Editorial Comment

Abstract

For decades, physicians caring for patients with nephrolithiasis have relied on abnormalities of 24-hour urine composition to explain recurrent stone disease and risk of future stone formation. 1 Levy F.L. Adams-Huet B. Pak C.Y. Ambulatory evaluation of nephrolithiasis: an update of a 1980 protocol. Am J Med. 1995; 98: 50-59 Abstract Full Text PDF PubMed Scopus (277) Google Scholar And yet, we are often puzzled to find either a patient with recurrent stone disease despite having a “normal” 24-hour urine, or a patient whose urine has been modified with drug therapy and nonetheless continues to form additional stones. In recent years, investigators have turned their attention to the immune system and its potential role in stone formation, and perhaps this work will result in future novel therapies to prevent recurrent nephrolithiasis. 2 Holoch P.A. Tracy C.R. Antioxidants and self-reported history of kidney stones: the National Health and Nutrition Examination Survey. J Endourol. 2011; 25: 1903-1908 Crossref PubMed Scopus (45) Google Scholar , 3 Khan S.R. Reactive oxygen species as the molecular modulators of calcium oxalate kidney stone formation: evidence from clinical and experimental investigations. J Urol. 2013; 189: 803-811 Abstract Full Text Full Text PDF PubMed Scopus (207) Google Scholar Specifically, studies have demonstrated that oxidative stress might play an important role in the pathogenesis of calcium oxalate stones, 3 Khan S.R. Reactive oxygen species as the molecular modulators of calcium oxalate kidney stone formation: evidence from clinical and experimental investigations. J Urol. 2013; 189: 803-811 Abstract Full Text Full Text PDF PubMed Scopus (207) Google Scholar and also that markers of oxidative stress and inflammation might be significantly elevated in stone-formers when compared with controls. 2 Holoch P.A. Tracy C.R. Antioxidants and self-reported history of kidney stones: the National Health and Nutrition Examination Survey. J Endourol. 2011; 25: 1903-1908 Crossref PubMed Scopus (45) Google Scholar , 4 Shoag J, Eisner BH. Relationship between C-reactive protein and kidney stone prevalence [e-pub ahead of print]. J Urol. doi: 10.1016/j.juro.2013.09.033, accessed October 4, 2013. Google Scholar Erythrocyte Oxidative Stress in Patients With Calcium Oxalate Stones Correlates With Stone Size and Renal Tubular DamageUrologyVol. 83Issue 2PreviewTo investigate how erythrocyte oxidative stress relates to renal tubular damage and calcium oxalate stone size in patients as oxidative stress has been demonstrated to be associated with stone formation in disease progression. Full-Text PDF ReplyUrologyVol. 83Issue 2PreviewUrinalysis of 24-hour urine sample reflects bona fide microenvironmental changes in kidneys. On the basis of such analysis, physicians prescribe medication to patients with stone disease, but poor outcomes in the form of stone recurrence and renal insufficiency are frequently observed. This clearly indicates a mechanism other than uncovered by urinalysis involved in stone formation contributes to disease progression not only in the kidney but also in association with blood circulation because the kidney has a higher rate of perfusion than any other organ. Full-Text PDF