Renal stone disease is a most ancient and common affliction of man. Over a seventy-year life span, it is estimated that as many as 15% of some populations will develop renal stones. No age is spared and no country or ethnic group protected from this common clinical problem. Most, but not all, patients who develop a stone will eventually form others. Although very few individuals die as a direct result of stone disease, it does lead to substantial morbidity from pain, urinary tract infections and obstructive uropathy.
In the past few decades, substantial progress has been made in understanding the basic pathophysiologic mechanisms of stone disease, which has subsequently led to rational and effective programs for both its treatment and prevention of recurrence. Diagnostic study protocols to identify underlying mechanisms have now become available in most countries, thereby allowing for an accurate categorization of patients with renal stone disease.
This handbook is oriented toward clinicians and health care professionals to help them quickly and effectively study and treat patients with stone disease and assist them in developing effective approaches to the prevention of further stone development. In addition, it is written in a manner that could make it very useful in explaining to patients the more important aspects of their disease. It is very well organized, making it simple to use as a reference work and its utility is strengthened by an outline format, which facilitates understanding of diagnostic studies and treatment plans. All of the major stone types are discussed in detail, including sections on the less frequent stones, such as those composed of xanthine and 2,8-dihydroxyadenine. Of particular value is the discussion of diagnostic studies to be performed in those patients for whom a stone is not available for analysis, an increasingly common event now that lithotripter use has made it more difficult to recover stones.
With our ability to determine more accurately than ever the basic mechanisms of stone formation and, therefore, to develop more effective treatment programs, recurrent stone disease should become less and less common. The editors and authors of this text have made an important contribution to this effort with this handbook which should be of immense help to health care professionals who care for patients with renal stones in efficiently and effectively guiding them through the appropriate diagnostic studies and the development of safe plans for treatment and prevention. Their patients will be ultimate beneficiaries of this text. We are grateful to its editors and authors for such a useful and usable book.
Contents
Introduction 1
General aspects 7
The emergency stone – Treatment of patients with acute renal colic 8
Standard procedures – Treatment and care of patients with urinary stones 21
Type of stone 37
Calcium oxalate stones 38
Uric acid stones 66
Calcium phosphate stones 86
Struvite stones 108
Cystine stones 124
2,8-Dihydroxyadenine stones 142
Xanthine stones 152
Ammonium urate stones 160
Appendix 173
Interventional procedures 174
Absorption/loading tests 178
Risk indices 186
Examination under standardized dietary conditions 190
Analytical methods 192
Unusual stone components/artifacts 198
Tables 1–3: Calcium, oxalate and purine contents of foods 200
Tables 4–6: Reference values for children 206
Crystals in the urinary sediment (colored illustrations) 213
References 216
Subject index 227