title: Urinary Stone Disease: Advancing Knowledge, Patient Care, and Population Health.
abstract: Expanding epidemiologic and physiologic data suggest that urinary stone disease is best conceptualized as a chronic metabolic condition punctuated by symptomatic, preventable stone events. These acute events herald substantial future chronic morbidity, including decreased bone mineral density, cardiovascular disease, and CKD. Urinary stone disease imposes a large and growing public health burden. In the United States, 1 in 11 individuals will experience a urinary stone in their lifetime. Given this high incidence and prevalence, urinary stone disease is one of the most expensive urologic conditions, with health care charges exceeding $10 billion annually. Patient care focuses on management of symptomatic stones rather than prevention; after three decades of innovation, procedural interventions are almost exclusively minimally invasive or noninvasive, and mortality is rare. Despite these advances, the prevalence of stone disease has nearly doubled over the past 15 years, likely secondary to dietary and health trends. The NIDDK recently convened a symposium to assess knowledge and treatment gaps to inform future urinary stone disease research. Reducing the public health burden of urinary stone disease will require key advances in understanding environmental, genetic, and other individual disease determinants; improving secondary prevention; and optimal population health strategies in an increasingly cost-conscious care environment.
authors.affiliation: Duke Clinical Research Institute and Division of Urologic Surgery, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Scales
authors.affiliation: Children's Hospital of Philadelphia and Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Tasian
authors.affiliation: Department of Pediatrics, Section of Nephrology, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Schwaderer
authors.affiliation: Division of Nephrology, New York University School of Medicine, New York, New York; and.
authors.forename: David S
authors.initials: DS
authors.lastname: Goldfarb
authors.affiliation: Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Star
authors.affiliation: Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
authors.forename: Ziya
authors.initials: Z
authors.lastname: Kirkali
mesh_terms: D004032:Diet / Q000009:adverse effects; D004781:Environmental Exposure / Q000009:adverse effects; D006801:Humans; D000075485:Population Health; D015995:Prevalence; D011322:Primary Prevention; D055502:Secondary Prevention; D014545:Urinary Calculi / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*
keywords: Cardiovascular Diseases; Disease Management; Health Expenditures; Humans; Morbidity; National Institute of Diabetes and Digestive and Kidney Diseases (U.S.); Patient Care; Public Health; Secondary Prevention; kidney stones