![]() Laboratory tests: electrolyte, blood urea nitrogen, creatinine, calcium, phosphate and uric acid levels, urinalysis, urine culture if indicated, stone analysis if available (if not, consider qualitative cystine screening) History: medications, occupation, family history of stones or other kidney disease, inflammatory bowel Disease (e.g., Crohn's disease)ĭiet: intake of protein, purines, sodium, fluids, oxalate and calcium Data now support the cost-effectiveness of evaluation and treatment of patients with recurrent stonesĮvaluation of patient with first stone episode Uric acid stones are most often treated with citrate supplementation. 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. In these patients, the major urinary risk factors include hypercalciuria, hyperoxaluria, hypocitraturia and hyperuricosuria. A 24-hour urine collection with measurement of the important analytes is usually reserved for use in patients with recurrent stone formation. Diseases such as hyperparathyroidism, sarcoidosis and renal tubular acidosis should be considered in patients with nephrolithiasis. Calcium restriction is not useful and may potentiate osteoporosis. Low fluid intake and excessive intake of protein, salt and oxalate are important modifiable risk factors for kidney stones. The first episode of nephrolithiasis provides an opportunity to advise patients about measures for preventing future stones.
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