Kidney stones are one of the most common urologic problems. In the United States, ~13% of men and 7% of women will develop a kidney stone during their lifetimes, and the prevalence is increasing throughout the industrialized world.
Calcium salts, uric acid, cystine, and struvite are the constituents of most kidney stones in the western hemisphere (Chap. e14). Calcium oxalate and calcium phosphate stones make up 75–85% of the total (Table 287-1) and those constituents may be admixed in the same stone. Calcium phosphate in stones is usually hydroxyapatite [Ca5(PO4)3OH] or, less commonly, brushite (CaHPO4H2O), although the incidence of brushite stones is increasing.
Table 287-1 Major Causes of Renal Stones
| Favorite Table
Table 287-1 Major Causes of Renal Stones
|Stone Type and Causes||Percent of all Stonesa||Percent Occurrence of Specific Causesa||Ratio of Males to Females||Etiology||Diagnosis||Treatment|
|Calcium stones||75–85||2:1 to 3:1|
|Idiopathic hypercalciuria||50–55||2:1||? Hereditary||Normocalcemia, unexplained hypercalciuriab||Low-sodium, low-protein diet; thiazide diuretics|
|Hyperuricosuria||20||4:1||Diet||Urine uric acid >750 mg per 24 h (women), >800 mg per 24 h (men)||Allopurinol or low-purine diet|
|Primary hyperparathyroidism||3–5||3:10||Neoplasia||Hypercalcemia with nonsuppressed parathyroid hormone||Surgery|
|Distal renal tubular acidosis||Rare||1:1||Hereditary or acquired||Hyperchloremic acidosis, minimum urine pH >5.5||Alkali replacement|
|Dietary hyperoxaluria||10–30||1:1||High-oxalate diet or low-calcium diet||Urine oxalate >40 mg per 24 h||Low-oxalate, normal-calcium diet|
|Enteric hyperoxaluria||∼1–2||1:1||Bowel surgery||Urine oxalate >75 mg per 24 h||Low-oxalate diet and oral calcium pills|
|Primary hyperoxaluria||Rare||1:1||Hereditary||Urine oxalate and glycolic or l-glyceric acid increased||Fluids, pyridoxine, citrate and neutral phosphate|
|Hypocitraturia||20–40||1:1 to 2:1||? Hereditary, diet||Urine citrate <320 mg per 24 h||Alkali supplements|
|Idiopathic stone disease||20||2:1||Unknown||None of the above present||Oral phosphate, fluids|
|Uric acid stones||5–10|
|Metabolic syndrome||∼30||1:1||Diet||Glucose intolerance, obesity, hyperlipidemia||Alkali and allopurinol if daily urine uric acid >1000 mg|
|Gout||∼30||3:1 to 4:1||Hereditary||Clinical diagnosis||Alkali and allopurinol|
|Idiopathic||∼30||1:1||? Hereditary||Uric acid stones, no gout||Alkali and allopurinol if daily urine uric acid >1000 mg|
|Dehydration||?||1:1||Intestinal, habit||History, intestinal fluid loss||Alkali, fluids, reversal of cause|
|Rare||Males only||Hereditary||Reduced hypoxanthine-guanine phosphoribosyltrans ferase level||Allopurinol|
|Cystine stones||1||1:1||Hereditary||Stone type; elevated cystine excretion||Massive fluids, alkali, D-penicillamine if needed|
|Struvite stones||5||1:3||Infection||Stone type||Antimicrobial agents and judicious surgery|
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessMedicine Full Site: One-Year Subscription
Connect to the full suite of AccessMedicine content and resources including more than 250 examination and procedural videos, patient safety modules, an extensive drug database, Q&A, Case Files, and more.
Pay Per View: Timed Access to all of AccessMedicine
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.