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Primary Care Jun 2019Incidence of nephrolithiasis has increased dramatically over the past 30 years, likely due to environmental changes such as dietary habits. Nephrolithiasis presents as... (Review)
Review
Incidence of nephrolithiasis has increased dramatically over the past 30 years, likely due to environmental changes such as dietary habits. Nephrolithiasis presents as acute flank or abdominal pain with nausea and vomiting. Hematuria is present in 90% of cases, but its absence does not rule out nephrolithiasis. Most cases can be managed expectantly as an outpatient with hydration, analgesia, and possibly medications to aide in passage. A metabolic evaluation may be indicated after a second episode of nephrolithiasis in adults or after a first episode in children or those with a family history of nephrolithiasis.
Topics: Adult; Child; Female; Hematuria; Humans; Male; Nephrolithiasis; Pregnancy; Pregnancy Complications; Risk Assessment; Risk Factors; Tomography, X-Ray Computed
PubMed: 31030821
DOI: 10.1016/j.pop.2019.02.001 -
Investigative and Clinical Urology Sep 2017Nephrolithiasis is a disease common in both the Western and non-Western world. Several population based studies have demonstrated a rising prevalence and incidence of... (Review)
Review
Nephrolithiasis is a disease common in both the Western and non-Western world. Several population based studies have demonstrated a rising prevalence and incidence of the disease over the last several decades. Recurrence occurs frequently after an initial stone event. The influence of diet on the risk of nephrolithiasis is important, particularly dietary calcium and fluid intake. An increasing intake of dietary calcium and fluid are consistently associated with a reduced risk of incident nephrolithiasis in both men and women. Increasing evidence suggests that nephrolithiasis is associated with systemic diseases like obesity, diabetes, and cardiovascular disease. Nephrolithiasis places a significant burden on the health care system, which is likely to increase with time.
Topics: Delivery of Health Care; Diet; Environment; Health Care Costs; Humans; Incidence; Nephrolithiasis; Prevalence; Recurrence; Risk Factors; United States
PubMed: 28868500
DOI: 10.4111/icu.2017.58.5.299 -
Urology May 2021To review the literature regarding the epidemiology of stone disease and develop a management algorithm based on current evidence and societal guidelines. (Review)
Review
OBJECTIVES
To review the literature regarding the epidemiology of stone disease and develop a management algorithm based on current evidence and societal guidelines.
METHODS
A structured literature review was performed to determine highest quality of evidence guiding care for pregnant patients with symptomatic nephrolithiasis. PUBMED and EMBASE databases were searched using terms "pregnancy," "nephrolithiasis," or "pregnancy" and "renal colic" alone and in combination with "stone", "kidney stone," "ultrasound," "MRI," "CT," "percutaneous nephrostomy," "ureteral stent," or "ureteroscopy." All English-language abstracts were reviewed for relevance and full-length articles were reviewed for content. Articles published prior to 1990 were excluded, and priority for inclusion was given to multi-institutional studies and larger institutional studies, reflecting the highest level of current available evidence and most contemporaneous practice patterns.
RESULTS
Symptomatic nephrolithiasis affects less than 1% of pregnancies but poses unique diagnostic challenges due to the physiologic changes of pregnancy and risks of ionizing radiation exposure to the fetus. Ultrasound remains the imaging modality of choice. Most patients may be managed non-operatively, but drainage with percutaneous nephrostomy or ureteral stent may be performed if warranted. Growing evidence also supports the safety and efficacy of definitive stone treatment.
CONCLUSIONS
Though rare, symptomatic nephrolithiasis poses significant clinical challenges due to the need to minimize risk for both mother and fetus with diagnostic and therapeutic interventions. A multi-disciplinary approach is paramount, as is shared decision making with the patient at each step of care.
Topics: Female; Humans; Nephrolithiasis; Pregnancy; Pregnancy Complications
PubMed: 32866511
DOI: 10.1016/j.urology.2020.06.097 -
Primary Care Jun 2008Kidney stones affect more than 5% of adults in the United States, and the prevalence is rising. The fundamental cause for all stones is supersaturation of urine with... (Review)
Review
Kidney stones affect more than 5% of adults in the United States, and the prevalence is rising. The fundamental cause for all stones is supersaturation of urine with respect to the stone components; factors affecting solubility include urine volume, pH, and total solute excretion. Calcium stones are the most common in both adults and children and are associated with several metabolic disorders, the most common of which is idiopathic hypercalciuria. Therapy to prevent stones rests on lowering supersaturation, using both diet and medication. Effective treatment decreases stone recurrence and the need for procedures for stone removal.
Topics: Acute Disease; Humans; Hypercalciuria; Hyperoxaluria; Hyperparathyroidism; Nephrolithiasis; Risk Factors; United States; Uric Acid
PubMed: 18486720
DOI: 10.1016/j.pop.2008.01.005 -
Nephrology, Dialysis, Transplantation :... Jan 2016Dietary sodium chloride intake is nowadays globally known as one of the major threats for cardiovascular health. However, there is also important evidence that it may... (Review)
Review
Dietary sodium chloride intake is nowadays globally known as one of the major threats for cardiovascular health. However, there is also important evidence that it may influence idiopathic calcium nephrolithiasis onset and recurrence. Higher salt intake has been associated with hypercalciuria and hypocitraturia, which are major risk factors for calcium stone formation. Dietary salt restriction can be an effective means for secondary prevention of nephrolithiasis as well. Thus in this paper, we review the complex relationship between salt and nephrolithiasis, pointing out the difference between dietary sodium and salt intake and the best methods to assess them, highlighting the main findings of epidemiologic, laboratory and intervention studies and focusing on open issues such as the role of dietary salt in secondary causes of nephrolithiasis.
Topics: Animals; Diet; Humans; Nephrolithiasis; Risk Factors; Sodium Chloride, Dietary
PubMed: 25031016
DOI: 10.1093/ndt/gfu243 -
Current Opinion in Nephrology and... Mar 2020Men have more kidney stones compared with women; however, the difference is progressively decreasing. The reasons for higher prevalence of stones in men, as well as... (Review)
Review
PURPOSE OF REVIEW
Men have more kidney stones compared with women; however, the difference is progressively decreasing. The reasons for higher prevalence of stones in men, as well as increasing prevalence in women, is a subject of ongoing speculation. In this review, we summarize the evidence of differences between men and women and expand on the speculative causes.
RECENT FINDINGS
Stone incidence is rising in women and adolescent girls. Stone disease is more heritable among men than women, and women demonstrate greater influence of the unique environment. Women under the age of 50 years who have been pregnant, have more than double the odds of kidney stones compared with those who have never been pregnant. Women are more burdened with obesity, bariatric surgery and dieting, all associated with increased stones. Women have higher urinary pH because of greater absorption of dietary organic anions leading to increased urinary citrate, compared with men, and they differ in tubular calcium handling.
SUMMARY
It is obvious that the cause of stones in men and women is complex and requires further study. Potential clues offered are in the change of the female environment, influencing increasing incidence in stones, particularly of younger women and female adolescents.
Topics: Adolescent; Calcium; Female; Humans; Male; Nephrolithiasis; Pregnancy; Prevalence; Sex Characteristics
PubMed: 31789849
DOI: 10.1097/MNH.0000000000000577 -
Pediatric Annals Jun 2017The incidence of pediatric nephrolithiasis is on the rise. The composition of kidney stones in children is different than in adults, as most stones in children have a... (Review)
Review
The incidence of pediatric nephrolithiasis is on the rise. The composition of kidney stones in children is different than in adults, as most stones in children have a composition of calcium oxalate and calcium phosphate mixed with a small amount of uric acid. The symptoms of pediatric nephrolithiasis are nonspecific. Computed tomography (CT) is the gold standard for diagnosis; however, because of radiation exposure associated with a CT scan, ultrasonography is also an accepted modality for the diagnosis. Extensive metabolic evaluation is important to rule out an underlying metabolic disorder. Urinary decompression, medical expulsion therapy, and surgical interventions such as ureteroscopy and extracorporeal shockwave lithotripsy are some of the options available for treating pediatric nephrolithiasis. [Pediatr Ann. 2017;46(6):e242-e244.].
Topics: Child; Humans; Kidney Calculi; Lithotripsy; Nephrolithiasis; Tomography, X-Ray Computed; Ultrasonography; United States; Ureteroscopy
PubMed: 28599030
DOI: 10.3928/19382359-20170517-02 -
Pediatric Annals Jun 2020Pediatric nephrolithiasis is a disease of increasing prevalence and economic burden, with data showing a rising trend among girls and adolescents. Kidney stones in... (Review)
Review
Pediatric nephrolithiasis is a disease of increasing prevalence and economic burden, with data showing a rising trend among girls and adolescents. Kidney stones in children tend to have a high recurrence rate related to underlying risk factors, and the aim of evaluation should be to understand such causes so that targeted therapy can be provided to decrease recurrence and complications. Metabolic, anatomic, and genetic abnormalities as well as environmental risk factors have all been implicated in the pathogenesis of nephrolithiasis. Recent studies have focused on identifying monogenic causes of nephrolithiasis and/or nephrocalcinosis in young patients that would result in personalization of treatment as well as future diagnostic implications for family members. Treatment aims to decrease stone burden and recurrence as well as minimize complications and is guided by stone size and location as well as surgical expertise. Multidisciplinary care for these patients has been on the rise to provide a more comprehensive medical and surgical support. [Pediatr Ann. 2020;49(6):e262-e267.].
Topics: Adolescent; Child; Female; Genetic Predisposition to Disease; Humans; Lithotripsy; Male; Medical History Taking; Nephrolithiasis; Physical Examination; Recurrence; Risk Factors; Urological Agents
PubMed: 32520367
DOI: 10.3928/19382359-20200518-01 -
Advances in Chronic Kidney Disease Sep 2011Similar to adults, stone disease in the pediatric patient may present clinically as flank/abdominal pain or hematuria. Unlike in adults, pediatric stone disease is less... (Review)
Review
Similar to adults, stone disease in the pediatric patient may present clinically as flank/abdominal pain or hematuria. Unlike in adults, pediatric stone disease is less frequent and is often associated with an underlying metabolic disorder. Because of the 50% likelihood of finding an underlying metabolic cause for stone formation in younger children, a metabolic workup is recommended for all children with stone disease, including first-time stone formers. Stone analysis, when available, can be very helpful in determining an underlying cause. If needed, all modalities of minimally invasive surgical treatment are possible for children with stones. Surgical approaches may be needed to achieve the goal of nephron preservation. Aggressive fluid intake is the mainstay of prevention for all forms of stone disease, but specific therapy targeted to the most likely underlying metabolic abnormality is often used. Newer data are now linking stone disease to CKD, thereby emphasizing the need for a better understanding and potentially more aggressive treatment approach. With increasing frequency of stone disease in the pediatric patient and increasing survival of these patients into adulthood, the adult caregiver must become familiar with different causes and treatment approaches to stone disease in young adult patients in whom disease onset began in childhood.
Topics: Child; Female; Fluid Therapy; Hematuria; Humans; Male; Metabolic Diseases; Minimally Invasive Surgical Procedures; Nephrolithiasis; Renal Insufficiency, Chronic; Secondary Prevention; Sex Factors
PubMed: 21896379
DOI: 10.1053/j.ackd.2011.07.002 -
Current Urology Reports Mar 2020From health systems to individuals, nephrolithiasis is economically burdensome. The aim of the current paper is to characterize the financial burden of disease... (Review)
Review
PURPOSE OF REVIEW
From health systems to individuals, nephrolithiasis is economically burdensome. The aim of the current paper is to characterize the financial burden of disease associated with nephrolithiasis with an emphasis on investigating treatment modality economic efficiency.
RECENT FINDINGS
For small volume practices and cases where there is high risk of scope damage, disposable flexible ureteroscope utilization seems to provide economic efficiency. The rise in global prevalence of stone disease is a large contributing factor to increasing costs associated with nephrolithiasis. A large proportion of costs from kidney stones stem from ED visits and inpatient care. There are opportunities to save money by transitioning care to outpatient settings in scenarios that allow such transition. Metaphylaxis and prevention strategies are effective at lowering costs in properly selected patient populations. Flexible ureteroscopy and percutaneous nephrolithotomy (PCNL) are the most economically efficient methods of surgically treating stone disease, with PCNL being reserved for large and lower pole stones. Time off work and other indirect costs, while challenging to quantify, are important considerations in the economics of nephrolithiasis.
Topics: Cost of Illness; Humans; Nephrolithiasis; Treatment Outcome
PubMed: 32236700
DOI: 10.1007/s11934-020-00971-6