Biochemical and Stone-Risk Profiles With Topiramate Treatment

Brian J. Welch, Dion Graybeal, Orson W. Moe, Naim M. Maalouf, Khashayar Sakhaee

Research output: Contribution to journalArticle

84 Citations (Scopus)

Abstract

Background: Topiramate is a novel neuromodulatory agent commonly prescribed for the treatment of seizure disorders and for migraine headache prophylaxis. Calcium phosphate kidney stones have been observed with topiramate treatment, but a comprehensive elucidation of stone-risk profile was not reported previously. This study explores the relationship between topiramate treatment and propensity for kidney stone formation. Methods: Thirty-two topiramate-treated subjects and 50 healthy volunteers participated in a cross-sectional study in which serum chemistry test and 24-hour urine collection results were evaluated for stone risk. Furthermore, a short-term longitudinal study was conducted in 7 patients to assess stone risk before and 3 months after topiramate treatment. Results: Serum bicarbonate levels were lower with topiramate treatment. Urinary pH, urinary bicarbonate excretion, and fractional excretion of bicarbonate increased, whereas urinary citrate excretion was significantly lower (737 ± 329 versus 278 ± 226 mg/d; P < 0.001). Net acid excretion did not change. The relative saturation ratio for brushite increased with topiramate treatment (3.14 ± 1.69 versus 1.27 ± 1.26; P < 0.001) because of urinary alkalinization and decreased urinary citrate levels. Urinary saturation of undissociated uric acid decreased (41 ± 52 versus 76 ± 60 mg/d; P < 0.001). Conclusion: Treatment with topiramate causes systemic metabolic acidosis, markedly lower urinary citrate excretion, and increased urinary pH. These changes increase the propensity to form calcium phosphate stones.

Original languageEnglish (US)
Pages (from-to)555-563
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume48
Issue number4
DOIs
StatePublished - Oct 2006

Fingerprint

Bicarbonates
Citric Acid
Kidney Calculi
Therapeutics
Urine Specimen Collection
topiramate
Acidosis
Uric Acid
Serum
Migraine Disorders
Longitudinal Studies
Epilepsy
Healthy Volunteers
Cross-Sectional Studies
Acids
calcium phosphate

Keywords

  • kidney stones
  • nephrolithiasis
  • Topiramate

ASJC Scopus subject areas

  • Nephrology

Cite this

Biochemical and Stone-Risk Profiles With Topiramate Treatment. / Welch, Brian J.; Graybeal, Dion; Moe, Orson W.; Maalouf, Naim M.; Sakhaee, Khashayar.

In: American Journal of Kidney Diseases, Vol. 48, No. 4, 10.2006, p. 555-563.

Research output: Contribution to journalArticle

@article{cfc038c054c24a2db552be319e4e6680,
title = "Biochemical and Stone-Risk Profiles With Topiramate Treatment",
abstract = "Background: Topiramate is a novel neuromodulatory agent commonly prescribed for the treatment of seizure disorders and for migraine headache prophylaxis. Calcium phosphate kidney stones have been observed with topiramate treatment, but a comprehensive elucidation of stone-risk profile was not reported previously. This study explores the relationship between topiramate treatment and propensity for kidney stone formation. Methods: Thirty-two topiramate-treated subjects and 50 healthy volunteers participated in a cross-sectional study in which serum chemistry test and 24-hour urine collection results were evaluated for stone risk. Furthermore, a short-term longitudinal study was conducted in 7 patients to assess stone risk before and 3 months after topiramate treatment. Results: Serum bicarbonate levels were lower with topiramate treatment. Urinary pH, urinary bicarbonate excretion, and fractional excretion of bicarbonate increased, whereas urinary citrate excretion was significantly lower (737 ± 329 versus 278 ± 226 mg/d; P < 0.001). Net acid excretion did not change. The relative saturation ratio for brushite increased with topiramate treatment (3.14 ± 1.69 versus 1.27 ± 1.26; P < 0.001) because of urinary alkalinization and decreased urinary citrate levels. Urinary saturation of undissociated uric acid decreased (41 ± 52 versus 76 ± 60 mg/d; P < 0.001). Conclusion: Treatment with topiramate causes systemic metabolic acidosis, markedly lower urinary citrate excretion, and increased urinary pH. These changes increase the propensity to form calcium phosphate stones.",
keywords = "kidney stones, nephrolithiasis, Topiramate",
author = "Welch, {Brian J.} and Dion Graybeal and Moe, {Orson W.} and Maalouf, {Naim M.} and Khashayar Sakhaee",
year = "2006",
month = "10",
doi = "10.1053/j.ajkd.2006.07.003",
language = "English (US)",
volume = "48",
pages = "555--563",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "4",

}

TY - JOUR

T1 - Biochemical and Stone-Risk Profiles With Topiramate Treatment

AU - Welch, Brian J.

AU - Graybeal, Dion

AU - Moe, Orson W.

AU - Maalouf, Naim M.

AU - Sakhaee, Khashayar

PY - 2006/10

Y1 - 2006/10

N2 - Background: Topiramate is a novel neuromodulatory agent commonly prescribed for the treatment of seizure disorders and for migraine headache prophylaxis. Calcium phosphate kidney stones have been observed with topiramate treatment, but a comprehensive elucidation of stone-risk profile was not reported previously. This study explores the relationship between topiramate treatment and propensity for kidney stone formation. Methods: Thirty-two topiramate-treated subjects and 50 healthy volunteers participated in a cross-sectional study in which serum chemistry test and 24-hour urine collection results were evaluated for stone risk. Furthermore, a short-term longitudinal study was conducted in 7 patients to assess stone risk before and 3 months after topiramate treatment. Results: Serum bicarbonate levels were lower with topiramate treatment. Urinary pH, urinary bicarbonate excretion, and fractional excretion of bicarbonate increased, whereas urinary citrate excretion was significantly lower (737 ± 329 versus 278 ± 226 mg/d; P < 0.001). Net acid excretion did not change. The relative saturation ratio for brushite increased with topiramate treatment (3.14 ± 1.69 versus 1.27 ± 1.26; P < 0.001) because of urinary alkalinization and decreased urinary citrate levels. Urinary saturation of undissociated uric acid decreased (41 ± 52 versus 76 ± 60 mg/d; P < 0.001). Conclusion: Treatment with topiramate causes systemic metabolic acidosis, markedly lower urinary citrate excretion, and increased urinary pH. These changes increase the propensity to form calcium phosphate stones.

AB - Background: Topiramate is a novel neuromodulatory agent commonly prescribed for the treatment of seizure disorders and for migraine headache prophylaxis. Calcium phosphate kidney stones have been observed with topiramate treatment, but a comprehensive elucidation of stone-risk profile was not reported previously. This study explores the relationship between topiramate treatment and propensity for kidney stone formation. Methods: Thirty-two topiramate-treated subjects and 50 healthy volunteers participated in a cross-sectional study in which serum chemistry test and 24-hour urine collection results were evaluated for stone risk. Furthermore, a short-term longitudinal study was conducted in 7 patients to assess stone risk before and 3 months after topiramate treatment. Results: Serum bicarbonate levels were lower with topiramate treatment. Urinary pH, urinary bicarbonate excretion, and fractional excretion of bicarbonate increased, whereas urinary citrate excretion was significantly lower (737 ± 329 versus 278 ± 226 mg/d; P < 0.001). Net acid excretion did not change. The relative saturation ratio for brushite increased with topiramate treatment (3.14 ± 1.69 versus 1.27 ± 1.26; P < 0.001) because of urinary alkalinization and decreased urinary citrate levels. Urinary saturation of undissociated uric acid decreased (41 ± 52 versus 76 ± 60 mg/d; P < 0.001). Conclusion: Treatment with topiramate causes systemic metabolic acidosis, markedly lower urinary citrate excretion, and increased urinary pH. These changes increase the propensity to form calcium phosphate stones.

KW - kidney stones

KW - nephrolithiasis

KW - Topiramate

UR - http://www.scopus.com/inward/record.url?scp=33748744783&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33748744783&partnerID=8YFLogxK

U2 - 10.1053/j.ajkd.2006.07.003

DO - 10.1053/j.ajkd.2006.07.003

M3 - Article

C2 - 16997051

AN - SCOPUS:33748744783

VL - 48

SP - 555

EP - 563

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 4

ER -