LITHOSCREEN: a comprehensive screening program and database for the assessment and treatment management of patients with kidney stones

Abstract

The aim of the LITHOSCREEN project was to construct a comprehensive screening program and database for recording and assessing the various risk factors for stone-formation in patients with urolithiasis. It is intended for use in Stone Clinics and is now being made available free of charge to researchers in the field who wish to maintain a comprehensive record of their patients’ medical histories, demographic backgrounds, lifestyle activities, metabolic abnormalities, biochemical risk of forming stones of various types, diet histories, stone analysis and long-term treatment records. From the recorded data for each patient, the program automatically calculates numerous functions important in the understanding of the clinical and chemical risk factors for stone-formation, including the renal handling of the ions involved, various metabolic functions, the biochemical risk of forming kidney stones (PSF), the Tiselius Indices of the supersaturation of urine with respect to calcium oxalate and calcium phosphate, the projected effects of changing the composition of each patient’s urinary composition on the risk of stone recurrence, and a program for analysing the diet of patients. It automatically produces one-page Summaries of each patient’s biochemical and dietary records with abnormal values highlighted according to a “traffic-light” colour-coding system and generates charts designed to improve patient compliance with treatment in the form of colour-coded “Target Diagrams” showing (a) the patient’s 24-h urine composition, (b) the patient's biochemical risk of forming stones of different types and (c) the composition of the patient’s diet. The Summary pages and “Target Diagrams” are suitable for inclusion in the patient’s Case Notes. LITHOSCREEN also produces charts projecting the effect of changing the composition of urine on the patient's biochemical risk of forming further stones. These graphs provide clues as to which urinary risk factors to target to reduce the patient’s risk of stone recurrence.

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Abbreviations

CaOx:

Calcium oxalate

CaP:

Calcium phosphate

UA:

Uric acid

MAP:

Magnesium ammonium phosphate

PSF :

Biochemical probability of being a stone-former rather than a non-stone-former

TA:

Total acidity

NAE:

Net acid excretion

PRAL:

Potential renal acid load

MSK:

Medullary sponge kidney

dRTA:

distal renal tubular acidosis

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Acknowledgements

The author wishes to acknowledge the immense debt of gratitude owed to the many researchers with whom he has collaborated over the past 58 years in the field of stone research. In particular, he appreciates (1) his mentoring from Professor George Nancollas* and Professor Chris Nordin* during his BSc and PhD studies, respectively; (2) his research experience with Professor Munro Peacock (who also laid the basis for LITHOSCREEN from procedures established in his Stone Clinic in Leeds), Professor Herbie Fleisch*, Professor Brian Morgan*, Professor Lyn Smith*, Professor Graham Russell, Professor Philippe Jaeger and Professor Robert Unwin from whom he learned much about the clinical and biochemical aspects of stone-formation; (3) his collaboration with a number of urologists (Mr Philip Clark, Mr Philip Smith, Mr Bob Williams*, Mr Imtiaz Husain*, Mr Hugh Whitfield, Mr Simon Choong, Mr Seshadri Sriprasad, Mr Oliver Wiseman and Mr Ben Turney) who provided a source of patients to screen; and (4) scientists and statisticians with whom he has worked on the basic aspects of stone-formation (Dr Albert Hodgkinson*, Dr Paul Zarembski*, Dr Bob Marshall, Dr David Marshall, Dr Bert Hughes, Dr Valerie Walker*, Professor Hans-Göran Tiselius, Professor Allen Rodgers and Professor Saeed Khan). He also would like to thank the many laboratory staff members who have helped him throughout his career with the work involved in developing and performing the numerous tests and analytical procedures required in the screening process.

*Deceased

Funding

The author acknowledges with gratitude the funding from the St Peter's Trust for Kidney, Bladder and Prostate Research for much of the latter part of this project.

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Correspondence to William G. Robertson.

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The author states that there is no conflict of interest with publishing this article.

Ethical approval

The screening project was approved by the Ethics Committee of University College Hospitals London, 1997.

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Robertson, W.G. LITHOSCREEN: a comprehensive screening program and database for the assessment and treatment management of patients with kidney stones. Urolithiasis (2021). https://doi.org/10.1007/s00240-021-01276-0

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Keywords

  • Urolithiasis
  • Calcium oxalate
  • Calcium phosphate
  • Uric acid
  • Metabolic screen
  • 24-h urine.