Evaluation and Medical Management of Kidney Stones

Nephrolithiasis is a worldwide epidemic affecting countries of affluence. The occurrence of kidney stones represents not only a high economic burden to health systems but also results in patient suffering and morbidity. Despite the widespread incidence, the exact cellular mechanisms that mediate the formation of kidney stones remain poorly understood. Clearly, environmental, dietary, and metabolic risk factors can be identified in many stone-forming individuals that increase stone-forming risk. In addition, treatment to correct those abnormalities can reduce the subsequent stone-forming rate. Therefore, this chapter will review the driving forces of stone formation, the theories of crystallization, the cost effectiveness of medical management, dietary and environmental factors that play a role in stone formation, the evaluation of stone-forming patients, and specific metabolic risk factors and the corresponding treatment strategies for which there is strong evidence of clinical efficacy. This information will provide a background in to the understanding of nephrolithiasis that should help the clinician with the appropriate evaluation and management of the most common stone-forming patients in their practice. It will provide a deeper insight into what drives kidney stone disease and offer clinically proven recommendations to improve care and reduce the risk of future symptomatic stone episodes. These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.