Abstract
Metabolic abnormalities are identified in over 90% of stone formers and the institution of preventative dietary and medical measures has resulted in substantial reduction in stone recurrence rates. We review the contemporary approach to metabolic evaluation of urolithiasis.A careful medical and dietary history, stone analysis, serologic tests, and urinalysis constitute the initial screening regimen in patients who have been diagnosed with stones. Risk stratification of patients, based on the outcome of the initial screening tests, determines the need for and extent of urinary evaluation in individual stone formers. Conservative dietary measures or a simple metabolic evaluation and treatment has been described for first-time or low-risk stone formers, although the number of 24-h urine collections needed is debatable. A more extensive metabolic evaluation is recommended for recurrent or high-risk stone formers or for those in whom empiric treatment or medical therapy based on simplified evaluation is unsuccessful.Regardless of etiology, all stone formers should be counseled on dietary measures for stone prevention. The need for medication is determined by the results of 24-h urine analysis and the risk level of the patient. Cost effectiveness of the metabolic evaluation and treatment is strongly influenced by recurrence rate and efficacy of therapy.Metabolic evaluation and treatment has clearly been shown in randomized trials to reduce stone recurrence rates. Further study will determine the extent of evaluation necessary and the need for selective vs. empiric medical therapy for first-time and recurrent stone formers.
Highlights
The prevalence of nephrolithiasis in the U.S is estimated at 5–12%; for a 70-year-old man, the lifetime chance of being diagnosed with a stone is nearly 1 in 8[1,2,3]
Genetic forms of stone disease associated with inborn errors of metabolism such as cystinuria[48], primary hyperoxaluria[49], and xanthinuria[50] are often suspected on the basis of family history or early age of onset and diagnosed with laboratory examination or genetic testing
Stone formers falling into the “other stone disease” group include those with struvite, cystine, uric acid, and medication-related stones and those with primary and enteric hyperoxaluria, primary gout, primary hyperparathyroidism, and renal tubular acidosis
Summary
The prevalence of nephrolithiasis in the U.S is estimated at 5–12%; for a 70-year-old man, the lifetime chance of being diagnosed with a stone is nearly 1 in 8[1,2,3]. Upper urinary tract stones are responsible for significant morbidity, loss of work, and medical cost. TheScientificWorldJOURNAL (2005) 5, 902-914 event, long-term effects such as loss of renal function are rarely taken into account in cost estimates of stone disease. After experiencing an initial episode of renal colic, most patients are receptive, at least in the short term, to preventive measures recommended by their physicians[9]. In light of these goals, a variety of environmental and genetic risk factors have been identified that may be targeted for medical intervention. We discuss our approach to the metabolic evaluation of stone disease and summarize the evidence in support of its use
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
