Diagnostic and Therapeutic Approach in Patients with Urinary Calculi

Abstract

The natural history of urolithiasis includes the risk of recurrence and of the development of chronic kidney and/or bone disease, which is why a thorough clinical and metabolic evaluation of these patients is of the utmost importance at disease onset. This paper is aimed at identifying the type of urolithiasis, the related risk factors, and the corresponding treatment options. The diagnostic and therapeutic approach described here includes 1) accurate history taking to detect secondary nephrolithiasis and screen for the main risk factors for kidney and bone disease; 2) metabolic evaluation graded according to different complexity levels based on the severity of the disease and the presence of risk factors; 3) carrying out appropriate imaging procedures. The resulting information allows to plan treatment based either on general rules of lifestyle and diet, or on selected medical intervention, if necessary. This report, which is based on current guidelines, was produced by the Gruppo Italiano di Studio Multidisciplinare per la Calcolosi Renale. It is addressed to all professionals involved in the management of patients suffering from nephrolithiasis, first of all general practitioners, who often become involved immediately at the onset of the disease.

Management of urinary stone disease in general practice: A French Delphi study

“…In regard to imaging, experts were more inclined to recommend unenhanced low-dose abdominal CT, although ultrasound -KUB X-ray seems an acceptable alternative. This is in accordance with most of the existing guidelines, [9][10][11][12][13] probably because CT can eliminate most of the alternative diagnoses and shows better diagnostic performances. [17] However, in a recent large multicentre randomized trial, Smith-Bindman et al found that initial ultrasonography for suspected renal colic was associated with lower cumulative radiation exposure than initial CT without significant differences in missing high-risk diagnoses, which emphasizes that controversies regarding this question are still ongoing.…”

“…[8] Guidelines for the management of urinary stone disease in the hospital setting have been made by urologists, [9] emergency physicians [10] and radiologists, [11] but there is a lack of recommendations for management in primary care. [12,13] The aim of this study was to generate proposals for the management of urolithiasis in general practice in France, using a Delphi method.…”

Medical Management of Urinary Calculi: Up to Date 2016

“…There is still much debate on whether a single collection be adequate, if spot urine could substitute for 24-hour urine, if complete evaluation should be only offered to recurrent stone formers or even to patients at first episode. These issues are discussed in referenced papers (23,71,72). The author's opinion is that one 24-hr urine collection associated with fasting urine collection could be a reasonable option to be offered to recurrent stone formers or even single stone formers with risk conditions such as systemic disorders, family history, early onset, renal insufficiency, etc.…”

A Preliminary Investigation on the “Swinging Kidney”: A Sonographic Sign Useful for Diagnosing Renal Colic

“…4,5 Some guidelines recommend a sonogram and an abdominal radiography as first diagnostic imaging investigations. 6,7 The sonogram has several advantageous features: fast, accurate execution at the bedside, at low cost, and allows for ruling out other possible causes of abdominal pain. A meta-analysis, aggregating five high-quality studies, found a modest overall accuracy, for sonography, in diagnosing nephrolithiasis: sensitivity of 70% and a specificity of 75%.…”