title: 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.
authors.affiliation: Centre for Nephrology, UCL Medical School, Royal Free Campus, London, UK.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Johri
authors.forename: Bruce
authors.initials: B
authors.lastname: Cooper
authors.forename: William
authors.initials: W
authors.lastname: Robertson
authors.forename: Simon
authors.initials: S
authors.lastname: Choong
authors.forename: David
authors.initials: D
authors.lastname: Rickards
authors.forename: Robert
authors.initials: R
authors.lastname: Unwin
mesh_terms: D017668:Age of Onset; D002129:Calcium Oxalate / Q000378:metabolism; D002130:Calcium Phosphates / Q000378:metabolism; D003430:Cross-Sectional Studies; D003553:Cystine / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D005440:Fluid Therapy; D020022:Genetic Predisposition to Disease; D006801:Humans; D007669:Kidney Calculi / Q000737:chemistry / Q000453:epidemiology / Q000209:etiology / Q000235:genetics / Q000503:physiopathology / Q000628:therapy*; D008096:Lithotripsy; D017616:Magnesium Compounds / Q000378:metabolism; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D010346:Patient Care Management; D010710:Phosphates / Q000378:metabolism; D015995:Prevalence; D012008:Recurrence; D012307:Risk Factors; D000069877:Struvite; D014527:Uric Acid / Q000378:metabolism
chemical_list: D002130:Calcium Phosphates; D017616:Magnesium Compounds; D010710:Phosphates; D002129:Calcium Oxalate; D014527:Uric Acid; D003553:Cystine; C020243:calcium phosphate; D000069877:Struvite