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PRIMEVIEW

KIDNEY STONES
For the Primer, visit doi:10.1038/nrdp.2016.8

Surgery to remove stones from the kidney is the mainstay of treatment.


Kidney stones (nephrolithiasis) form The main procedures for stone treatment are extracorporeal DIAGNOSIS
MANAGEMENT shockwave lithotripsy (SWL), rigid or flexible retrograde ureteroscopic
when urine becomes supersaturated
with respect to a mineral, leading to stone fragmentation and retrieval and percutaneous nephrolithotomy.
Diagnosing kidney stone
crystal formation, growth, aggregation
disease requires an
and retention within the kidneys. Stones
understanding of
range in size and can be as small as a grain
the metabolic
of sand. A stone does not have to cause
N background
symptoms in the patient to be a stone. L that promotes

SW
EP
lithogenesis. Approximately

HR
80% of kidney stones

OLITHOTOMY
The metabolic
EPIDEMIOLOGY evaluation of are calcium based,
patients aims predominantly CaOx
Data from seven countries places the to estimate the mixed with small
incidence of kidney stones at 114–720 propensity of urine to amounts of CaP
per 100,000 individuals and the crystallize, investigate the
prevalence at 1.7–14.8%. In metabolic mechanisms of nephrolithiasis, diagnose
nearly all countries surveyed, underlying systemic causes of nephrolithiasis,
the rates are rising. The determine the risk of chronic kidney disease and
propensity to form stones metabolic bone disease and to achieve insights
varies according to sex, on nutritional habits. Stone composition should
ethnicity and geography. be determined, and laboratory assessments to
For example, stone disease determine metabolic activity include measurement
can reflect environmental L of serum levels of creatinine, calcium, potassium,

SW
risk factors, with higher stone
URETEROSCOPY
inorganic phosphate and other ions; estimation
prevalence in hot, arid climates. of glomerular filtration rate; and measurement of
urinary volume, pH and stone substrate levels.

MECHANISMS
PREVENTION
On the basis of experimental and available
clinical data, stone formation can be viewed For some individuals, stone formation can be
as a multistep process involving the formation a recurring disease that has consequences
of mineral plugs and plaques in the kidneys. such as chronic kidney disease and
For example, calcium phosphate (CaP) crystals The majority of stone formers will form metabolic bone disease. The aim of
OUTLOOK only a single symptomatic stone in their
deposited in the interstitium grow outwards preventive strategies should also focus
towards the papillary surface. This growth can lifetime or over a long observation period. on preventing these outcomes. Calcium
become exposed to the pelvic urine and provides Emerging therapies in kidney enzymes (with slow-release stone prevention relies on increasing
a nidus for calcium oxalate (CaOx) nucleation, stones include methods to deal functionality) might eliminate of spontaneous expulsion. The water intake, controlling calcium intake and
leading to stone formation. At the same time, with residual fragments after these fragments. Inversion therapy altered position of the kidneys reducing intake of meat, poultry and salt. For
CaP crystals can form in the renal tubules and SWL, which could act as foci for is a procedure carried out with combined with applied vibrational other stone compositions, such as uric acid
can aggregate to form a plug. Deposition of regrowth of the stone. For example, the aim of changing the position energy is thought to help eliminate stones, supersaturation in the urine must be
CaOx crystals on the plugs in the ducts of Bellini stents and other intracorporeal of fragments in the lower pole of the fragments, but further research decreased. Strategies here include increasing
leads to the formation of kidney stones. devices loaded with digestive the kidneys, which have a low rate is needed to assess its efficacy. urinary volume and modulating urinary pH.

Designed by Laura Marshall Article number: 16009; doi:10.1038/nrdp.2016.9; published online 25 Feb 2016
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