Abstract
Urinary stone disease is a very common disease whose prevalence is still increasing. Stone formation is frequently associated with other diseases of affluence such as hypertension, osteoporosis, cardiovascular disease, metabolic syndrome, and insulin resistance. The increasing concentration of lithogenic solutes along the different segments of the nephron involves supersaturation conditions leading to the formation, growth, and aggregation of crystals. Crystalline aggregates can grow free in the tubular lumen or coated on the wall of the renal tubule. Plugs of crystalline material have been highlighted in the tubular lumen in some patients, but crystalline growth starting from plaques of calcium phosphate within the renal papillae has been demonstrated in others. Urinary supersaturation is the result of a complex interaction between predisposing genetic features and environmental factors. Dietary intake is certainly the most important environmental risk factor. In particular, an insufficient intake of dietary calcium (<600 mg/day) can increase the intestinal absorption of oxalate and the risk of calcium oxalate stone formation. Other possible risk factors that have been identified include excessive intake of salt and proteins. The potential role of dietary acid load seems to play an important role in causing a state of subclinical chronic acidosis; therefore, the intake of vegetables is encouraged in stone-forming patients. Consumption of sugar-sweetened soda and punch is associated with a higher risk of stone formation, whereas consumption of coffee, tea, beer, wine, and orange juice is associated with a lower risk. A high fluid intake is widely recognized as the cornerstone of prevention of all forms of stones. The effectiveness of protein and salt restriction has been evaluated in some studies that still do not allow definitive conclusions to be made. Calcium stone formation can be prevented by the use of different drugs with different mechanisms of action (thiazide diuretics, allopurinol, and potassium citrate), but there is no ideal drug that is both risk free and well tolerated.
Highlights
Urinary stone disease is the formation or the presence of concretions in the urinary tract
Urolithiasis is the result of a complex interaction between genetic and environmental factors, and current research is oriented in these two directions, which should enable us to study genetic aspects in combination with environmental exposures
Free or fixed particle theory The increasing concentration of lithogenic solutes along the different segments of the nephron involves supersaturation conditions leading to the formation, growth, and aggregation of crystals that might get trapped in the tubular lumen and begin the process of stone formation
Summary
Urinary stone disease is the formation or the presence of concretions in the urinary tract. The potential role of the acid load of the diet, related to the content in animal protein and the relationship between intake of calcium, magnesium, and potassium and that of chlorine and phosphates, seems to play an important role in causing a state of subclinical chronic acidosis and the consequent excessive mobilization of calcium from bone and its excretion in the urine[44,45,46,47] For this reason, the intake of vegetables in association with the reduction in salt is encouraged in stone-forming patients. Diet Numerous studies have shown the effects of different types of nutritional intervention on urinary risk factors for the formation of kidney stones, but the evidence from randomized trials is still low and of uncertain meaning[53]. Compliance to a prolonged pharmacological treatment remains a serious limitation of all forms of long-term treatment for a chronic disease, for which treatment effectiveness is conditioned by an efficient follow-up organization
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