Dados do Trabalho

Título

THE INCIDENCE OF NEPHROLITHIASIS IN PATIENTS ON TOPIRAMATE THERAPY: A LITERATURE REVIEW

Resumo

Epilepsy is a chronic disease related to the nervous system, in which the brain oscillates between moments of stability and instability, in the latter presenting epileptic seizures. In order for the individual to control the incidence of seizures, there are antiepileptic drugs (AEDs), among them Topiramate (TPM), which acts by blocking voltage-dependent sodium channels, improves chloride influx, weakly inhibits carbonic anhydrase, potentiates the GABA receptor, and blocks the AMPA receptor. Among the adverse effects manifested in patients taking long-term PMT, there is the incidence of nephrolithiasis. The objective of this study is to describe the occurrence of kidney stones in individuals, especially epileptic patients, who are treated with the drug TPM, based on research in PubMed and SciELO databases. The research showed that, despite having a low incidence rate, some patients on long-term therapy with the drug may develop renal lithiasis. However, in most of the reported cases, discontinuation of the drug improved the symptoms and the stones disappeared. It was also possible to notice a certain incredulity described by older authors about this adverse effect, in which many did not consider relevant the relationship between renal lithiasis and the use of TPM. In contrast, more current studies emphasized the relationship as something significant. One study from 2002 does not report the incidence of nephrolithiasis, but, the duration of treatment of the individuals who participated in the study ranged from 20 to 1143 days, a time that may be insufficient to determine the risk of kidney stones, since this is an effect provided by long-term therapy. Finally, one study tried to associate the use of the drug with a ketogenic diet, which proved to be contraindicated because the ketogenic diet provides a significant reduction in HCO3- levels, increasing metabolic acidosis, a predisposing factor for the occurrence of kidney stones. It can be concluded that nephrolithiasis may have a great impact on the patient's quality of life, and may result in life-threatening complications such as sepsis and renal failure. Knowing the predisposing factors for its occurrence in each individual is of utmost importance when prescribing drugs that inhibit carbonic anhydrase, such as Topiramate, in order to provide quality of life and longevity to them, especially to patients with epilepsy.

Palavras Chave

epilepsy, topiramate, nephrolithiasis