In a recent article the results on the satisfaction of urologists of the program of the Cape Town congress on urolithiasis have been analysed (1). The main result is that there is a strong interest in knowing more on the basic science behind renal stones.
What was particularly remarkable in that congress was, rather than the interdisciplinarity which is an old tradition in research and congresses on stones, the interest on the pathogenesis and metabolic aspects of the disease by very busy surgeons, with demanding clinical activities.
It was the format of some of the congress sessions (a mix of “basic” and strong clinically-applied presentations) that made to come to light this apparently surprising interest.
We guess this is due to the fact that while some of the previous basic science of renal stones dealt with somehow exoteric issues, now the “basic science” is perhaps not any more that “basic”. Actually it deals with the relationship between genetics, endocrinology, renal physiology and stones. In the absence of a reliable in vivo model of the most common forms of nephrolithiasis, the “basic” science in many examples has moved from the bench to the single patient (2,3).
The interest of urologists on these aspects is increasingly high since they have realized that these aspects may have an impact on their practice too. But the opposite is equally true. In the more recent annual meetings of the ERA EDTA (i.e. the European association of nephrology) the CME courses on renal stones were among those more attended underling a renewed interest by nephrologists on this condition, and not only on its metabolic aspects but also on the chance offered by the new and evolving scenario of the urological treatments.
The two tribes, the urologists and the nephrologists (in a general sense the internists), have clearly different interests and different knowledge of urolithiasis which are complementary. This is what came out from a survey between stone doctors that we have performed in the preparation stage of the recent Consensus Conference for the metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations held in Rome on March 26-28, 2015 which was endorsed by EULIS and ERA EDTA (4). What the urologists know of the disease is not known by the nephrologists, and vice versa. Each is (should be) the counterpart of the other. Is this obvious? It should be, but it is not! How many urologists who treat stone patients share at least some of their patients with the nephrologist? On the other way round, how many nephrologist who do stone metaphylaxis interact with the urologist for stone-related problems different from their removal?
However, it is day by day more evident the increasing interest in understanding the clinical problems of the counterpart. In Rome the Faculty was mixed, but the “dialect” was not surprisingly the same.
An example? Unbelievable until a while ago, but now the endourologists during stone surgeries may grasp useful information for the “metabolic” diagnosis of renal stones. Indeed how the papilla looks like could be very informative on the pathogenic mechanisms involved in that specific stone patient. It could work as a short cut in the diagnostic algorithms of renal stone (5).
And it is clearer and clearer that the role of urologists and nephrologists is not just a matter of the technical challenge in removing stones, and in metabolic diagnosing and metaphylaxing stones. Understanding the pathophysiology involved in that specific renal stone patient may disclose the existence of unknown and frequent systemic disorders (with a bone and cardiovascular risk) thus allowing the prevention of undesirable long-term consequences.
It is such a new awareness that is contaminating the two tribes that is leading to a common language.
This is a strong argument for promoting initiatives for stimulating the cooperation between urologists and nephrologists in the care of stone patients: for instance, meetings and congresses like those in Cape Town and Rome; or CME courses for both specialties together in the annual meetings of their respective Societies. The goal should be that complementarity becomes operative because this will constitute a real added value in the treatment of our stone patients.
References
1) Buchholz NN, Howairis Mel F, Durner L, Harry D, Kachrilas S, Rodgers AL, Hakenberg O.Acceptance of mixed scientific and clinical activities in a sub-speciality urology meeting. Urolithiasis. 2015 Apr;43(2):101-5.
2) Mezzabotta F, Cristofaro R, Ceol M, Del Prete D, Priante G, Familiari A, Fabris A, D'Angelo A, Gambaro G, Anglani F. Spontaneous calcification process in primary renal cells from a medullary sponge kidney patient harbouring a GDNF mutation. J Cell Mol Med. 2015 Apr;19(4):889-902.
3) Halbritter J, Baum M, Hynes AM, Rice SJ, Thwaites DT, Gucev ZS, Fisher B, Spaneas L, Porath JD, Braun DA, Wassner AJ, Nelson CP, Tasic V, Sayer JA, Hildebrandt F. Fourteen monogenic genes account for 15% of nephrolithiasis/nephrocalcinosis. J Am Soc Nephrol. 2015 Mar;26(3):543-51
4) Buchholz NN, Gambaro G. EULIS participates in a working panel on interdisciplinary communication between urologists and nephrologists on stone disease. What does the Urologist ask the Nephrologist? What does the Nephrologist ask the Urologist? European Urology Today 2015
5) Ferraro PM, D’Addessi A, Gambaro G Randall's plaques, plugs and the clinical workup of the renal stone patient. Urolithiasis. 2015 Jan;43 Suppl 1:59-61.
Written by:
Giovanni Gambaro
Noor N. Buchholz
Abstract: Acceptance of mixed scientific and clinical activities in a sub-speciality urology meeting