Nephrolithiasis. Pathofisiology, metabolic evaluation, and therapy

Abstract

Nephrolithiasis is a frequent disease in developed and developing countries. Its prevalence varies from 4 to 20%, and increases with age in both sexes. It is more frequent among young men. Recurrences are common, and many times the episodes of renal colic require endoscopic procedures or surgical interventions. In average, 15% of the patients have a recurrence within the year after the first episode of renal colic, and the rates of recurrence climb to 40 and 60% after 5 and 10 years, respectively. There are genetic factors that explain familial aggregation of kidney stones. There are dietary factors that contribute importantly to the future risk of recurrence. In more than 90% of those affected it is possible to identify metabolic alterations that not only help in making an etiological diagnosis, but also allow a more rational management, with dietary intervention and pharmacological treatment when indicated. This management can significantly decrease the rate of recurrence. This review considers the pathophysiology of hypercalciuria, hyperoxaluria, hypocitraturia, and of uric acid and cystine stone formation. Guidelines are provided for the management of the renal colic, and for the long term dietary and pharmacological treatment of each type of urolithiasis.