A diagnostic-therapeutic pathway for patients with kidney stone disease: 2020 update

Abstract

The natural history of urinary kidney stone disease includes the risk of relapses and can be associated with the risk of chronic kidney disease, bone and cardiovascular disease. For this reason, a wide clinical-metabolic assessment of the kidney stone patient is of great importance since the first presentation of the stone, to set an appropriate preventive treatment. The proposed diagnostic-therapeutic pathway includes a careful medical history, in order to highlight a secondary kidney stone disease and the main risk factors for kidney stones, chronic renal disease, or cardiovascular and bone disease; a metabolic evaluation on multiple levels, according to the severity of the disease, and the presence or absence of risk factors, and appropriate instrumental investigations.

Thus, the information collected makes it possible to set a preventive treatment consisting of general rules and, if necessary, specific pharmacological or nutritional interventions.

This paper has been prepared by the Italian Multidisciplinary Study Group for Kidney Stone Disease, and it is addressed to the several professional figures involved in the management of patients suffering from nephrolithiasis, from the emergency doctor to the general practitioner, urologist, nephrologist, radiologist, and dietician.

A diagnostic-therapeutic pathway for patients with kidney stone disease was first published on this Journal in 2010. The present contribution aims at amending and updating the article published exactly ten years ago, to serve as an easy-to-use reference and to guide good clinical practice in this field.

 

Keywords: kidney stones, urolithiasis, nutrition, diagnosis, prevention

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Introduzione

La calcolosi urinaria, da sempre ritenuta patologia di esclusiva pertinenza chirurgica, deve più propriamente essere considerata una malattia sistemica e di interesse multidisciplinare. Infatti, il miglioramento delle tecniche di laboratorio, strumentali e delle conoscenze epidemiologiche ha consentito di ampliare le conoscenze sulla fisiopatologia della nefrolitiasi, mettendo in evidenza una serie di “alterazioni” biochimiche, la cui correzione, quando possibile, può influenzare favorevolmente il decorso della malattia litiasica e delle sue complicanze. Si sono così andate delineando le caratteristiche di un approccio medico alla malattia che affianchi ed integri quello chirurgico. Purtroppo, nonostante l’esistenza di linee guida sull’argomento [1-3], il paziente affetto da nefrolitiasi trova ancora oggi difficoltà nell’individuare le figure professionali di cui avvalersi per una diagnostica metabolica più ampia. 

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