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Best Practice No 181

Chemical pathology clinical investigation and management of nephrolithiasis

Correspondence to:
Professor T M Reynolds
Clinical Chemistry Department, Queen’s Hospital, Belvedere Road, Burton on Trent, Staffordshire DE13 0RB, UK; tim.reynolds{at}burtonh-tr.wmids.nhs.uk
ABSTRACT
Renal stones have afflicted humans for millennia but there is still no solution to this problem. This review discusses the laboratory and metabolic aspects of the clinical management of patients with renal stones, both primary and secondary in origin. First, non-pharmacological interventions such as increased fluid intake, decreased protein consumption, dietary changes in sodium, calcium, oxalate, potassium, purine, vitamins, and essential fatty acids are considered. Then specific pharmacological treatment to modify urine calcium, oxalate, urate, citrate, and acidity are considered. Finally, more unusual types of stone are examined.

Keywords: nephrolithiasis; calcium oxalate; clinical management; cystinuria; uric acid