Practical outpatient evaluation for recurrent nephrolithiasis

N. A. Breslau, C. Y C Pak

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

An important aspect of recent progress in urolithiasis research has been the discovery that certain metabolic derangements may be associated with and may play a pathogenetic role in renal stone formation. The goal of an outpatient evaluation is to identify, as economically and efficiently as possible, the particular physiologic defect present in a given stone-former so that selective, rational therapy can be applied. Such an evaluation should be capable of detecting primary hyperparathyroidism, renal tubular acidosis, intestinal diseases that cause hyperoxaluria, and stones composed of uric acid, cystine, or struvite. In each of these instances, a selective treatment program is required. However, for the remaining 80 to 90 per cent of calcium stone-formers, many believe that diagnostic efforts are largely unwarrranted since most of these patients respond to a thiazide diuretic. Why bother to determine whether a patient with calcium nephrolithiasis has absorptive hypercalciuria, renal hypercalciuria, hyperuricosuria, or no detectable physiologic abnormality if thiazide diuretics reduce the incidence of stone recurrence in each circumstance? The answer to this important question determines the extent of the metabolic evaluation.

Original languageEnglish (US)
Pages (from-to)253-263
Number of pages11
JournalUrologic Clinics of North America
Volume8
Issue number2
StatePublished - Dec 1 1981

ASJC Scopus subject areas

  • Urology

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