106. Treatment of Renal Stones

  1. Clifford J. Rosen MD
  1. John R. Asplin

Published Online: 19 JUL 2013

DOI: 10.1002/9781118453926.ch106

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

Asplin, J. R. (2013) Treatment of Renal Stones, 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.ch106

Publication History

  1. Published Online: 19 JUL 2013

ISBN Information

Print ISBN: 9781118453889

Online ISBN: 9781118453926

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Keywords:

  • calcium stones;
  • cystine stones;
  • renal stones;
  • struvite stones;
  • uric acid stones

Summary

Renal stones form in urine that is supersaturated with respect to the salt of which the stone is composed. Optimal treatment is based on the type of stone and the lithogenic risk factors identified in 24-hour urine chemistries. There are four abnormalities of urine chemistries known to cause calcium oxalate kidney stones: hypercalciuria, hyperoxaluria, hypocitraturia and hyperuricosuria. Three factors contribute to uric acid stone formation: urine flow rate, uric acid excretion rate, and urine pH. Low urine pH is the most common abnormality found in uric acid stone formers. Captopril, an angiotensin-converting enzyme inhibitor, contains a thiol group and has been suggested as therapy for cystinuria. Struvite (magnesium—ammonium—phosphate) stones require elevated urine pH and high ammonium concentration to form. Although acetohydroxamic acid (AHA) will not eradicate infection, it does prevent the breakdown of urea and the change in the urinary environment that leads to struvite stone formation.