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Evaluation of Patients with Nephrolithiasis (Diagnosis of Nephrolithiasis)

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Nutritional and Medical Management of Kidney Stones

Part of the book series: Nutrition and Health ((NH))

Abstract

Kidney stones affect 11% of men and 6% of women and incidence is on the rise. When stones pass through urinary tract, the symptoms can be debilitating, resulting in significant morbidity and cost to the medical system. Almost half of first-time stone formers have a recurrent episode. Thus, prevention of recurrence is important. Evaluation of the patient for stone-forming risk factors includes history, imaging, stone analysis, and metabolic workup. The evaluation begins with patient history focused on medications, diseases, diet, and work habits that increase the risk. Imaging with computed tomography and ultrasound helps determine the burden, size, and location of the stone(s) in the urinary tract. Stone analysis when available is important in determining the type of stone. Metabolic workup consists of targeted blood work and urinalysis as well as a 24-hour urine collection. The cornerstone of the stone evaluation is the 24-hour urine collection especially in recurrent stone formers as its components determine the risk of stone formation. The 24-hour urine values guide medical management and dietary modifications for prevention of recurrence, and follow-up collections determine the effectiveness of the therapy.

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Notes

  1. 1.

    A basic metabolic panel includes sodium, potassium, chloride, bicarbonate, BUN, creatinine, glucose, calcium, and albumin.

References

  1. Asplin JR. Evaluation of the kidney stone patient. Semin Nephrol. 2008;28(2):99–110.

    Article  CAS  PubMed  Google Scholar 

  2. Sutherland JW, Parks JH, Coe F. Recurrence after a single renal stone in a community practice. Miner Electrolyte Metab. 1985;11:267–9.

    CAS  PubMed  Google Scholar 

  3. Ingimarsson JP, Krambeck AE, Pais VM Jr. Diagnosis and management of nephrolithiasis. Surg Clin North Am. 2016;96(3):517–32.

    Article  PubMed  Google Scholar 

  4. Krambeck AE, Lieske JC, Li X, Bergstralh EJ, Melton LJ 3rd, Rule AD. Effect of age on the clinical presentation of incident symptomatic urolithiasis in the general population. J Urol. 2013;189(1):158–64.

    Article  PubMed  Google Scholar 

  5. Wimpissinger F, Turk C, Kheyfets O, Stackl W. The silence of the stones: asymptomatic ureteral calculi. J Urol. 2007;178(4 Pt 1):1341–4. discussion 4.

    Article  PubMed  Google Scholar 

  6. Safriel Y, Malhotra A, Sclafani SJ. Hematuria as an indicator for the presence or absence of urinary calculi. Am J Emerg Med. 2003;21(6):492–3.

    Article  PubMed  Google Scholar 

  7. Leslie SW, Shenot PJ. Bladder, stones. Treasure Island: StatPearls; 2018.

    Google Scholar 

  8. Holdgate A, Pollock T. Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. BMJ. 2004;328(7453):1401.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gottlieb M, Long B, Koyfman A. The evaluation and management of urolithiasis in the ED: A review of the literature. Am J Emerg Med. 2018;36(4):699–706.

    Article  PubMed  Google Scholar 

  10. Pickard R, Starr K, MacLennan G, Lam T, Thomas R, Burr J, et al. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet. 2015;386(9991):341–9.

    Article  PubMed  Google Scholar 

  11. Worcester EM. Stones from bowel disease. Endocrinol Metab Clin N Am. 2002;31(4):979–99.

    Article  CAS  Google Scholar 

  12. Wiederkehr MR, Moe OW. Uric acid nephrolithiasis: a systemic metabolic disorder. Clin Rev Bone Miner Metab. 2011;9(3–4):207–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Rodman JS, Mahler RJ. Kidney stones as a manifestation of hypercalcemic disorders. Hyperparathyroidism and sarcoidosis. Urol Clin North Am. 2000;27(2):275–85. viii.

    Article  CAS  PubMed  Google Scholar 

  14. Goldfarb DS, Arowojolu O. Metabolic evaluation of first-time and recurrent stone formers. Urol Clin North Am. 2013;40(1):13–20.

    Article  PubMed  Google Scholar 

  15. Gambaro G, Croppi E, Coe F, Lingeman J, Moe O, Worcester E, et al. Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement. J Nephrol. 2016;29(6):715–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Milvy P, Colt E, Thornton J. A high incidence of urolithiasis in male marathon runners. J Sports Med Phys Fitness. 1981;21(3):295–8.

    CAS  PubMed  Google Scholar 

  17. Izzedine H, Lescure FX, Bonnet F. HIV medication-based urolithiasis. Clin Kidney J. 2014;7(2):121–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Matlaga BR, Shah OD, Assimos DG. Drug-induced urinary calculi. Rev Urol. 2003;5(4):227–31.

    PubMed  PubMed Central  Google Scholar 

  19. Ferraro PM, Lombardi G, Gambaro G. Prevention of nephrolithiasis: a review. Urologia. 2014;81(2):88–92.

    Article  PubMed  Google Scholar 

  20. Coe FL, Parks JH, Moore ES. Familial idiopathic hypercalciuria. N Engl J Med. 1979;300(7):337–40.

    Article  CAS  PubMed  Google Scholar 

  21. Karet FE. Inherited distal renal tubular acidosis. J Am Soc Nephrol. 2002;13(8):2178–84.

    Article  CAS  PubMed  Google Scholar 

  22. 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.

    Article  CAS  PubMed  Google Scholar 

  23. Coursey CA, Casalino DD, Remer, EM, Arellano RS, Bishoff JT, Fulgham P et al. ACR Appropriateness Criteria acute onset flank pain – suspicion of stone disease. Ultrasouns Q. 2012;28(3):227–33.

    Google Scholar 

  24. Fulgham PF, Assimos DG, Pearle MS, Preminger GM. Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment. J Urol. 2013;189(4):1203–13.

    Article  PubMed  Google Scholar 

  25. Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU guidelines on diagnosis and conservative management of urolithiasis. Eur Urol. 2016;69(3):468–74.

    Article  PubMed  Google Scholar 

  26. Brisbane W, Bailey MR, Sorensen MD. An overview of kidney stone imaging techniques. Nat Rev Urol. 2016;13(11):654–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. 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.

    Article  CAS  PubMed  Google Scholar 

  28. Memarsadeghi M, Heinz-Peer G, Helbich TH, Schaefer-Prokop C, Kramer G, Scharitzer M, et al. Unenhanced multi-detector row CT in patients suspected of having urinary stone disease: effect of section width on diagnosis. Radiology. 2005;235(2):530–6.

    Article  PubMed  Google Scholar 

  29. Niemann T, Kollmann T, Bongartz G. Diagnostic performance of low-dose CT for the detection of urolithiasis: a meta-analysis. AJR Am J Roentgenol. 2008;191(2):396–401.

    Article  PubMed  Google Scholar 

  30. Health risks from exposure to low levels of ionizing radiation: BEIR VII, Phase I, Letter Report (1998). Washington (DC). 1998.

    Google Scholar 

  31. Tenant S, Pang CL, Dissanayake P, Vardhanabhuti V, Stuckey C, Gutteridge C, et al. Intra-patient comparison of reduced-dose model-based iterative reconstruction with standard-dose adaptive statistical iterative reconstruction in the CT diagnosis and follow-up of urolithiasis. Eur Radiol. 2017;27(10):4163–72.

    Article  PubMed  Google Scholar 

  32. Gutjahr R, Polster C, Henning A, Kappler S, Leng S, McCollough CH, et al. Dual energy CT kidney stone differentiation in photon counting computed tomography. Proc SPIE Int Soc Opt Eng. 2017;10132:1013237.

    PubMed  PubMed Central  Google Scholar 

  33. Bonatti M, Lombardo F, Zamboni GA, Pernter P, Pycha A, Mucelli RP, et al. Renal stones composition in vivo determination: comparison between 100/Sn140 kV dual-energy CT and 120 kV single-energy CT. Urolithiasis. 2017;45(3):255–61.

    Article  CAS  PubMed  Google Scholar 

  34. Gentle DL, Stoller ML, Jarrett TW, Ward JF, Geib KS, Wood AF. Protease inhibitor-induced urolithiasis. Urology. 1997;50(4):508–11.

    Article  CAS  PubMed  Google Scholar 

  35. Ray AA, Ghiculete D, Pace KT, Honey RJ. Limitations to ultrasound in the detection and measurement of urinary tract calculi. Urology. 2010;76(2):295–300.

    Article  PubMed  Google Scholar 

  36. Smith-Bindman R, Aubin C, Bailitz J, Bengiamin RN, Camargo CA Jr, Corbo J, et al. Ultrasonography versus computed tomography for suspected nephrolithiasis. N Engl J Med. 2014;371(12):1100–10.

    Article  CAS  PubMed  Google Scholar 

  37. Coursey CA, Nelson RC, Boll DT, Paulson EK, Ho LM, Neville AM, et al. Dual-energy multidetector CT: how does it work, what can it tell us, and when can we use it in abdominopelvic imaging? Radiographics. 2010;30(4):1037–55.

    Article  PubMed  Google Scholar 

  38. Sorensen MD, Harper JD, Hsi RS, Shah AR, Dighe MK, Carter SJ, et al. B-mode ultrasound versus color Doppler twinkling artifact in detecting kidney stones. J Endourol. 2013;27(2):149–53.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Duzenli K, Ozturk M, Yildirim IO, Erdem G. The utility of diffusion-weighted imaging to assess acute renal parenchymal changes due to unilateral ureteral stone obstruction. Urolithiasis. 2016;45(4):401–5.

    Article  PubMed  Google Scholar 

  40. Preminger GM. The metabolic evaluation of patients with recurrent nephrolithiasis: a review of comprehensive and simplified approaches. J Urol. 1989;141(3 Pt 2):760–3.

    Article  CAS  PubMed  Google Scholar 

  41. Chandhoke PS. When is medical prophylaxis cost-effective for recurrent calcium stones? J Urol. 2002;168(3):937–40.

    Article  PubMed  Google Scholar 

  42. Rule AD, Lieske JC, Li X, Melton LJ 3rd, Krambeck AE, Bergstralh EJ. The ROKS nomogram for predicting a second symptomatic stone episode. J Am Soc Nephrol. 2014;25(12):2878–86.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Eisner BH, Sheth S, Dretler SP, Herrick B, Pais VM Jr. Abnormalities of 24-hour urine composition in first-time and recurrent stone-formers. Urology. 2012;80(4):776–9.

    Article  PubMed  Google Scholar 

  44. Parks JH, Coe FL. An increasing number of calcium oxalate stone events worsens treatment outcome. Kidney Int. 1994;45(6):1722–30.

    Article  CAS  PubMed  Google Scholar 

  45. Cloutier J, Villa L, Traxer O, Daudon M. Kidney stone analysis: “Give me your stone, I will tell you who you are!”. World J Urol. 2015;33(2):157–69.

    Article  PubMed  Google Scholar 

  46. Castle SM, Cooperberg MR, Sadetsky N, Eisner BH, Stoller ML. Adequacy of a single 24-hour urine collection for metabolic evaluation of recurrent nephrolithiasis. J Urol. 2010;184(2):579–83.

    Article  CAS  PubMed  Google Scholar 

  47. Alruwaily AF, Dauw CA, Bierlein MJ, Yan P, Asplin JR, Ghani KR, et al. How much information is lost when you only collect one 24-hour urine sample during the initial metabolic evaluation? J Urol. 2016;196(4):1143–8.

    Article  PubMed  Google Scholar 

  48. Nicar MJ, Hsu MC, Johnson T, Pak CY. The preservation of urine samples for determination of renal stone risk factors. Lab Med. 1987;18(6):382–4.

    Article  CAS  PubMed  Google Scholar 

  49. Ennis JL, Asplin JR. The role of the 24-h urine collection in the management of nephrolithiasis. Int J Surg. 2016;36(Pt D):633–7.

    Article  PubMed  Google Scholar 

  50. Curhan GC, Taylor EN. 24-h uric acid excretion and the risk of kidney stones. Kidney Int. 2008;73(4):489–96.

    Article  CAS  PubMed  Google Scholar 

  51. Reilly RF, Perazella MA. Nephrology in 30 days. 2nd ed. New York: McGraw-Hill; 2014. xiii. p. 402.

    Google Scholar 

  52. Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol. 1996;155(3):839–43.

    Article  CAS  PubMed  Google Scholar 

  53. Hamm LL. Renal handling of citrate. Kidney Int. 1990;38(4):728–35.

    Article  CAS  PubMed  Google Scholar 

  54. Fink HA, Wilt TJ, Eidman KE, Garimella PS, MacDonald R, Rutks IR, et al. Medical management to prevent recurrent nephrolithiasis in adults: a systematic review for an American College of Physicians Clinical Guideline. Ann Intern Med. 2013;158(7):535–43.

    Article  PubMed  Google Scholar 

  55. Werness PG, Brown CM, Smith LH, Finlayson B. EQUIL2: a BASIC computer program for the calculation of urinary saturation. J Urol. 1985;134(6):1242–4.

    Article  CAS  PubMed  Google Scholar 

  56. Hsi RS, Sanford T, Goldfarb DS, Stoller ML. The role of the 24-hour urine collection in the prevention of kidney stone recurrence. J Urol. 2017;197(4):1084–9.

    Article  PubMed  Google Scholar 

  57. Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014;192(2):316–24.

    Article  PubMed  Google Scholar 

  58. Parks J, Coe F, Favus M. Hyperparathyroidism in nephrolithiasis. Arch Intern Med. 1980;140(11):1479–81.

    Article  CAS  PubMed  Google Scholar 

  59. Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med. 1999;341(17):1249–55.

    Article  CAS  PubMed  Google Scholar 

  60. Oliveira B, Kleta R, Bockenhauer D, Walsh SB. Genetic, pathophysiological, and clinical aspects of nephrocalcinosis. Am J Physiol Renal Physiol. 2016;311(6):F1243–F52.

    Article  CAS  PubMed  Google Scholar 

  61. Hebert SC. Extracellular calcium-sensing receptor: implications for calcium and magnesium handling in the kidney. Kidney Int. 1996;50(6):2129–39.

    Article  CAS  PubMed  Google Scholar 

  62. Wang WH, Lu M, Hebert SC. Cytochrome P-450 metabolites mediate extracellular Ca(2+)-induced inhibition of apical K+ channels in the TAL. Am J Phys. 1996;271(1 Pt 1):C103–11.

    Article  CAS  Google Scholar 

  63. Rose BD, Post TW. Clinical physiology of acid-base and electrolyte disorders. 5th ed. New York: McGraw-Hill, Medical Pub. Division; 2001. x. p. 992.

    Google Scholar 

  64. Nerli R, Jali M, Guntaka AK, Patne P, Patil S, Hiremath MB. Type 2 diabetes mellitus and renal stones. Adv Biomed Res. 2015;4:180.

    PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Brown Medicine, East Providence, RI, USA

    Matthew Lynch

  2. Department of Nephrology, Atrius Health, Quincy, MA, USA

    Samer Nasser

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  1. Matthew Lynch
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  2. Samer Nasser
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Correspondence to Samer Nasser .

Editor information

Editors and Affiliations

  1. Department of Nephrology, Harvard Vanguard Medical Associates, Boston, MA, USA

    Haewook Han

  2. Division of Nephrology, Newton-Wellesley Hospital, Newton, MA, USA

    Walter P. Mutter

  3. Department of Nephrology, Harvard Vanguard Medical Associates, Boston, MA, USA

    Samer Nasser

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Lynch, M., Nasser, S. (2019). Evaluation of Patients with Nephrolithiasis (Diagnosis of Nephrolithiasis). In: Han, H., Mutter, W., Nasser, S. (eds) Nutritional and Medical Management of Kidney Stones. Nutrition and Health. Humana, Cham. https://doi.org/10.1007/978-3-030-15534-6_5

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  • DOI: https://doi.org/10.1007/978-3-030-15534-6_5

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