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1、reVieWCMEEDUCATIONALOBJECTIVE:ReaderswilldistinguishthevarioustypesofurinestonesandenumerateCREDITmeasurestopreventtheirrecurrencePhilliPM.hall,MDDepartmentofNephrology,GlickmanUrologicalandKidneyInstitute,ClevelandClinicNephrolithiasis:Treatment,causes,andprevention
2、■■AbstrActKidneystonesarenotallthesame,andneitheraretheircauses(TABLE1),treat-Factorsthatpromotestoneformationincludelowdailyment,andprevention.Thispaperreviewstheurinevolumes;saturationoftheurinewithcalcium,diagnosticapproachandpathophysiologicoxalate,calciumphospha
3、te,uricacid,orcystine;acidicmechanismsfornephrolithiasisinordertopro-urine;andbacterialinfection.Theauthoridentifiesthevidearationaleforpreventivemanagement.mechanismsofstoneformationandoutlinesmanage-Seerelatedarticle,page592mentaimedatpreventingrecurrences.■■KeyPoi
4、nts■COMMONANDONTHEINCREASEDuringanacutestoneevent,medicalmanagementNephrolithiasisiscommon,withalifetimefocusesonpaincontrol.Hydrationandcertaindrugsmayprevalenceof10%inmenand5%inwomen.1,2helpthestonetopass.Studieshaveshownthattheprevalenceisin-creasingintheUnitedSta
5、tes.InthesecondMoststonesarecomposedofcalciumoxalateorcalciumNationalHealthandNutritionExaminationSurvey(1988–1994),theprevalenceinadultsphosphate.Lesscommonareuricacid,magnesiumam-ages20to74wasgreaterthaninthe1976–moniumphosphate,andcystinestones.31980survey(5.2%vs3
6、.2%).TheincreasewasobservedinwhitesbutnotinAfricanAmeri-Topreventstonesfromrecurring,patientswhohavehadcansorMexicanAmericans,wasgreaterinanytypeofstoneshouldmaintainanadequatefluidmenthaninwomen,andwasgreaterwithageintaketokeeptheurinedilute.ineachtimeperiod.Inaddit
7、ion,stonesoftenrecur,andeachParadoxically,calciumrestrictionisnotwarrantedforstoneeventcanbeassociatedwithsignificantpatientswhohavehadcalciumstones,andmayevenbemetabolicandintervention-relatedmorbidity.harmful.■pRESENTATION:SEVERECOLICAlkalinizationoftheurinemayhelp
8、preventrecurrentMostpatientspresentwithmoderatetosevereuricacidstonesandcystinestones.colic,causedbythestoneenteringtheureter.Stone
