Recurrent renal stone disease - Advances in pathogenesis and clinical management
Date
2001
Authors
Bihl G.
Meyers A.
Journal Title
Journal ISSN
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Abstract
Kidney stones are common in industrialised nations: up to 15% of white men and 6% of all women will develop one stone, with recurrence in about half these people. Risk factors for formation of stones include urinary promoters (calcium, urate, cystine, and sodium) and urinary inhibitors (magnesium, citrate, and nephrocalcin). Acute renal colic can be precipitated by dehydration and reduced urine output, increased protein intake, heavy physical exercise, and various medicines. Such colic manifests as severe loin pain and can be accompanied by frequent urination, dysuria, oliguria, and haematuria. Documentation of stone characteristics is extremely important: type, size, location, and underlying metabolic abnormalities. Such details can be obtained with a combination of biochemical investigations, microscopic examination of urine under polarised light, and an intravenous pyelogram. Ultrasonography and plain abdominal radiographs are also useful, especially for patients unable to tolerate an intravenous pyelogram. Acute therapy includes complete pain relief, rehydration, and encouragement of diuresis. Long-term management encompasses education of patients with regard to diet and fluid intake, control of calciuria, citrate replacement, and treatment of any underlying urinary-tract infection or metabolic abnormality. Stones smaller than 5 mm normally pass spontaneously, whereas larger stones, as big as 2 cm, are best treated with extracorporeal shock-wave lithotripsy. All physicians should have a clear understanding of the pathogenesis and clinical management (acute treatment and prevention of recurrence) of renal stone disease.
Description
Keywords
acetazolamide, acetylsalicylic acid, acid protein, allopurinol, calcium, calcium carbonate, citrate potassium, citric acid, codeine, cysteine, dextropropoxyphene, gluconate magnesium, hydrochlorothiazide, hydroxyzine, indapamide, magnesium, magnesium derivative, morphine, narcotic analgesic agent, nephrocalcin, nonsteroid antiinflammatory agent, paracetamol, penicillamine, pethidine, phosphate binding agent, sodium, unclassified drug, urate, analgesia, calcium stone, conference paper, dehydration, diet restriction, diuresis, echography, extracorporeal lithotripsy, hematuria, human, intravenous pyelography, kidney colic, long term care, nephrolithiasis, nephrolithotomy, oliguria, pain, pathogenesis, priority journal, protein intake, rehydration, risk factor, side effect, urinary tract infection, urine volume, Acute Disease, Chronic Disease, Humans, Kidney Calculi, Recurrence
Citation
Lancet
358
9282
358
9282