![]() 1, 4, 9 – 11 Increasing exposure to these risk factors may explain the rising incidence of kidney stones and their prevalence in men, non-Hispanic whites, and persons with low socioeconomic status. 3 – 8 Most are of noninfectious etiology and are associated with low fluid intake, hot climate, and certain comorbidities and risk factors (e.g., hypertension gout obesity nonalcoholic fatty liver disease excessive intake of protein, carbohydrates, and sodium). ![]() 3, 4 Table 1 lists the incidence of different types of kidney stones among children and adults in developed countries. 1, 2 Worldwide, it is also increasing in Europe and is even higher in the hot-climate “stone belt” extending from the southeastern United States to northern Australia. The prevalence of nephrolithiasis (kidney stones) is increasing in the United States, from one in 20 adults in 1994 to one in 11 adults in 2010. Patients at high risk of stone recurrence should be referred for additional metabolic assessment, which can serve as a basis for tailored preventive measures. Lifestyle modifications such as increased fluid intake should be recommended for all patients, and thiazide diuretics, allopurinol, or citrates should be prescribed for patients with recurrent calcium stones. All patients with kidney stones should be screened for risk of stone recurrence with medical history, basic laboratory evaluation, and imaging. Asymptomatic kidney stones should be followed with serial imaging, and should be removed in case of growth, symptoms, urinary obstruction, recurrent infections, or lack of access to health care. Conservative management consists of pain control, medical expulsive therapy with an alpha blocker, and follow-up imaging within 14 days to monitor stone position and assess for hydronephrosis. ![]() The diagnostic workup consists of urinalysis, urine culture, and imaging to confirm the diagnosis and assess for conditions requiring active stone removal, such as urinary infection or a stone larger than 10 mm. During an episode of renal colic, the first priority is to rule out conditions requiring immediate referral to an emergency department, then to alleviate pain, preferably with a nonsteroidal anti-inflammatory drug. Kidney stones are a common disorder, with an annual incidence of eight cases per 1,000 adults. ![]()
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