Académique Documents
Professionnel Documents
Culture Documents
ABSTRACT
Renal stones are a common condition causing significant morbidity and economic burden. The prevalence
of urinary tract stones in the developed nations ranges from 4–20%. Renal stones are of different types,
the most common being the calcium oxalate stones. Various dietary, non-dietary, and urinary risk factors
contribute to their formation. Their frequent association with systemic diseases (like hypertension, diabetes,
and obesity) highlights the role of dietary and lifestyle changes in their occurrence, recurrence, and possible
prevention. Non-contrast computed tomography (CT) identifies almost every stone and is the preferred
investigation for identification. Ultrasound has its advantages, as it is low cost and requires no radiation,
but is observer dependent. Metabolic profiles (including blood calcium, phosphate, magnesium, creatinine,
uric acid, sodium, and potassium) should be measured and a detailed urinalysis should be done. This review
further discusses the formation in depth, and covers risk factors and management of renal stones, and lays
down the importance of preventive measures to avoid their recurrence.
Factor Example
High urine calcium
High urine oxalate
Metabolic
Low urine citrate
Low urine volume
Low fluid intake
Low calcium intake
Dietary
High intake of animal protein
High oxalate intake
Infections Recurrent urinary tract infection
Hereditary Positive family history
Congenital anatomic defects Medullary sponge kidney, horseshoe kidney, and ureteropelvic junction obstruction
Hot and arid climate. People working outdoors in hot weather have an increased
Environmental
risk of stone formation due to excessive fluid loss from sweating.
Systemic disorders Hyperparathyroidism, diabetes mellitus, hyperuricemia, metabolic syndrome etc.
Renal stones are common in obese and diabetic aggregating the crystals, and causing them to grow
individuals. The recurrence rate of renal stones is into a mass sufficient to cause clinical symptoms.6
high, with 50% recurring within 5 years of the initial In the second mechanism, which is mostly
stone event. The factors that determine the responsible for calcium oxalate stones, deposition
accelerating pace of stone formation in recurrent of stone material occurs on a renal papillary
stone formers are not well known. Therefore, calcium phosphate nidus, typically a Randall’s
in any single stone former, one cannot predict plaque (which always consists of calcium
which patient will relapse, however, the natural phosphate).7 The majority of stones are composed
history of stone disease and the high rate of of mostly calcium salts, including those of calcium
recurrence requires careful diagnostic evaluation oxalate and calcium phosphate. Uric acid, cystine,
and early treatment. and magnesium ammonium phosphate (struvite)
compose the remainder of the stones.
CLASSIFICATION OF RENAL STONES
CLINICAL MANIFESTATIONS
There are different kinds of renal stones and their
correct identification is important in the selection of The three narrowest parts of the ureter are at
optimal treatment. The frequency of different stone the pelvo-ureteric junction, the mid-ureter, where
type occurrence is shown in Table 1.6 the ureter crosses the iliac vessels, and the
There are various risk factors for the development vesico-ureteric junction (VUJ). The VUJ is the
of stones in the urinary tract, for example dietary, most common site of obstruction. Patients may
non-dietary, and urinary. These risk factors vary present with renal colic, experiencing a severe sharp
by stone type and by clinical characteristics.7,8 pain at the flanks which has a sudden onset, with
Major factors causing an increased risk for the fluctuation and intensification over 15–45 minutes.
development of renal stones are mentioned It then becomes steady and unbearable,
in Table 2. often accompanied by nausea and emesis. As the
stone passes down the ureter towards the bladder,
PATHOPHYSIOLOGY flank pain changes in a downward direction towards
the groin. When the stone is lodged at the VUJ,
Renal stones are composed of insoluble salts from urinary frequency and dysuria may appear. The pain
the urine and are formed by two basic mechanisms. may clear as the stone moves into the bladder or
The first mechanism is the aggregation of crystals from the calyceal system into the ureter. Stones
with a non-crystalline protein (matrix) component. may obstruct the urinary tract and impair renal
The salts in the urine precipitate and crystallise, function. There is an increased risk of infection with
Surgical treatment
REFERENCES
1. Scales CD Jr et al.; Urologic Diseases picture of prevalence, incidence, and of Urolithiasis. Eur Urol. 2016;69(3):
in America Project. Prevalence of kidney associated risk factors. Rev Urol. 2010; 468-74.
stones in the United States. Eur Urol. 2012; 12(2-3):e86-96. 10. Glowacki LS et al. The natural history
62(1):160-5. 6. Coe FL et al. The pathogenesis and of asymptomatic urolithiasis. J Urol. 1992;
2. Trinchieri A. Epidemiology of urolithiasis. treatment of kidney stones. N Engl J Med. 147(2):319-21.
Arch Ital Urol Androl. 1996;68:203-49. 1992;327(16):1141-52. 11. Eisner BH et al. Ureteral stone location at
3. Hesse A et al. Study on the prevalence 7. Evan AP et al. Mechanism of formation emergency room presentation with colic.
and incidence of urolithiasis in Germany of human calcium oxalate renal stones on J Urol. 2009;182(1):165-8.
comparing the years 1979 vs. 2000. Eur Randall’s plaque. Anat Rec (Hoboken). 12. Paterson R et al. Evaluation and
Urol. 2003;44(6):709-13. 2007;290(10):1315-23. medical management of the kidney stone
4. Trinchieri A et al. Increase in the 8. Taylor EN, Curhan GC. Oxalate intake patient. Can Urol Assoc J. 2010;4(6):
prevalence of symptomatic urinary tract and the risk for nephrolithiasis. J Am Soc 375-9.
stones during the last ten years. Eur Urol. Nephrol. 2007;18(7):2198-204. 13. Taylor EN, Curhan GC. Body size and
2000;37(1):23-5. 9. Türk C et al. EAU Guidelines on 24-hour urine composition. Am J Kidney
5. Romero V et al. Kidney stones: a global Diagnosis and Conservative Management Dis. 2006;48(6):905-15.
If you would like reprints of any article, contact: +44 (0) 1245 334450.