Excerpt
It's been estimated that half of all symptomatic kidney stones could be prevented with proper diagnosis and prophylactic treatment of underlying chemical nephrolithiasis risk factors. [1][2] Preventive medical evaluation and treatment of stone disease are underutilized, inconsistent, and generally inadequate.[3] Additionally, quality of life scores are dramatically lowered in nephrolithiasis patients, even in those with asymptomatic stones.[4] Direct and indirect costs are estimated at over $10 billion yearly, and this is predicted to exceed $15 billion by 2030. This is due to the increasing incidence of stone disease in part from the rise in other associated disorders that contribute to nephrolithiasis, such as diabetes and obesity, together with general population growth and global warming.[5] Low urinary citrate excretion (hypocitraturia) is one of the most common, treatable causes of kidney stones. This was first reported by Boothby and Adams in 1934 and later confirmed by Kissin and Locks in 1941. This information was largely ignored or attributed to bacterial consumption of citrate until 1962 when Hodgkinson first suggested hypocitraturia as a unique urinary chemical disorder present in nephrolithiasis patients.[6] Hypocitraturia is officially defined as less than 320 mg of urinary citrate excretion a day, but this definition has been questioned by many experts as it is based on statistical analyses of large numbers of 24-hour urine tests from the general population and not on saturation ratios, supersaturation, pH, crystallization points, stone chemical composition or the minimal concentrations necessary to prevent urinary stones.[7][8] Currently, "optimal" levels of urinary chemistries like citrate are not even reported in standard laboratory reports. It is estimated that hypocitraturia is found in about 30% (10% to 60%) of all stone formers, but this will vary according to the particular definition of hypocitraturia used and the stone type.[9] It is the sole, identifiable stone promoting chemical abnormality in about 10% of all calcium stone-forming patients and is a contributing factor associated with other metabolic problems in about half.
Sections
- Introduction
- Etiology
- Epidemiology
- Pathophysiology
- History and Physical
- Evaluation
- Treatment / Management
- Differential Diagnosis
- Prognosis
- Complications
- Deterrence and Patient Education
- Pearls and Other Issues
- Enhancing Healthcare Team Outcomes
- Continuing Education / Review Questions
- References
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Stephen W. Leslie, Khalid Bashir
Creighton University Medical Center, Creighton University School of Medicine