Metabolic evaluation may prevent stone recurrence, is economically sound yet vastly underused.
In first time stone formers conservative therapy with dietary advice is cost-effective. In recurrent stone formers however, medical therapy significantly reduces recurrence and is cost effective.
- Basic metabolic evaluation (for every stone former)
- Medical history including dietary intake
- Urine test: urinalysis and urine pH
- Blood test: RFT, calcium, uric acid level
- Stone analysis
- Comprehensive metabolic evaluation (for high risk stone former)
Recurrent stone former
Young stone formers (under 30)
>1 significant stone at presentation
Stone type: Non-calcium urinary tract stones (infection stones, uric acid stones, cystine stone)
Predisposing medication conditions: Gout, DM, obesity, hyperparathyroidism, GI disease
Strong family history
- In addition to basic metabolic work-up, 24-hour urine analysis is necessary to identify predisposing factors for recurrent kidney stones.
- 24 hour urine analysis usually includes the assessment of:
total volume, urine pH, creatinine, sodium, calcium , oxalate, uric acid and citrate