General Advice on Recurrent Stone Former

General factors

Early onset of urolithiasis (especially children and teenagers)

Familial stone formation

Brushite-containing stones (CaHPO4.2H2O)

Uric acid and urate-containing stones

Infection stones

Solitary kidney (the kidney itself does not particularly increase the risk of stone formation, but prevention

Diseases associated with stone formation


Metabolic syndrome


Gastrointestinal diseases (i.e., jejuno-ileal bypass, intestinal resection, Crohn’s disease, malabsorptive conditions, enteric hyperoxaluria after urinary diversion) and bariatric surgery


Genetically determined stone formation

Cystinuria (type A, B and AB)

Primary hyperoxaluria


Renal tubular acidosis (RTA) type I


Lesch-Nyhan syndrome

Cystic fibrosis

Anatomical abnormalities associated with stone formation

Medullary sponge kidney (tubular ectasia)

Ureteropelvic junction (UPJ) obstruction

Calyceal diverticulum, calyceal cyst

Ureteral stricture

Vesico-uretero-renal reflux

Horseshoe kidney


Drugs associated with stone formation

Active compounds crystallizing in urine

Allopurinol/oxypurinol, Amoxicillin/ampicillin, Ceftriaxone, Quinolones, Ephedrine Indinavir, Magnesium trisilicate, Sulphonamides, Triamterene, Zonisamide

Substances impairing urine composition

Acetazolamide, Allopurino, Aluminum magnesium hydroxide, Ascorbic acid, Calcium, Furosemide, Laxatives, Methoxyflurane, Vitamin D, Topiramate

Selection of Patients for Metabolic Evaluation

Nowadays there is still a debate which patient requires metabolic evaluation. One helpful consideration could be the stratification of patient to low and high risk of recurrence. For routine every day practice abbreviated protocol for low-risk single stone formers may be applied in stone formers evaluated without increases risk of recurrence [2, 3] (Table 24.2). A comprehensive evaluation is mandatory in patient who present with episodes of recurrence and are evaluated as stone formers at high risk. Historically extensive metabolic evaluation included fast and calcium loaded tests in order to discriminate between various forms of hyperoxaluria. In every day setting routine performance of calcium fast/load test is not required t complete metabolic evaluation (Table 24.3). Most urologists would perform specific metabolic evaluation of collection of two consecutive 24-h urine samples [4, 7]. For the initial specific metabolic work-up, the patient should stay on a self-determined diet under the conditions of everyday lifestyle. Follow-up should be performed at 6–12 weeks after the initiation of treatment regimen for stone recurrence.

Table 24.2
Abbreviated protocol for low-risk single stone formers

Low-risk single stone formers

Medical history

Information on dietary habits and social history

Blood investigations

Urine investigations


Stone analyses

Rule out bowel disease, chronic diarrhea, Crohn, (enteric hyperoxaluria), gout (hyperuricosuria), leading to calcium oxalate or uric acid stone formation

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Nov 21, 2017 | Posted by in UROLOGY | Comments Off on General Advice on Recurrent Stone Former

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