Ferraro PM. Mediterranean diet adherence and risk of incident kidney stones. The American journal of clinical nutrition. 2020;111(5):1100-6. https://doi.org/10.1093/ajcn/ nqaa066.
26. Arivoli K, Valicevic AN, Oerline MK, Hsi RS, Patel SR, Hollingsworth JM, et al. Preventive pharmacological therapy and risk of recurrent urinary stone disease. Clinical Journal of the American Society of Nephrology. 2024:10.2215. https://doi.org/10.2215/CJN.0000000000000428.
27. Curhan GC, Goldfarb DS. Thiazide use for the prevention of recurrent calcium kidney stones. Clinical Journal of the American Society of Nephrology. 2023:10.2215. https://doi.org/10.2215/CJN.0000000000000399.
28. Ghazaani MZ, Rizi FSD, Malekpour E, Momeni E, Abbasi F. Hydrochlorothiazide and kidney stone recurrence; an in-depth analysis of the NOSTONE trial. Journal of Renal Injury Prevention. 2024;13(3):e32279-e. https://doi. org/10.34172/jrip.2024.32279.
29. Li D-f, Gao Y-l, Liu H-c, Huang X-c, Zhu R-f, Zhu C-t. Use of thiazide diuretics for the prevention of recurrent kidney calculi: a systematic review and meta-analysis. Journal of Translational Medicine. 2020;18:1-12. https://doi. org/10.1186/s12967-020-02270-7.
30. Goldfarb DS, Modersitzki F, Asplin JR, Nazzal L. Effect of a high-citrate beverage on urine chemistry in patients with calcium kidney stones. Urolithiasis. 2023;51(1):96. https://doi.org/10.1007/s00240-023-01468-w.
31. Moe OW, Xu LHR. Hyperuricosuric calcium urolithiasis. Journal of Nephrology. 2018;31(2):189-96. https://doi.org/10.1007/s40620-018-0469-3.
32. Arowojolu O, Goldfarb DS. Treatment of calcium nephrolithiasis in the patient with hyperuricosuria. Journal of nephrology. 2014;27:601-5. https://doi.org/10.1007/s40620-014-0084-x.
33. Sfoungaristos S, Gofrit ON, Yutkin V, Pode D, Duvdevani M. Prevention of renal stone disease recurrence. A systematic review of contemporary pharmaceutical options. Expert opinion on pharmacotherapy. 2015;16(8):1209- 18. https://doi.org/10.1517/14656566.2015.1037740.
34. Das P, Gupta G, Velu V, Awasthi R, Dua K, Malipeddi H. Formation of struvite urinary stones and approaches towards the inhibition—A review. Biomedicine & pharmacotherapy. 2017;96:361-70. https://doi.org/10.1016/j. biopha.2017.10.015.
35. Türkmen MA, Kavukçu S. Primer Hiperokzalüri. Turkiye Klinikleri Pediatric Nephrology-Special Topics. 2024;5(2):37- 45.
36. Roberson D, Sperling C, Shah A, Ziemba J. Economic considerations in the management of nephrolithiasis. Current urology reports. 2020;21:1-9. https://doi.org/10.1007/s11934-020-00971-6.
37. Kianian R, Carter M, Finkelshtein I, Eleswarapu SV, Kachroo N. Application of artificial intelligence to patient-targeted health information on kidney stone disease. Journal of Renal Nutrition. 2024;34(2):170-6. https://doi.org/10.1053/j.jrn.2023.10.002.

Toplam 37 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	Türkçe
Konular	Üroloji
Bölüm	Derleme
Yazarlar	Nihat Karabacak 0000-0001-5758-5909 Ali Atan 0000-0002-7114-068X Fazlı Polat 0009-0007-3582-8798
Yayımlanma Tarihi	30 Mayıs 2025
Gönderilme Tarihi	22 Nisan 2025
Kabul Tarihi	24 Mayıs 2025
Yayımlandığı Sayı	Yıl 2025 Cilt: 17 Sayı: 2

Kaynak Göster

Vancouver	Karabacak N, Atan A, Polat F. Üriner Sistem Taş Hastalığında Metaflaksi. Endourol Bull. 2025;17(2):97-104.

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