Update in Diagnosis and Management
Interestingly, the exact series of events that transpire during the formation of a kidney stone are poorly understood. Urine is almost always supersaturated in most humans, in some persons more so than others. However, there is likely more to stone formation that simple physical chemistry. Although tubular fluid along a nephron is saturated as early as the thin limb of the loop of Henle, any crystals that nucleate there are not likely to grow big enough to block a tubular lumen and grow into a stone. Therefore, these smaller crystals must aggregate together to form a larger mass, adhere to a tubular cell, or perhaps they even nucleate directly in the renal interstitium and grow into a stone precursor lesion there.
There is evidence to suggest all of these processes occur in certain circumstances and are under the control of various proteins and cell biologic processes. However, as of 2009, we know most about the factors that drive urinary supersaturation and how to treat it. Therefore, the diagnosis and treatment of stone formers is tightly focused on urinary supersaturation, and what factors might be addressed to improve it in individual patients.
Why do Stones Form?
Jump to section:
- Kidney Stones
- Why do Kidney Stones Form?
- Genetics and Environment
- Not All Stones are Created Equal: Stone Analysis is Very Helpful
- Laboratory Evaluation
- Supersaturation Index
- Components of the Urinary Supersaturation Profile
- Uses of Urinary Supersaturation
- Common Features Increase Urinary Supersaturation in Patients with Idiopathic Calcium Oxalate Nephrolithiasis
- "Conservative" Dietary Recommendations for Calcium Oxalate Stone Formers
- Causes of Hypercalciuria
- Genetic Hypercalciuria
- Genetic Hypercalciuria: Treatment
- What is Oxalate?
- Hyperoxaluria: What is the Relevant Concentration?
- Oxalate Balance on a Typical Western Diet
- Enteric Hyperoxaluria is Caused by Fat Malabsorption
- Control of Urinary Citrate: Largely Due to Systemic Acid Base Balance
- Treatments for Enteric Hyperoxaluria
- Low Urinary Citrate
- Hyperuricosuria is a Risk Factor for Calcium Oxalate Stones
- Uric Acid is Very Insoluble at Low pH
- Calcium Phosphate is Very Insoluble at High pH!
- Cystine Stones
- Struvite stones