Nephrolithiasis: why doesn't our "learning" progress?
OBJECTIVE
Stone research is stagnant with minor clinical fall-out. We wonder whether this, in the ESWL era, depends only on ESWL and the consequent change in our clinical management habits, or is rather due to mistakes made by investigators. We feel that indeed we did and do make some: (1) the patients we are investigating may not be appropriate; and (2) we are missing to properly recognise disease heterogeneity.


CONCLUSIONS
From the public health side most likely we are not investigating the right patients, and we probably need to address the large part of the problem, i.e. the rarely relapsing stone formers demanding 80% of all urological interventions. Although there is a consensus that urolithiasis is very heterogeneous, this position is presently under reconsideration. It is necessary to investigate the single or "occasional" stone former, and go back to the epidemiology and clinics with multicentre, prospective studies. Being a multifactorial disease, we will need to evaluate as many aspects as possible contemporaneously in the same patient. It is also necessary to "revisit" the disease in an unbiased manner, because its relationship with relevant aspects could be different than previously thought due to our incomplete knowledge of its pathogenesis and pathophysiology.
Gambaro
Giovanni
G
Department of Medical and Surgical Sciences, Division of Nephrology, University of Padova, Padova, Italy. giga@unipd.it
Reis-Santos
Josè M
JM
Rao
Nagaraja
N
D035843:Biomedical Research; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*