Management of patients with kidney stones

Abstract

Proper management of lithiasis-related diseases is essential, as they often cause pain that can be difficult to alleviate, leading to significant morbidity and substantial healthcare costs. In rare cases, lithiasis may indicate a more serious underlying condition that could progress to chronic kidney disease. The French Association of Urology (AFU) provides recommendations for the initial assessment of any patient experiencing a first episode of lithiasis, emphasizing the importance of stone analysis, dietary assessment, and crystalluria analysis when available. Simple measures, such as ensuring adequate hydration and a balanced intake of sodium, protein, and calcium, can help reduce the risk of stone formation in most cases. The use of a crystallization inhibitor, such as citrate, may also be indicated. Additional treatments may be considered depending on the stone type and any underlying biochemical abnormalities. These guidelines also describe criteria leading to a more comprehensive secondary evaluation, which may reveal conditions such as hyperoxaluria. This condition can be dietary, secondary to malabsorption, or due to genetic causes, such as primary hyperoxaluria (PH). Diagnosing PH is particularly crucial in the case of type 1 PH, as it can lead to renal failure and systemic oxalate accumulation, with a high risk of immediate recurrence in transplanted kidneys. Before the advent of RNA interference (siRNA) therapies, conservative treatment options—such as pyridoxine, hyperhydration, and crystallization inhibitors—were the primary strategies to slow the progression toward renal failure, with combined liver-kidney transplantation considered for end-stage renal disease. Current approaches now favor isolated kidney transplantation with adjunctive siRNA therapy, although this strategy requires careful, case-by-case consideration.