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2016 ; 5
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Recent advances in managing and understanding nephrolithiasis/nephrocalcinosis
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Gambaro G
; Trinchieri A
F1000Res
2016[]; 5
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Urinary stone disease is a very common disease whose prevalence is still
increasing. Stone formation is frequently associated with other diseases of
affluence such as hypertension, osteoporosis, cardiovascular disease, metabolic
syndrome, and insulin resistance. The increasing concentration of lithogenic
solutes along the different segments of the nephron involves supersaturation
conditions leading to the formation, growth, and aggregation of crystals.
Crystalline aggregates can grow free in the tubular lumen or coated on the wall
of the renal tubule. Plugs of crystalline material have been highlighted in the
tubular lumen in some patients, but crystalline growth starting from plaques of
calcium phosphate within the renal papillae has been demonstrated in others.
Urinary supersaturation is the result of a complex interaction between
predisposing genetic features and environmental factors. Dietary intake is
certainly the most important environmental risk factor. In particular, an
insufficient intake of dietary calcium (<600 mg/day) can increase the intestinal
absorption of oxalate and the risk of calcium oxalate stone formation. Other
possible risk factors that have been identified include excessive intake of salt
and proteins. The potential role of dietary acid load seems to play an important
role in causing a state of subclinical chronic acidosis; therefore, the intake of
vegetables is encouraged in stone-forming patients. Consumption of
sugar-sweetened soda and punch is associated with a higher risk of stone
formation, whereas consumption of coffee, tea, beer, wine, and orange juice is
associated with a lower risk. A high fluid intake is widely recognized as the
cornerstone of prevention of all forms of stones. The effectiveness of protein
and salt restriction has been evaluated in some studies that still do not allow
definitive conclusions to be made. Calcium stone formation can be prevented by
the use of different drugs with different mechanisms of action (thiazide
diuretics, allopurinol, and potassium citrate), but there is no ideal drug that
is both risk free and well tolerated.
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