8/31/2023 0 Comments Calculi in medical terms![]() Many randomized controlled trials (RCTs) have studied dietary or pharmacological interventions to reduce risk of recurrent nephrolithiasis. Current practice varies in the use of both initial and followup biochemical testing, particularly in patients who present with a stone for the first time. Controversies include whether pretreatment laboratory test results predict effectiveness of treatment on final health outcomes whether treatment tailored to pretreatment laboratory results is associated with better final health outcomes than empiric therapy and whether followup biochemical test results are valid surrogates for predicting the effectiveness of treatment on final health outcomes. However, the value of baseline and followup laboratory evaluations in patients with nephrolithiasis are unclear. 19 Clinicians may use these results initially to guide treatment selection or later as a marker of treatment adherence or effectiveness. Testing may include an analysis of stone composition and biochemical evaluations of blood (e.g., calcium, albumin, creatinine, uric acid, potassium, bicarbonate) and urine (e.g., pH, volume, calcium, creatinine, uric acid, oxalate, citrate, sodium). 1 Laboratory Evaluation of NephrolithiasisĬlinical guidelines recommend laboratory evaluation of patients who experience a kidney stone. Direct medical expenditures for nephrolithiasis in the United States have been estimated at $2.1 billion annually. 17,18 Nephrolithiasis also may lead to hospitalizations and procedure-related morbidity. Some studies have suggested that nephrolithiasis also may increase the risk of chronic kidney disease. Large struvite stones remain in the renal pelvis and may not cause pain. 16 Potential symptoms of nephrolithiasis include: urinary symptoms such as dysuria, hematuria, and urgency renal colic with severe abdominal and flank pain nausea and vomiting urinary tract obstruction infection and acute, though generally transient, impairment in renal function. While larger stones may cause symptoms, more than 90 percent of stones ≤5 mm in diameter still pass through the urinary tract without intervention, as compared to spontaneous passage of approximately 50 percent of stones 5 to 10 mm in diameter. 15 Small stones generally pass through the urinary tract without symptoms. Nephrolithiasis often is incidentally identified in asymptomatic patients who undergo plain radiographs or computed tomographic imaging for another indication. 14 The most common biochemical abnormality identified in patients with nephrolithiasis is hypercalciuria other abnormalities may include hypercalcemia, hyperuricemia, hyperuricosuria, hyperoxaluria, hypernatriuria, and hypocitraturia. By comparison, struvite stones and uric acid stones each account for 5 to 10 percent of stones, and cystine stones are rare. 12,13Īpproximately 80 percent of adults with nephrolithiasis have stones comprised predominately of calcium oxalate and/or calcium phosphate. 8-11 With respect to fluid intake, different beverage types appear to have different impacts on the risk of nephrolithiasis. However, evidence is mixed for diets with increased animal protein, low dietary magnesium, low dietary potassium, and increased sodium. 7 In large observational studies, dietary factors associated with increased risk of nephrolithiasis include low fluid intake and low dietary calcium. ![]() Medical conditions that increase the risk of nephrolithiasis include primary hyperparathyroidism, 4 obesity, 5 diabetes, 6 and gout. 1,2 Following an initial stone event, the spontaneous 5-year recurrence rate is 35 to 50 percent. Lifetime prevalence is estimated at 13 percent for men and 7 percent for women. Epidemiology of NephrolithiasisĪlthough nephrolithiasis may occur at any age, onset is more common in young and middle-aged adults. Stone formation may occur when the urinary concentration of crystal-forming substances (calcium, oxalate, uric acid) is high and/or that of substances that inhibit stone formation (citrate) is low. Stones form from crystals that precipitate (separate) out of the urine. Nephrolithiasis, or kidney stone disease, is a condition in which individuals form calculi (stones) within the renal pelvis and tubular lumens. Background and Objectives for the Systematic Review Definition of Nephrolithiasis
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