Urolithiasis unveiled: pathophysiology, stone dynamics, types, and inhibitory mechanisms: a review

Abstract

Urolithiasis is a multifaceted and common urological disorder characterized by the development of renal calculi. Calcium oxalate stones are the most prevalent type of calculi, forming when calcium and oxalate combine to produce crystalline structures in the urine. The incidence rates of urolithiasis exhibit geographical variations, which are determined by factors such as geographic location, age, sex, dietary habits, and genetics. The increasing trend of urolithiasis has emerged as a noteworthy public health issue, potentially attributed to shifts in dietary and lifestyle habits. In response to this challenge, various inhibitors of calcium oxalate crystal formation, including small molecules, peptides, and proteins, have been developed. Moreover, substances such as citrate, magnesium, inter-alpha-trypsin inhibitors, phytate, potassium, and pyrophosphates show promise in preventing kidney stones. A comprehensive metabolic assessment is crucial, customized for each patient, to effectively manage and avoid the recurrence of urolithiasis. Although specific pharmacological treatments for urolithiasis are currently unavailable, some drugs can reduce pain. Some drugs, including calcium channel blockers like nifedipine, phosphodiesterase-5 inhibitors like tadalafil, and alpha-blockers like tamsulosin, are thought to lower ureteral contractions by making the ureteral smooth muscle relax. In acute and severe pain cases, intravenous administration of narcotic analgesics and anti-inflammatory agents may be employed in emergency medical settings. To enhance therapeutic approaches, it is essential to gain more knowledge about the pathophysiology of renal calculi. The development of inhibitors targeting calcium oxalate crystal formation offers a promising avenue for urolithiasis prophylaxis. Identifying and investigating potential inhibitors lays the framework for the creation of more effective and targeted therapeutic options. Graphical Abstract