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Topiramate (TPM) has been widely used in epilepsy and migraine. Its use, however, has been associated with development of metabolic disturbances such as acidosis, hypokalaemia, hyperuricaemia, and renal stone disease.1 The routine use of ultrasonography (USG) of the urinary system to screen for nephrolithiasis remains controversial. We performed a single-centre retrospective survey of nephrolithiasis associated with TPM use. Medical records of children with epilepsy who had ever been prescribed TPM between January 2005 and December 2014 in our institute were reviewed. Patients with a pre-existing history of renal stones; long-standing or intermittent urinary catheterisation; history of recurrent urinary tract infection; chronic diarrhoea; or concomitant use of other carbonic anhydrase inhibitors, antacids, or diuretics were excluded. Their demographic data including age, sex, ambulatory status, age at initiation of treatment, duration and dosage of TPM treatment, and concurrent use of a ketogenic diet were recorded. Urinary symptoms reported by patients or carers including stone passage, haematuria, and dysuria were noted. The occurrence of nephrolithiasis was assessed by USG screening that was arranged at around 1 year after initiation of TPM treatment or when any urinary symptoms were reported. The study was approved by the local institutional ethics review board and conducted in accordance with good clinical practice guidelines and the Declaration of Helsinki. During the study period, 81 patients were prescribed TPM. The study group comprised 48 patients who had been on TPM treatment for at least 12 months of whom 16 (33.3%) were female and 35 (72.9%) were ambulatory; TPM was initiated at the age of 1.1-15.4 years with dose range of 1.212.0 mg/kg/day (mean, 6 mg/kg/day). Length of time on treatment was 1.3-12.0 years (mean, 8.3 years) and at least one renal USG examination had been performed in 29 (60.4%) patients. In this group of patients, 21 (72.4%) were ambulatory. The group without USG (n=19) were older at commencement Hong Kong Med J 2017;23:654–5 DOI: 10.12809/hkmj176908

Nephrolithiasis associated with the use of topiramate in children