The first kidney stone and asymptomatic nephrolithiasis in adults
- Glenn M Preminger, MD
Glenn M Preminger, MD
- Section Editor — Renal Ureteral Stones
- Professor of Urologic Surgery
- Duke University Medical Center
- Director of Education
- Endourological Society
- Gary C Curhan, MD, ScD
Gary C Curhan, MD, ScD
- Section Editor — Chronic Kidney Disease
- Editor-in-Chief emeritus
- Harvard Medical School
- Section Editors
- Stanley Goldfarb, MD
Stanley Goldfarb, MD
- Editor-in-Chief — Nephrology
- Section Editor — Mineral and Bone Metabolism; Renal Ureteral Stones
- Professor of Medicine
- University of Pennsylvania School of Medicine
- Michael P O'Leary, MD, MPH
Michael P O'Leary, MD, MPH
- Section Editor — Urology
- Professor of Surgery, Harvard Medical School
- Senior Urologic Surgeon, Brigham and Women's Hospital
Renal stones (nephrolithiasis) are a relatively common problem [1-5]. In the United States, almost 2 million outpatient visits for a primary diagnosis of urolithiasis were recorded in 2000 . Up to 16 percent of men and 8 percent of women will have at least one symptomatic stone by the age of 70 years ; over 80 percent of these stones will contain calcium, usually as calcium oxalate.
The prevalence of kidney stones appears to be increasing in the United States. In a report from the National Health and Nutritional Examination Survey, the prevalence increased from 3.8 percent in the period 1976 to 1980 to 8.4 percent in the period from 2007 to 2010 [1,3]. Furthermore, the male-to-female ratio has changed over the past 25 years, from 3:1 (male:female) to now less than 2:1 [1,6,7]. Whether this represents an actual increase in incidence or an increase in detection is uncertain . If true, some have speculated that it is due to changes in lifestyle factors, such as increasing obesity among women .
The prevalence of nephrolithiasis varies regionally. In one study of over 40,000 men between the ages of 45 and 70 years, the risk of having a history of kidney stones was 13 and 31 percent lower in the mid-Atlantic and northwestern regions, respectively, compared with the southeastern United States . A second study confirmed this regional variation, but found that differences were greatly reduced after adjustment for temperature, sunlight, and beverage consumption .
The prevalence of nephrolithiasis increases with age, is slightly higher in men compared with women, and in whites compared with blacks, Asians, and those of Hispanic ethnicity [1,3,11,12]. Although urinary calcium excretion tends to be lower in blacks [13,14], other urinary factors are similar among patients of different races and ethnicities.
The goal of a diagnostic evaluation of nephrolithiasis is to identify, as efficiently and economically as possible, the particular physiologic defect present in a given patient so that effective therapy can be established and the prognosis can be better defined. Therefore, the type and extent of evaluation depends in part upon the following :
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- THE FIRST KIDNEY STONE
- CONSERVATIVE APPROACH
- Focused history for stone risk factors
- Stone analysis
- APPROACH BASED UPON RISK ASSESSMENT
- Abbreviated protocol
- - Laboratory tests
- - Radiography
- Urine stone risk profile
- ASYMPTOMATIC NEPHROLITHIASIS
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS