Background

Ketogenic diet (KD) is widely used for drug-resistant epilepsy (DRE). The study was designed to evaluate one of the risk factors for development of renal calculi with KD.

Methods

Twenty patients with DRE on Modified Atkins diet (MAD) were subjected to full history and laboratory investigations, including microscopic urine analysis, urinary calcium after overnight fasting, and calcium/creatinine ratio, as well as pelviabdominal ultrasound. Frequency and severity of seizures assessed by Chalfont severity score were recorded. All assessment measures were repeated after 3 and 6 months of KD therapy.

Results

There were significant reductions in both frequency and severity of seizures, yet 2 patients (10%) developed renal stones after 6 months on KD. Gross hematuria was reported in 1 of those 2 patients (50%), but microscopic hematuria was detected in both patients. The urine calcium and the urine calcium/creatinine ratio were elevated in both patients having renal calculi after 6 months.

Conclusions

KD increases the risk of renal stones with hypercalciuria among the causes. We recommend initiation of prophylactic measures once KD is commenced by maximizing fluid intake and urine alkalinization with regular urinary studies including calcium/creatinine ratio and renal ultrasound for patients with symptoms.

Impact

• KD has been increasingly used in epilepsy management and beyond. The potential side effects of such diet should be highlighted while valuing the merits.

• KD increases the risk of renal stones because of hypercalciuria among other causes.

• We recommend initiation of prophylactic measures once KD is commenced by maximizing fluid intake and urine alkalinization with estimation of urinary calcium/creatinine ratio and renal ultrasound in patients with relevant symptoms.

中文翻译：

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改良阿特金斯饮食治疗耐药性癫痫和尿石症风险

背景

生酮饮食（KD）广泛用于治疗耐药性癫痫（DRE）。该研究旨在评估 KD 发生肾结石的危险因素之一。

方法

对 20 名采用改良阿特金斯饮食 (MAD) 的 DRE 患者进行了完整的病史和实验室检查，包括显微镜尿液分析、隔夜禁食后的尿钙、钙/肌酐比以及盆腹超声检查。记录由 Chalfont 严重程度评分评估的癫痫发作频率和严重程度。在 KD 治疗 3 个月和 6 个月后重复所有评估措施。

结果

癫痫发作的频率和严重程度均显着降低，但 2 名患者 (10%) 在 KD 治疗 6 个月后出现肾结石。这 2 名患者中有 1 名（50%）报告肉眼血尿，但两名患者均检测到镜下血尿。6个月后，两名患有肾结石的患者的尿钙和尿钙/肌酐比均升高。

结论

KD 会增加肾结石的风险，其中高钙尿症是其中的原因。我们建议一旦开始 KD 就开始预防措施，通过最大限度地增加液体摄入量和尿液碱化，定期进行尿液检查，包括对有症状的患者进行钙/肌酐比和肾脏超声检查。

影响

• KD 已越来越多地用于癫痫管理及其他领域。在重视优点的同时，应强调这种饮食的潜在副作用。

• 由于高钙尿症等原因，KD 会增加肾结石的风险。

• 我们建议一旦开始 KD 就开始预防措施，通过最大限度地增加液体摄入量和尿液碱化，估计有相关症状的患者的尿钙/肌酐比和肾脏超声。