Abstract
be due to azotemia induced fatigue from gradual crystal obstruction of the ureters, similar to uric acid sludge. In the study by Kalaitzis et al all 11 patients underwent some form of intervention, with 6 undergoing drainage procedures and 5 undergoing ureteroscopy. I question the need for any invasive therapy (eg ureteroscopy), unless after 24 to 48 hours of conservative therapy (ie hydration and acidification) symptoms or signs of obstruction persist. For the most part, the problem is excessive crystalluria, not a bona fide concretion. Ralph V. Clayman, M.D.
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