Kidney Stones
Urinary stone disease is characterized by crystalline depositions (called calculi) in the renal calyces, pelvis, or ureter, which are classified due to their location and chemical composition. About 80 % of urinary stones are calcium oxalate stones with a
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Introduction to Kidney Stones Urinary stone disease is characterized by crystalline depositions (called calculi) in the renal calyces, pelvis, or ureter, which are classified due to their location and chemical composition. About 80 % of urinary stones are calcium oxalate stones with a variable amount of calcium phosphate. Less than 20 % of stones are non-calcium calculi composed out of uric acid, magnesium ammonium phosphate (struvite), or cysteine (two cysteines linked by a disulfide bond). Stone disease (ureterolithiasis) occurs with an increasing prevalence in the population of industrialized countries, currently ~ 9 % in the United States (compared with only ~5 % in 1994) [1], causing a significant health-care burden in the working-age population. The prevalence is higher for men (with ~11 %) than for women (with ~7 %). After a first calcium stone, the risk
A. Neisius Department of Urology, Universitätsmedizin der Johannes-Gutenberg Universität, Langenbeckstrasse 1, Mainz 55131, Germany Division of Urologic Surgery, Department of Urology, Comprehensive Kidney Stone Center, Duke University Medical Center, Room 1572D, White Zone, 3167, Durham, NC 27710, USA e-mail: [email protected] G.M. Preminger (*) Department of Urology, Universitätsmedizin der Johannes-Gutenberg Universität, Langenbeckstrasse 1, Mainz 55131, Germany e-mail: [email protected]
of recurrence is 40 % at 5 years and 75 % at 20 years. Recently, incidence of stone disease has been correlated to the “metabolic syndrome” (see chapter “Metabolic syndrome”) [2]. Recognized risk factors are determined by various metabolic and environmental factors (Fig. 1), but some are related to genetics. These factors have to be analyzed individually depending on stone analysis and 24-h urine profiles. In this chapter, we will provide a brief review of the pathophysiology of stone disease, its metabolic evaluation, and selective medical treatment, which is highly effective in preventing new stone formation, thereby reducing the need for repeated invasive procedures in patients predisposed to nephrolithiasis.
Pathophysiology of Kidney Stones and Metabolic Alterations Epidemiology and Evaluation of Nephrolithiasis The urinary environment of stone patients is conducive to the crystallization of stone-forming salts, due to increased supersaturation and/ or reduced inhibitor activity. A metabolic or environmental etiology (i.e., dietary habits) can be found in ~97 % of stone disease patients [3]; genetic reasons are rare and include cystinuria [4] and primary hyperoxaluria. Environmental triggers for stone formation include low urinary volume, low urinary Mg2+,
E. Lammert, M. Zeeb (eds.), Metabolism of Human Diseases, DOI 10.1007/978-3-7091-0715-7_53, © Springer-Verlag Wien 2014
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A. Neisius and G.M. Preminger
362 Lifestyle, diet, climate, occupation
Genetics and epigenetics Gender, ancestry
Inhibitors Citrate Magnesium
Promoters Sodium intake Dietary calcium High acid intake Kidney stones Non-infection stones
Drug treatment
Metaboli
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