Kidney stones are one of the most common urologic problems. In the United States, ~13% of men and 7% of women will develop a kidney stone during their lifetimes, and the prevalence is increasing throughout the industrialized world.
Calcium salts, uric acid, cystine, and struvite are the constituents of most kidney stones in the western hemisphere (Chap. e14). Calcium oxalate and calcium phosphate stones make up 75–85% of the total (Table 287-1) and those constituents may be admixed in the same stone. Calcium phosphate in stones is usually hydroxyapatite [Ca5(PO4)3OH] or, less commonly, brushite (CaHPO4H2O), although the incidence of brushite stones is increasing.
Table 287-1 Major Causes of Renal Stones
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Table 287-1 Major Causes of Renal Stones
|Stone Type and Causes||Percent of all Stonesa||Percent Occurrence of Specific Causesa||Ratio of Males to Females||Etiology||Diagnosis||Treatment|
|Calcium stones||75–85||2:1 to 3:1|
|Idiopathic hypercalciuria||50–55||2:1||? Hereditary||Normocalcemia, unexplained hypercalciuriab||Low-sodium, low-protein diet; thiazide diuretics|
|Hyperuricosuria||20||4:1||Diet||Urine uric acid >750 mg per 24 h (women), >800 mg per 24 h (men)||Allopurinol or low-purine diet|
|Primary hyperparathyroidism||3–5||3:10||Neoplasia||Hypercalcemia with nonsuppressed parathyroid hormone||Surgery|
|Distal renal tubular acidosis||Rare||1:1||Hereditary or acquired||Hyperchloremic acidosis, minimum urine pH >5.5||Alkali replacement|
|Dietary hyperoxaluria||10–30||1:1||High-oxalate diet or low-calcium diet||Urine oxalate >40 mg per 24 h||Low-oxalate, normal-calcium diet|
|Enteric hyperoxaluria||∼1–2||1:1||Bowel surgery||Urine oxalate >75 mg per 24 h||Low-oxalate diet and oral calcium pills|
|Primary hyperoxaluria||Rare||1:1||Hereditary||Urine oxalate and glycolic or l-glyceric acid increased||Fluids, pyridoxine, citrate and neutral phosphate|
|Hypocitraturia||20–40||1:1 to 2:1||? Hereditary, diet||Urine citrate <320 mg per 24 h||Alkali supplements|
|Idiopathic stone disease||20||2:1||Unknown||None of the above present||Oral phosphate, fluids|
|Uric acid stones||5–10|
|Metabolic syndrome||∼30||1:1||Diet||Glucose intolerance, obesity, hyperlipidemia||Alkali and allopurinol if daily urine uric acid >1000 mg|
|Gout||∼30||3:1 to 4:1||Hereditary||Clinical diagnosis||Alkali and allopurinol|
|Idiopathic||∼30||1:1||? Hereditary||Uric acid stones, no gout||Alkali and allopurinol if daily urine uric acid >1000 mg|
|Dehydration||?||1:1||Intestinal, habit||History, intestinal fluid loss||Alkali, fluids, reversal of cause|
|Rare||Males only||Hereditary||Reduced hypoxanthine-guanine phosphoribosyltrans ferase level||Allopurinol|
|Cystine stones||1||1:1||Hereditary||Stone type; elevated cystine excretion||Massive fluids, alkali, D-penicillamine if needed|
|Struvite stones||5||1:3||Infection||Stone type||Antimicrobial agents and judicious surgery|
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