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


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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Fig. 1
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Fig. 3



Calcium oxalate


Calcium phosphate


Uric acid


Magnesium ammonium phosphate


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


Total acidity


Net acid excretion


Potential renal acid load


Medullary sponge kidney


distal renal tubular acidosis


  1. 1.

    Robertson WG (1982) Urolithiasis: epidemiology and pathogenesis. In: Husain I (ed) Tropical urology and renal disease. Churchill Livingstone, Edinburgh, pp 143–164

    Google Scholar 

  2. 2.

    Smith LH (1989) The medical aspects of urolithiasis: an overview. J Urol 141(3 Pt 2):707–710

    CAS  Article  Google Scholar 

  3. 3.

    Pak CYC (1998) Kidney stones. Lancet 351(9118):1797–1801

    CAS  Article  Google Scholar 

  4. 4.

    Robertson WG, Peacock M, Nordin BEC (1968) Activity products in stone-forming and non-stone-forming urine. Clin Sci 34:579–594

    CAS  PubMed  Google Scholar 

  5. 5.

    Tiselius H-G (1989) Standardized estimate of the ion activity product of calcium oxalate in urine from renal stone formers. Eur Urol 16:48–50

    CAS  Article  Google Scholar 

  6. 6.

    Kok DJ, Papapoulos SE (1993) Physicochemical considerations in the development and prevention of calcium. Bone Miner 20:1–15

    CAS  Article  Google Scholar 

  7. 7.

    Kavanagh JP (2006) Supersaturation and renal precipitation: the key to stone formation? Urol Res 34:81–85

    Article  Google Scholar 

  8. 8.

    Fleisch H, Bisaz S (1962) Isolation from urine of pyrophosphate, a calcification inhibitor. Am J Physiol 203:671–675

    CAS  Article  Google Scholar 

  9. 9.

    Coe FL, Parks JH (1990) Defenses of an unstable compromise: crystallization inhibitors and the kidney’s role in mineral regulation. Kidney Int 38:625–631

    CAS  Article  Google Scholar 

  10. 10.

    Shiraga H, Min W, Van Dusen WJ, Clayman MD, Miner D, Terrell CH, Sherbotie JR, Foreman JW, Przysiecki C, Neilson EG (1992) Inhibition of calcium oxalate crystal growth in vitro by uropontin: another member of the aspartic acid-rich protein superfamily. Proc Natl Acad Sci USA 89:426–430

    CAS  Article  Google Scholar 

  11. 11.

    Ryall RL (1997) Urinary inhibitors of calcium oxalate crystallization and their potential role in stone formation. World J Urol 15:155–164

    CAS  Article  Google Scholar 

  12. 12.

    Cifuentes Delatte L, Minon-Cifuentes J, Medina JA (1985) Papillary stones: calcified renal tubules in Randall’s plaques. J Urol 133:490–494

    CAS  Article  Google Scholar 

  13. 13.

    Evan AP, Lingeman JE, Coe FL, Parks JH, Bledsoe SB, Shao Y, Sommer AJ, Paterson RF, Kuo RL, Grynpas M (2003) Randall’s plaque of patients with nephrolithiasis begins in basement membranes of thin Loops of Henle. J Clin Invest 111:607–616

    CAS  Article  Google Scholar 

  14. 14.

    Khan SR (2011) Crystal/cell interaction and nephrolithiasis. Arch Ital Urol Androl 83:1–5

    PubMed  Google Scholar 

  15. 15.

    Robertson WG (2017) Do “inhibitors of crystallization” play any role in the prevention of kidney stones? A critique. Urolithiasis 45:43–56

    CAS  Article  Google Scholar 

  16. 16.

    Robertson WG (2004) The scientific basis of urinary stone-formation. In: Mundy AR, Fitzpatrick JM, Neal DE, George NJR (eds) Scientific basis of urology, 2nd edn. Taylor and Francis, London & New York, pp 205–227

    Google Scholar 

  17. 17.

    Robertson WG, Peacock M, Nordin BEC (1969) Calcium crystalluria in recurrent renal stone-formers. Lancet 2:21–24

    CAS  Article  Google Scholar 

  18. 18.

    Robertson WG, Peacock M, Marshall RW, Marshall DH, Nordin BEC (1976) Saturation-inhibitor index as a measure of the risk of calcium oxalate stone-formation in the urinary tract. N Engl J Med 294:249–252

    CAS  Article  Google Scholar 

  19. 19.

    Robertson WG (2015) Potential role of fluctuations in the composition of renal tubular fluid through the nephron in the initiation of Randall’s Plugs and calcium oxalate crystalluria in a computer model of renal function. Urolithiasis 43(Suppl 1):S93–S107

    Article  Google Scholar 

  20. 20.

    Robertson WG (1969) Measurement of ionized calcium in biological fluids. Clin Chim Acta 24:149–157

    CAS  Article  Google Scholar 

  21. 21.

    Werness PG, Brown CM, Smith LH, Finlayson B (1985) EQUIL2: a BASIC computer program for the calculation of urinary saturation. J Urol 134:1242–1244

    CAS  Article  Google Scholar 

  22. 22.

    Brown CM, Ackermann DK, Purich DL (1994) EQUIL93: a tool for experimental and clinical urolithiasis. Urol Res 22:119–126

    CAS  Article  Google Scholar 

  23. 23.

    Ashby RA, Byrne JP, Györy AZ (1999) Urine is a saturated equilibrium and not a metastable supersaturated solution: evidence from crystalluria and the general composition of calcium salt and uric acid calculi. Urol Res 27:297–305

    CAS  Article  Google Scholar 

  24. 24.

    May PM, Murray K (1991) JESS, a joint expert speciation system – 1. Raison d’être. Talanta 38:1409–1417

    CAS  PubMed  Google Scholar 

  25. 25.

    Marangella M, Petrarulo M, Vitale C, Daniele P, Sammartano S (2021) LITHORISK.COM: the novel version of a software for calculating and visualizing the risk of renal stone. Urolithiasis 49:211–217

  26. 26.

    Tiselius H-G, Larsson L (1981) Biochemical evaluation of patients with urolithiasis. Europ Urol 7:31–34

    CAS  Article  Google Scholar 

  27. 27.

    Tiselius H-G (1984) A simplified estimate of the ion-activity product of calcium phosphate in urine. Europ Urol 10:91–195

    Article  Google Scholar 

  28. 28.

    Robertson WG, Tiselius H-G, Rodgers AL Comparison of various indices of urinary supersaturation and biochemical risk of stone-formation (in preparation)

  29. 29.

    Robertson WG, Peacock M, Heyburn PJ, Marshall DH, Clark PB (1978) Risk factors in calcium stone disease of the urinary tract. Br J Urol 50:449–454

    CAS  Article  Google Scholar 

  30. 30.

    Robertson WG (2003) A risk factor model of stone-formation. Frontiers Biosci 8:1330–1338

    Article  Google Scholar 

  31. 31.

    Dauw CA, Alruwaily AF, Bierlein MJ, Asplin JR, Ghani KR, Wolf JS Jr, Hollingsworth JM (2015) Provider variation in the quality of metabolic stone management. J Urol 193:885–890

    Article  Google Scholar 

  32. 32.

    Kok DJ (2012) Metaphylaxis, diet and lifestyle in stone disease. Arab J Urol 10:240–249

    Article  Google Scholar 

  33. 33.

    Pearle MS, Goldfarb DS, Assimos DG et al (2014) Medical management of kidney stones: AUA guideline. J Urol 192:316–324

    Article  Google Scholar 

  34. 34.

    Robertson WG (2012) General and specific dietary advice for the prevention of stone recurrence. In: Talati JJ, Tiselius H-G, Albala DM, Ye Z (eds) Urolithiasis–basic science and clinical practice. Springer, London, pp 709–720

    Google Scholar 

  35. 35.

    Robertson WG (2012) Methods for diagnosing the risk factors of stone-formation. Arab J Urol 10:250–257

    Article  Google Scholar 

  36. 36.

    Wu W, Yang B, Ou L, Liang Y, Wan S, Li S, Zeng G (2014) Urinary stone analysis on 12,846 patients: a report from a single center in China. Urolithiasis 42:39–43

    Article  Google Scholar 

  37. 37.

    Remer T, Manz F (1995) Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc 95:791–797

    CAS  Article  Google Scholar 

  38. 38.

    Robertson WG, Peacock M, Heyburn PJ, Hanes FA (1980) Epidemiological risk factors in calcium stone disease. Scand J Urol Nephrol 53(Suppl):15–28

    CAS  Google Scholar 

  39. 39.

    Ӧner M, Koutsoukos P, Robertson WG (2021) Kidney stones formation – thermodynamic, kinetic and clinical aspects, In: Amjad Z, Demadis K eds. Water-Formed Deposits: Fundamentals and Mitigation Strategies; chapter 25. Elsevier (in press)

  40. 40.

    Hosking DH, Erickson SB, Van den Berg CJ, Wilson DM, Smith LH (1983) The stone clinic effect in patients with idiopathic calcium urolithiasis. J Urol 130:1115–1118

    CAS  Article  Google Scholar 

  41. 41.

    Robertson WG, Peacock M (1985) The origin of metabolic abnormalities in primary calcium stone disease - natural or unnatural selection? In: Schwille PO, Smith LH, Robertson WG, Vahlensieck W (eds) Urolithiasis and related clinical research. Plenum Press, New York, pp 287–290

    Chapter  Google Scholar 

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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.



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 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).

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