An Update and Practical Guide to Renal Stone Management

Abstract

Renal stone disease covers kidney and lower urinary tract stones caused by a variety of conditions, including metabolic and inherited disorders, and anatomical defects with or without chronic urinary infection. Most cases are idiopathic, in which there is undoubtedly a genetic predisposition, but where environmental and lifestyle factors play an important role. Indeed, it is becoming apparent that renal stone disease is often part of a larger ‘metabolic picture’ commonly associated with type 2 diabetes, obesity, dyslipidaemia, and hypertension. Renal stone disease is a growing problem in the UK (and other developed and developing populations) with a cross-sectional prevalence of ∼1.2%. This means that there are currently ∼720,000 individuals with a history of kidney stones in the UK. Almost 40% of first-time stone formers will form a second stone within 3 years of the first episode if no prophylactic measures are instituted to prevent stone recurrence, since removal or disintegration of the first stone does not treat the underlying cause of stones in the majority of patients. The age of onset is getting younger and the sex ratio (until recently more men than women) is becoming almost even. Metabolic screening remains an important part of investigating renal stone disease, but to the disappointment and frustration of many doctors, medical treatment is still essentially pragmatic, except perhaps in cystinuria, and to a limited extent in primary hyperoxaluria (if pyridoxine-sensitive); although newer treatments may be emerging. This review summarizes current thinking and provides a practical basis for the management of renal stone disease.

The difficult ureter: what is the incidence of pre-stenting?

“…These statistics mean there are approximately 720,000 individuals with a history of kidney stones in the UK. 1 The increased prevalence of kidney stones parallels the well-publicised increase in the nation's prevalence of obesity and its well-documented relationship to urolithiasis. 2 In 1912, the first visualisation of the upper urinary tract was performed by Hampton Young.…”

Prevalence of carotid artery calcification on panoramic radiographs in patients with renal stones

“…The lifetime prevalence of KS is increasing in the United States (22) and the prevalence is found to be 11.1% in Turkey (23); it varies between 2% and 20% worldwide (3). KS has been associated with obesity, hypertension, and diabetes mellitus (24)(25)(26).…”

“…Although important advances were made during the last decades in defining kidney stone formation, many problems regarding calculus pathogenesis still remain unexplained. It is becoming apparent that renal stone disorder is generally associated with type 2 diabetes, hypertension, dyslipidemia, obesity, and cardiovascular diseases (3,4). There is some evidence that subjects who have kidney stones are at elevated risk for myocardial infarction, and this risk is found to be independent of chronic renal failure and other risk factors (5).…”

Kidney stone disease: pathophysiology, investigation and medical treatment

“…27 The minimum initial investigations we recommend are outlined in Table 1. Diurnal calcium excretion is highly variable.…”