- The presence of kidney calculi is established through kidney imaging (usually CT scanning).
- Metabolic profiling, measuring substances in the blood such as uric acid, calcium, phosphate, and metabolites in urine such as calcium, phosphate, citrate, uric acid and oxalate are useful.
- Determining whether there is a systemic disease, such as hyperparathyroidism, that may contribute to stone formation.
- Excluding genetic stone forming diseases such as cysteinuria.
- Much depends on whether there was a single episode of kidney stone, recurrent episodes associated with complications, or whether there is a disease process which if treated would reduce the chances of kidney stone.
- The patient’s symptomatologies are very important in determining whether intervention is required.
- Treatments begins with a very good fluid through-put to maintain a urine volume of about 2L/day.
- Patient’s with a raised urinary calcium may benefit from Thiazide diuretics.
- Dietary restriction generally is not helpful; particularly reducing dietary calcium input. There are rare exceptions. For example:
- Patients with an excessive oxalate intake my benefit by dietary manipulation. These often are dietary faddists on an excess of vegetable blended diets.
- In a similar vein, patients with excessive animal protein intake may benefit by some protein restriction.
- Preventing calcium stone nucleation with citrate (Urocit-K), or Allopurinol, is useful particularly if the patient has a low urinary citrate or has uricosuria.
- Preventative medical treatment is most effective if there has been surgical “stone clearance” by the Urologist.