Disease Information for Kidney stone/urolithiasis/nephrolithias: Definition

  • Incidence of symptomatic ureteral stones is greatest during hot summer months; Diet and fluid intake may be important factors in the development of urinary stones; Those afflicted with recurrent urinary stone disease are encouraged to maintain a diet restricted in sodium and protein intake; Sodium should be restricted to 100 meq/d. Increased sodium intake will increase sodium and calcium excretion, increase monosodium urate saturation (that can act as a nidus for stone growth), increase the relative saturation of calcium phosphate, and decrease urinary citrate excretion;

    All of these factors encourage stone growth; Protein intake should be limited to 1 g/kg/d; An increased protein load can also increase calcium, oxalate, and uric acid excretion and decrease urinary citrate excretion; Bran can significantly decrease urinary calcium by increasing bowel transit time and mechanically binding to calcium; Excess intake of oxalate and purines can increase the incidence of stones in predisposed individuals; Although a reduction in dietary calcium results in reduced urinary calcium, the concurrent increase in urinary oxalate may promote stone formation; Persons in sedentary occupations have a higher incidence of stones than manual laborers; Genetic factors may contribute to urinary stone formation; Cystinuria is an autosomal recessive disorder; Distal renal tubular acidosis may be transmitted as a hereditary trait, and urolithiasis occurs in up to 75% of patients affected with this disorder; Obstructing urinary stones usually present with colic; Pain usually occurs suddenly and may awaken patients from sleep; It is localized to the flank, is usually severe, and may be associated with nausea and vomiting; Patients are constantly moving-in sharp contrast to those with an acute abdomen; The pain may occur episodically and may radiate anteriorly over the abdomen; As the stone progresses down the ureter, the pain may be referred into the ipsilateral testis or labium; If the stone becomes lodged at the ureterovesical junction, patients will complain of marked urinary urgency and frequency; Stone size does not correlate with the severity of the symptoms; Metabolic Evaluation Stone analysis should be performed on recovered stones; Controversy exists in deciding which patients need a thorough metabolic evaluation for stone disease;

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