Medical Management of Unknown Stone Types

  • Eric S. Kerns
  • Kenneth Ralto
  • Adam M. SegalEmail author
Part of the Nutrition and Health book series (NH)


Evaluation and management of the patient with kidney stones of unknown composition present a difficult challenge to the clinician. In the event that a stone cannot be obtained for analysis, the work-up should include a targeted dietary and medical history with attention to comorbid conditions and vitamin supplements. Abdominal imaging and 24-hour urine collection add important information to the diagnostic evaluation to narrow the differential. Once a treatment plan is determined, regular laboratory and imaging surveillance is necessary to ensure that dietary and medication changes effectively reduce the risk of recurrent stone formation.


Unknown stone composition Diagnostic tests Calcium oxalate Calcium phosphate Uric acid 


  1. 1.
    Singh P, Enders FT, Vaughan LE, Bergstralh EJ, Knoedler JJ, Krambeck AE, et al. Stone composition among first-time symptomatic kidney stone formers in the community. Mayo Clin Proc. 2015;90(10):1356–65.CrossRefGoogle Scholar
  2. 2.
    Coe FL, Evan A, Worcester E. Kidney stone disease. J Clin Invest. 2005;115:2598–608.CrossRefGoogle Scholar
  3. 3.
    Cameron A, Sakhaee K. Uric acid nephrolithiasis. Urol Clin North Am. 2007;34:335–46.CrossRefGoogle Scholar
  4. 4.
    Nakada SY, Hoff DG, Attai S, Heisey D, Blankenbaker D, Pozniak M. Determination of stone composition by noncontrast spiral computed tomography in the clinical setting. Urology. 2000;55(6):816–9.CrossRefGoogle Scholar
  5. 5.
    Parks JH, Coward M, Coe FL. Correspondence between stone composition and urine supersaturation in nephrolithiasis. Kidney Int. 1997;51(3):894–900.CrossRefGoogle Scholar
  6. 6.
    Curhan GC, Willett WC, Rimm EB, Stampfer MJ. A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med. 1993;328(12):833–8.CrossRefGoogle Scholar
  7. 7.
    Borghi L, Schianchi T, Meschi T, Guerra A, Allegri F, Maggiore U, Novarini A. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med. 2002;346:77–84.CrossRefGoogle Scholar
  8. 8.
    Domrongkitchaiporn S, Sopassathit W, Stitchantrakul W, Prapaipanich S, Ingsathit A, Rajatanavin R. Schedule of taking calcium supplement and the risk of nephrolithiasis. Kidney Int. 2004;65(5):1835–41.CrossRefGoogle Scholar
  9. 9.
    Parks JH, Coe FL. A urinary calcium-citrate index for the evaluation of nephrolithiasis. Kidney Int. 1986;30(1):85–90.CrossRefGoogle Scholar
  10. 10.
    Curhan GC, Taylor EN. 24-h uric acid excretion and the risk of kidney stones. Kidney Int. 2008;73(4):489–96.CrossRefGoogle Scholar
  11. 11.
    Taylor EN, Curhan GC. Diagnosis and management of stone disease. Nephrol Rounds. 2006;4(1):1–6.Google Scholar
  12. 12.
    Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, Monga M, Penniston KL, Preminger GM, Turk TMT, White JR. Medical management of kidney stones: AUA guideline. J Urol. 2014;192:316–24.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Nephrology, Department of MedicineLahey Hospital and Medical CenterBurlingtonUSA
  2. 2.UMass Memorial Medical GroupWorcesterUSA

Personalised recommendations