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This review draws the recent state of the art in metabolic diagnosis and metaphylaxis of stone disease. It is the basis for the consensus approval with the other medical societies and institutions in Germany involved in the guideline process of the new "Urolithiasis Guideline". The German Working Committee on Stone Disease reviewed critically the current literature in the field of urolithiasis-including the existing German and EAU-Guidelines as well as the Conference Book of the First International Consultation on Stone Disease. As far as possible the references were rated according to the EBM criteria. On this basis the expert group discussed all pathways and statements regarding the management of stone disease. The present review coincides with the consented guideline draft of the German Working Committee on Stone Disease. Occurrence of stone disease in the western world increases seriously. Modern lifestyle, dietary habits and overweight-problems of the affluent societies-emerge to be the important promoters of the "stone-boom" in the new millennium. This even affects children, whose stone prevalence is otherwise significantly less than that of adults. Criteria for the high risk group of stone formers were clearly defined. A diagnostic standard is formulated for the basic and the elaborate metabolic evaluation of a stone patient. Approximately 75% of all stone patients could anticipate stone recurrence with elementary reorientation of their lifestyle and dietary habits, summarized as general metaphylaxis. About 25% of the stone formers require additional pharmacological intervention to normalize their individual biochemical risk, precisely compiled for each stone type as specific metaphylaxis.

The most frequent structures of the majority of possible urolith components are assessed by scanning electron microscopic investigations. Typical examples of the conversion of uric acid dihydrate into uric acid, weddellite into whewellite and MgHN4PO4 . 6 H20 into MgNH4PO4 . H2O are given.

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Crystal formation reflects the entire composition of the surrounding solution. In case of urolithiasis, induced crystal formation in native urine has led to the development of the Bonn-Risk-Index (BRI), a valuable tool to quantify an individual's risk of calcium oxalate urolithiasis. If the progression of a disease is associated with characteristic changes in the activities of urinary components, this leads to an altered urinary crystallisation capacity. Therefore, the results of induced urinary crystal formation can be used to detect and monitor any disease linked to the altered urinary composition. Since crystal formation inherently takes into account the entire urinary composition, the influence of the disease on individual urinary parameters does not have to be known in order to monitor the consequent pathologic alterations. In this paper, we review the background of urinary crystal formation analysis and describe its established application in urolithiasis monitoring as well as potential further fields of clinical application.

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Emotional stress is associated with e.g. increased hormone release, high blood-sugar level and blood pressure. Stress clearly affects metabolism. Whether chronic stress exposure leads to altered urinary compositions with increased risk of CaOx; urolithiasis was examined by investigating the relation between stress burden and urine composition. 29 controls (CG), 29 CaOx stone formers (SF), and 28 patients with chronic inflammatory bowel diseases (CIBD) were advised to avoid unfavorable aliment. Any urolithiasis-related medications were stopped. At day 5, a 24-h urine was collected and comprehensive urinalysis performed. AP (CaOx) index was calculated. Subjects completed a questionnaire designed to measure perceived stress ("Trier-Inventory-of-Chronic-Stress"). Mean AP (CaOx) in CG, SF and CIBD amount to 0.8 (+/-0.3), 1.2 (+/-0.7), and 1.9 (+/-1.2), respectively. Increased AP (CaOx) in SF is mainly attributed to an increased effect of calcium and oxalate, whereas in CIBD this is additionally caused by a reduced effect of citrate, magnesium and volume. Stress dimensions are correlated to any investigated urinary parameter with an absolute value of r< or = 0.600; some correlations are statistically significant: whereas in SF only one combination, "lack of social recognition" versus calcium, shows significance, in CIBD various combinations are significantly related. In particular, sodium excretion increases with stress. In CG, some stress dimensions are directly related to citrate; with increasing stress, protection against CaOx crystallization tends to increase. It could be shown that stress load and urinary composition are related by statistical means. The observed metabolic stress response patterns in urinary compositions are different for the distinct groups, thereby, reflecting a conclusive picture. This is in particular in CIBD, for which a link between stress and inflammatory activity and between inflammatory activity and altered urinary composition is well established.

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