Skip to main content

Advertisement

SpringerLink
Log in

Approach to the Adult Kidney Stone Former

  • Original Paper
  • Published:
Clinical Reviews in Bone and Mineral Metabolism Aims and scope Submit manuscript

Abstract

Nephrolithiasis is a prevalent and costly condition with high recurrence rate. A medical evaluation to identify abnormalities responsible for nephrolithiasis and guide subsequent therapy has been advocated to reduce the risk of stone recurrence. The evaluation of kidney stone formers generally comprises an extensive medical history to identify metabolic, environmental, dietary, and/or genetic factors contributing to stone formation. Imaging studies are utilized to evaluate and follow stone burden. Laboratory studies including stone composition analysis and serum and urinary chemistries are commonly obtained to further assess for any underlying systemic disorders, to detect environmental and metabolic processes contributing to stone disease, and to guide initial and follow-up dietary and pharmacological therapy. The nature and extent of such an evaluation is discussed in this review article.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Pearle MS, Calhoun EA, Curhan GC. Urologic diseases in America project: urolithiasis. J Urol. 2005;173(3):848–57.

    Article  PubMed  Google Scholar 

  2. Sutherland JW, Parks JH, Coe FL. Recurrence after a single renal stone in a community practice. Miner Electrolyte Metab. 1985;11(4):267–9.

    PubMed  CAS  Google Scholar 

  3. Uribarri J, Oh MS, Carroll HJ. The first kidney stone. Ann Intern Med. 1989;111(12):1006–9.

    PubMed  CAS  Google Scholar 

  4. Sakhaee K. Nephrolithiasis as a systemic disorder. Curr Opin Nephrol Hypertens. 2008;17(3):304–9.

    Article  PubMed  Google Scholar 

  5. Peacock M. Primary hyperparathyroidism and the kidney: biochemical and clinical spectrum. J Bone Miner Res. 2002;17(Suppl 2):N87–94.

    PubMed  CAS  Google Scholar 

  6. Odvina CV, Sakhaee K, Heller HJ, Peterson RD, Poindexter JR, Padalino PK, et al. Biochemical characterization of primary hyperparathyroidism with and without kidney stones. Urol Res. 2007;35(3):123–8.

    Article  PubMed  CAS  Google Scholar 

  7. Sakhaee K, Maalouf NM. Metabolic syndrome and uric acid nephrolithiasis. Semin Nephrol. 2008;28(2):174–80.

    Article  PubMed  CAS  Google Scholar 

  8. Thomas B, Tolley D. Concurrent urinary tract infection and stone disease: pathogenesis, diagnosis and management. Nat Clin Pract Urol. 2008;5(12):668–75.

    Article  PubMed  Google Scholar 

  9. Nadler RB, Rubenstein JN, Eggener SE, Loor MM, Smith ND. The etiology of urolithiasis in HIV infected patients. J Urol. 2003;169(2):475–7.

    Article  PubMed  CAS  Google Scholar 

  10. Worcester EM. Stones from bowel disease. Endocrinol Metab Clin North Am. 2002;31(4):979–99.

    Article  PubMed  CAS  Google Scholar 

  11. Maalouf NM, Tondapu P, Guth ES, Livingston EH, Sakhaee K. Hypocitraturia and hyperoxaluria after Roux-en-Y gastric bypass surgery. J Urol. 2010;183(3):1026–30.

    Article  PubMed  CAS  Google Scholar 

  12. Curhan GC, Willett WC, Rimm EB, Stampfer MJ. Family history and risk of kidney stones. J Am Soc Nephrol. 1997;8(10):1568–73.

    PubMed  CAS  Google Scholar 

  13. Koyuncu HH, Yencilek F, Eryildirim B, Sarica K. Family history in stone disease: how important is it for the onset of the disease and the incidence of recurrence? Urol Res. 2010;38(2):105–9.

    Article  PubMed  Google Scholar 

  14. Griffin DG. A review of the heritability of idiopathic nephrolithiasis. J Clin Pathol. 2004;57(8):793–6.

    Article  PubMed  CAS  Google Scholar 

  15. Goldfarb DS, Fischer ME, Keich Y, Goldberg J. A twin study of genetic and dietary influences on nephrolithiasis: a report from the Vietnam Era Twin (VET) Registry. Kidney Int. 2005;67(3):1053–61.

    Article  PubMed  Google Scholar 

  16. Attanasio M. The genetic components of idiopathic nephrolithiasis. Pediatr Nephrol. 2011;26(3):337–46.

    Article  PubMed  Google Scholar 

  17. Moe OW, Bonny O. Genetic hypercalciuria. J Am Soc Nephrol. 2005;16(3):729–45.

    Article  PubMed  Google Scholar 

  18. Hoppe B, Beck BB, Milliner DS. The primary hyperoxalurias. Kidney Int. 2009;75(12):1264–71.

    Article  PubMed  CAS  Google Scholar 

  19. Shah O, Assimos DG, Holmes RP. Genetic and dietary factors in urinary citrate excretion. J Endourol. 2005;19(2):177–82.

    Article  PubMed  Google Scholar 

  20. Chillaron J, Font-Llitjos M, Fort J, Zorzano A, Goldfarb DS, Nunes V, et al. Pathophysiology and treatment of cystinuria. Nat Rev Nephrol. 2010;6(7):424–34.

    Article  PubMed  CAS  Google Scholar 

  21. Fakheri RJ, Goldfarb DS. Ambient temperature as a contributor to kidney stone formation: implications of global warming. Kidney Int. 2011;79(11):1178–85.

    Article  PubMed  Google Scholar 

  22. Brikowski TH, Lotan Y, Pearle MS. Climate-related increase in the prevalence of urolithiasis in the United States. Proc Natl Acad Sci U S A. 2008;105(28):9841–6.

    Article  PubMed  CAS  Google Scholar 

  23. Better OS, Shabtai M, Kedar S, Melamud A, Berenheim J, Chaimovitz C. Increased incidence of nephrolithiasis (N) in lifeguards (LG) in Israel. Adv Exp Med Biol. 1980;128:467–72.

    PubMed  CAS  Google Scholar 

  24. Borghi L, Meschi T, Amato F, Novarini A, Romanelli A, Cigala F. Hot occupation and nephrolithiasis. J Urol. 1993;150(6):1757–60.

    PubMed  CAS  Google Scholar 

  25. Pin NT, Ling NY, Siang LH. Dehydration from outdoor work and urinary stones in a tropical environment. Occup Med (Lond). 1992;42(1):30–2.

    Article  CAS  Google Scholar 

  26. Nygaard I, Linder M. Thirst at work–an occupational hazard? Int Urogynecol J Pelvic Floor Dysfunct. 1997;8(6):340–3.

    Article  PubMed  CAS  Google Scholar 

  27. Chang MA, Goldfarb DS. Occupational risk for nephrolithiasis and bladder dysfunction in a chauffeur. Urol Res. 2004;32(1):41–3.

    Article  PubMed  CAS  Google Scholar 

  28. Milvy P, Colt E, Thornton J. A high incidence of urolithiasis in male marathon runners. J Sports Med Phys Fitness. 1981;21(3):295–8.

    PubMed  CAS  Google Scholar 

  29. Sakhaee K, Nigam S, Snell P, Hsu MC, Pak CY. Assessment of the pathogenetic role of physical exercise in renal stone formation. J Clin Endocrinol Metab. 1987;65(5):974–9.

    Article  PubMed  CAS  Google Scholar 

  30. Jarup L, Elinder CG. Incidence of renal stones among cadmium exposed battery workers. Br J Ind Med. 1993;50(7):598–602.

    PubMed  CAS  Google Scholar 

  31. Laerum E, Aarseth S. Urolithiasis in railroad shopmen in relation to oxalic acid exposure at work. Scand J Work Environ Health. 1985;11(2):97–100.

    Article  PubMed  CAS  Google Scholar 

  32. Sakhaee K, Harvey JA, Padalino PK, Whitson P, Pak CY. The potential role of salt abuse on the risk for kidney stone formation. J Urol. 1993;150(2 Pt 1):310–2.

    PubMed  CAS  Google Scholar 

  33. Breslau NA, Brinkley L, Hill KD, Pak CY. Relationship of animal protein-rich diet to kidney stone formation and calcium metabolism. J Clin Endocrinol Metab. 1988;66(1):140–6.

    Article  PubMed  CAS  Google Scholar 

  34. Curhan GC, Willett WC, Rimm EB, Stampfer MJ. A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med. 1993;328(12):833–8.

    Article  PubMed  CAS  Google Scholar 

  35. Curhan GC, Willett WC, Speizer FE, Spiegelman D, Stampfer MJ. Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann Intern Med. 1997;126(7):497–504.

    PubMed  CAS  Google Scholar 

  36. Holmes RP, Goodman HO, Assimos DG. Contribution of dietary oxalate to urinary oxalate excretion. Kidney Int. 2001;59(1):270–6.

    Article  PubMed  CAS  Google Scholar 

  37. Siener R. Impact of dietary habits on stone incidence. Urol Res. 2006;34(2):131–3.

    Article  PubMed  CAS  Google Scholar 

  38. Daudon M, Jungers P. Drug-induced renal calculi: epidemiology, prevention and management. Drugs. 2004;64(3):245–75.

    Article  PubMed  Google Scholar 

  39. Asper R. Iatrogenic urinary calculi: detection and identification by X-ray diffraction. Clin Chem. 1986;24:767–8.

    Google Scholar 

  40. Dorfman LE, Smith JP. Sulfonamide crystalluria: a forgotten disease. J Urol. 1970;104(3):482–3.

    PubMed  CAS  Google Scholar 

  41. Ettinger B, Oldroyd NO, Sorgel F. Triamterene nephrolithiasis. JAMA. 1980;244(21):2443–5.

    Article  PubMed  CAS  Google Scholar 

  42. Kopp JB, Miller KD, Mican JA, Feuerstein IM, Vaughan E, Baker C, et al. Crystalluria and urinary tract abnormalities associated with indinavir. Ann Intern Med. 1997;127(2):119–25.

    PubMed  CAS  Google Scholar 

  43. Engeler DS, John H, Rentsch KM, Ruef C, Oertle D, Suter S. Nelfinavir urinary stones. J Urol. 2002;167(3):1384–5.

    Article  PubMed  Google Scholar 

  44. Wallace RB, Wactawski-Wende J, O’Sullivan MJ, Larson JC, Cochrane B, Gass M, et al. Urinary tract stone occurrence in the Women’s Health Initiative (WHI) randomized clinical trial of calcium and vitamin D supplements. Am J Clin Nutr. 2011;94(1):270–7.

    Article  PubMed  CAS  Google Scholar 

  45. Maalouf NM, Langston JP. Van Ness PC. Sakhaee K. Nephrolithiasis in topiramate users. Urol Res: Moe OW; 2010.

    Google Scholar 

  46. Welch BJ, Graybeal D, Moe OW, Maalouf NM, Sakhaee K. Biochemical and stone-risk profiles with topiramate treatment. Am J Kidney Dis. 2006;48(4):555–63.

    Article  PubMed  CAS  Google Scholar 

  47. Traxer O, Huet B, Poindexter J, Pak CY, Pearle MS. Effect of ascorbic acid consumption on urinary stone risk factors. J Urol. 2003;170(2 Pt 1):397–401.

    Article  PubMed  CAS  Google Scholar 

  48. Stote RM, Smith LH, Dubb JW, Moyer TP, Alexander F, Roth JL. Oxypurinol nephrolithiasis in regional enteritis secondary to allopurinol therapy. Ann Intern Med. 1980;92(3):384–5.

    PubMed  CAS  Google Scholar 

  49. Pais VM Jr, Lowe G, Lallas CD, Preminger GM, Assimos DG. Xanthine urolithiasis. Urology. 2006;67(5):1084e9–11.

    Article  Google Scholar 

  50. Dhar M, Denstedt JD. Imaging in diagnosis, treatment, and follow-up of stone patients. Adv Chronic Kidney Dis. 2009;16(1):39–47.

    Article  PubMed  Google Scholar 

  51. Yilmaz S, Sindel T, Arslan G, Ozkaynak C, Karaali K, Kabaalioglu A, et al. Renal colic: comparison of spiral CT, US and IVU in the detection of ureteral calculi. Eur Radiol. 1998;8(2):212–7.

    Article  PubMed  CAS  Google Scholar 

  52. Smith RC, Verga M, McCarthy S, Rosenfield AT. Diagnosis of acute flank pain: value of unenhanced helical CT. AJR Am J Roentgenol. 1996;166(1):97–101.

    PubMed  CAS  Google Scholar 

  53. Thomas C, Heuschmid M, Schilling D, Ketelsen D, Tsiflikas I, Stenzl A, et al. Urinary calculi composed of uric acid, cystine, and mineral salts: differentiation with dual-energy CT at a radiation dose comparable to that of intravenous pyelography. Radiology. 2010;257(2):402–9.

    Article  PubMed  Google Scholar 

  54. Kluner C, Hein PA, Gralla O, Hein E, Hamm B, Romano V, et al. Does ultra-low-dose CT with a radiation dose equivalent to that of KUB suffice to detect renal and ureteral calculi? J Comput Assist Tomogr. 2006;30(1):44–50.

    Article  PubMed  Google Scholar 

  55. Levine JA, Neitlich J, Verga M, Dalrymple N, Smith RC. Ureteral calculi in patients with flank pain: correlation of plain radiography with unenhanced helical CT. Radiology. 1997;204(1):27–31.

    PubMed  CAS  Google Scholar 

  56. Ruggera L, Beltrami P, Ballario R, Cavalleri S, Cazzoletti L, Artibani W. Impact of anatomical pyelocaliceal topography in the treatment of renal lower calyces stones with extracorporeal shock wave lithotripsy. Int J Urol. 2005;12(6):525–32.

    Article  PubMed  Google Scholar 

  57. Niall O, Russell J, MacGregor R, Duncan H, Mullins J. A comparison of noncontrast computerized tomography with excretory urography in the assessment of acute flank pain. J Urol. 1999;161(2):534–7.

    Article  PubMed  CAS  Google Scholar 

  58. Bhayani S, Siegel C. Urinary tract imaging: Basic principles. In: Wein A, Kavoussi L, Novick A, editors. Philadelphia. PA: Saunders Elsevier; 2007. p. 111–43.

    Google Scholar 

  59. Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol. 1996;155(3):839–43.

    Article  PubMed  CAS  Google Scholar 

  60. Barbey F, Joly D, Rieu P, Mejean A, Daudon M, Jungers P. Medical treatment of cystinuria: critical reappraisal of long-term results. J Urol. 2000;163(5):1419–23.

    Article  PubMed  CAS  Google Scholar 

  61. Parks JH, Goldfischer ER, Coe FL. Changes in urine volume accomplished by physicians treating nephrolithiasis. J Urol. 2003;169(3):863–6.

    Article  PubMed  Google Scholar 

  62. Maalouf NM, Cameron MA, Moe OW, Sakhaee K. Novel insights into the pathogenesis of uric acid nephrolithiasis. Curr Opin Nephrol Hypertens. 2004;13(2):181–9.

    Article  PubMed  Google Scholar 

  63. Maalouf NM. Metabolic syndrome and the genesis of uric acid stones. J Ren Nutr. 2011;21(1):128–31.

    Article  PubMed  CAS  Google Scholar 

  64. Hesse A, Heimbach D. Causes of phosphate stone formation and the importance of metaphylaxis by urinary acidification: a review. World J Urol. 1999;17(5):308–15.

    Article  PubMed  CAS  Google Scholar 

  65. Bichler KH, Eipper E, Naber K, Braun V, Zimmermann R, Lahme S. Urinary infection stones. Int J Antimicrob Agents. 2002;19(6):488–98.

    Article  PubMed  CAS  Google Scholar 

  66. Buckalew VM Jr. Nephrolithiasis in renal tubular acidosis. J Urol. 1989;141(3 Pt 2):731–7.

    PubMed  Google Scholar 

  67. Parks JH, Coe FL, Evan AP, Worcester EM. Clinical and laboratory characteristics of calcium stone-formers with and without primary hyperparathyroidism. BJU Int. 2009;103(5):670–8.

    Article  PubMed  Google Scholar 

  68. Robertson WG. Is prevention of stone recurrence financially worthwhile? Urol Res. 2006;34(2):157–61.

    Article  PubMed  CAS  Google Scholar 

  69. Parks JH, Coe FL. The financial effects of kidney stone prevention. Kidney Int. 1996;50(5):1706–12.

    Article  PubMed  CAS  Google Scholar 

  70. Lotan Y, Cadeddu JA, Roerhborn CG, Pak CY, Pearle MS. Cost-effectiveness of medical management strategies for nephrolithiasis. J Urol. 2004;172(6 Pt 1):2275–81.

    Article  PubMed  Google Scholar 

  71. Preminger GM, Pak CY. The practical evaluation and selective medical management of nephrolithiasis. Semin Urol. 1985;3(3):170–84.

    PubMed  CAS  Google Scholar 

  72. Paterson RF. Arguments for a comprehensive metabolic evaluation of the first-time stone former. Can Urol Assoc J. 2010;4(3):209–10.

    PubMed  Google Scholar 

  73. Razvi H. Metabolic testing of the first-time calcium oxalate stone former: Is it indicated? No. Can Urol Assoc J. 2010;4(3):211–2.

    PubMed  Google Scholar 

  74. Parks JH, Goldfisher E, Asplin JR, Coe FL. A single 24-hour urine collection is inadequate for the medical evaluation of nephrolithiasis. J Urol. 2002;167(4):1607–12.

    Article  PubMed  Google Scholar 

  75. Pak CY, Peterson R, Poindexter JR. Adequacy of a single stone risk analysis in the medical evaluation of urolithiasis. J Urol. 2001;165(2):378–81.

    Article  PubMed  CAS  Google Scholar 

  76. Castle SM, Cooperberg MR, Sadetsky N, Eisner BH, Stoller ML. Adequacy of a single 24-hour urine collection for metabolic evaluation of recurrent nephrolithiasis. J Urol. 2010;184(2):579–83.

    Article  PubMed  CAS  Google Scholar 

  77. Rivers K, Shetty S, Menon M. When and how to evaluate a patient with nephrolithiasis. Urol Clin North Am. 2000;27(2):203–13.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The author is funded by the National Institutes of Health (grant R01-DK081423).

Conflict of interest

The author has no direct or indirect financial interest in the subject matter of the submitted manuscript.

Author information

Authors and Affiliations

  1. Department of Internal Medicine and Charles and Jane Pak Center for Mineral Metabolism, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8885, USA

    Naim M. Maalouf

Authors
  1. Naim M. Maalouf
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Naim M. Maalouf.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maalouf, N.M. Approach to the Adult Kidney Stone Former. Clinic Rev Bone Miner Metab 10, 38–49 (2012). https://doi.org/10.1007/s12018-011-9111-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12018-011-9111-9

Keywords

Search

Navigation