symptom of kidney stones : Prevention of Recurrent Nephrolithiasis

The first episode of nephrolithiasis provides an opportunity to advise patients about measures for preventing future stones. Low fluid intake and excessive intake of protein, salt and oxalate are important modifiable risk factors for kidney stones. Calcium restriction is not useful and may potentiate osteoporosis. Diseases such as hyperparathyroidism, sarcoidosis and renal tubular acidosis should be considered in patients with nephrolithiasis. A 24-hour urine collection with measurement of the important analytes is usually reserved for use in patients with recurrent stone formation. In these patients, the major urinary risk factors include hypercalciuria, hyperoxaluria, hypocitraturia and hyperuricosuria. Effective preventive and treatment measures include thiazide therapy to lower the urinary calcium level, citrate supplementation to increase the urinary citrate level and, sometimes, allopurinol therapy to lower uric acid excretion. Uric acid stones are most often treated with citrate supplementation. Data now support the cost-effectiveness of evaluation and treatment of patients with recurrent stones (Am Fam Physician 1999;60:2269-76.)

After an episode of acute urolithiasis, patients are particularly motivated to learn about preventive strategies. Because kidney stones affect as many as 15 percent of men and 7 percent of women in the United States,1 family physicians have frequent opportunities to dispense preventive advice. Compared with urology practices, family practice settings are more conducive to and appropriate for the dissemination of requisite recommendations on the prevention of kidney stones.

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