Access Nephrology

A Commitment To Private Practice In Renal Medicine

RENAL CALCULI – KIDNEY STONE DISEASE

Diagnosis

  1. The presence of kidney calculi is established through kidney imaging (usually CT scanning).
  2. 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.
  3. Determining whether there is a systemic disease, such as hyperparathyroidism, that may contribute to stone formation.
  4. Excluding genetic stone forming diseases such as cysteinuria.

Management

  • 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.