Medical Management of Urinary Calculi: Up to Date 2016

Abstract

Nephrolithiasis (NL) is one of the most prevalent nontransmissible diseases in western countries. It is being associated with other frequent diseases, including osteoporosis, cardiovascular disease, hypertension, diabetes mellitus, through a putative common link with metabolic syndrome and insulin resistance or altered mineral metabolism. This review will focus on classification, physicochemical basis, risk factors, laboratory and imaging investigations, medical management.Classification as to stone composition includes calcium, uric acid (UA), cystine (Cys), infected, 2-8 dihydroxyadenine and rare NL. According to pathophysiology, NL is classified as primary, secondary to systemic diseases or drugs, caused by renal or metabolic hereditary disorders.A stone can only form in supersaturated environment, and this is sufficient in UA, Cys and infected NL, but not in Ca-NL, which results from the imbalance between supersaturation and inhibition. All types are characterized by derangements of peculiar risk factors. Laboratory investigations aim at identifying type of NL, underlying risk factors and state of saturation, and pathophysiology. This justifies a rationale therapy able to dissolve some types of stones and/or produce reduction in recurrence rate in others.Medical management includes alkali and allopurinol for UA nephrolithiasis (UA-NL), thiols and alkali in Cys-NL, dietary and pharmacological intervention for Ca-NL. Thiazides and alkaline citrate salts are the most widely used drugs in Ca-NL, where they proved efficient to prevent new stones. Other drugs have only been used in particular subsets.Proper medical management and modern urological approaches have already notably improved clinical outcomes. Future studies will further clarify mechanisms of NL with expected new and targeted therapeutic options.

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“…The difference was statistically significant. The cause of urolithiasis is complex, on account of the combined actions of many different factors (8)(9)(10). These pathogenic factors can be divided into two groups: individual factors and environmental factors.…”

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Review of a selective Ayurvedic formula in the management of Ashmari (Urinary stones)

“…In modern medicine, Alkali and allopurinol are used in the treatment of uric acid nephrolithiasis, thiols and alkali are used to treat cystine nephrolithiasis and dietary and pharmaceutical interventions are used to treat calcium nephrolithiasis. The most often prescribed medications for Calcium-nephrolithiasis are thiazides and alkaline citrate salts because they are effective at preventing new stones [9] .…”