104. Diagnosis and Evaluation of Nephrolithiasis

  1. Clifford J. Rosen MD
  1. Stephen J. Knohl and
  2. Steven J. Scheinman

Published Online: 19 JUL 2013

DOI: 10.1002/9781118453926.ch104

Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition

Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition

How to Cite

Knohl, S. J. and Scheinman, S. J. (2013) Diagnosis and Evaluation of Nephrolithiasis, in Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition (ed C. J. Rosen), John Wiley & Sons, Inc., Ames, USA. doi: 10.1002/9781118453926.ch104

Publication History

  1. Published Online: 19 JUL 2013
  2. Published Print: 19 AUG 2013

ISBN Information

Print ISBN: 9781118453889

Online ISBN: 9781118453926

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Keywords:

  • metabolic profiling;
  • nephrolithiasis;
  • radiographic evaluation;
  • stone analysis

Summary

The physician evaluating a patient with nephrolithiasis needs to keep in mind the relative prevalence of various stone types. Calcium salts (oxalate, phosphate, or mixed) are the most common stone types, together accounting for 70-75% of nephrolithiasis; low urinary volume, hypercalciuria, hyperoxaluria, hypocitraturia, and hyperuricosuria are identified risk factors. Stone analysis is the most direct way to identify stone type and allows for stone-specific therapy. Beyond this evaluation of patients with acute renal colic, the cost-effectiveness of additional testing is not established for all adult first-time stone formers. A major goal of stone prevention is to reduce supersaturation. The normally higher levels of two important stone constituents, and normally lower levels of citrate, explain much, though not all, of the increased risk of stones in men. The supersaturation ratios for each stone salt that are provided by specialty laboratories are particularly helpful.