Review

Nephrolithiasis: Evaluation and Management

Authors: Zachary Z. Brener, MD, James F. Winchester, MD, Hertzel Salman, MD, Michael Bergman, MD

Abstract

Nephrolithiasis is a major cause of morbidity involving the urinary tract. The prevalence of this disease in the United States has increased from 3.8% in the 1970s to 5.2% in the 1990s. There were nearly two million physician-office visits for nephrolithiasis in the year 2000, with estimated annual costs totaling $2 billion. New information has become available on the clinical presentation, epidemiologic risk factors, evaluative approach, and outcome of various therapeutic strategies. In this report, we will review the epidemiology and mechanisms of kidney-stone formation and outline management aimed at preventing recurrences. Improved awareness and education in both the general population and among health-care providers about these modifiable risk factors has the potential to improve general health and decrease morbidity and mortality secondary to renal-stone disease.


Key Points


* Nephrolithiasis is a major cause of morbidity involving the urinary tract.


* Increasing daily fluid intake is very important in preventing recurrent stone disease.


* The cornerstone of the evaluation is 24-hour urine collection.


* The mostly commonly-used noninvasive procedure for smaller stones is lithotripsy.

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