2014 Top Stories in Urology: Medical Management of Stone Disease.


In 2014, the American Urological Association (AUA) released a clinical guidelines document focused on the medical management of kidney stone disease.1 This important, but often overlooked, aspect of stone management is an “orphan” field. It requires administration and titration of medications, which is not something that urologists commonly do, but it also entails an understanding of surgical stone management, which is not something that nephrologists commonly do.

The document provides detailed guidelines for the metabolic evaluation and medical management of stone patients, with associated levels of evidence (eg, treatment “standards” based on higher level of evidence vs “expert opinion”) to enable the reader to understand the basis for the recommendations. The detailed literature review combined with professional opinion provides recommendations for initial evaluation, dietary therapies, pharmacologic therapies, and follow-up of newly diagnosed patients and those with recurrent disease.

These guidelines are most welcome, as they demystify and organize the approach to the management of patients with this complex problem. While treating a stone surgically is in the purview of most urologists, employing dietary and pharmacological means to reduce recurrence is a less comfortable task for many. The latter is particularly important given the high recidivism of stone formers, the quality-of-life concerns associated with recurrent symptomatic disease, and the significant financial costs associated with this disease.

The lack of level 1 evidence in the guidelines is apparent and calls for more rigorous, prospective study of the prevention and management of stone disease. The take-away point is that there is good evidence for prevention that is already available and underutilized, and these guidelines should provide a digestible means for practitioners to work on prevention rather than simply treatment.

2014 Top Stories in Urology: Medical Management of Stone Disease


In 2014, the American Urological Association (AUA) released a clinical guidelines document focused on the medical management of kidney stone disease.1 This important, but often overlooked, aspect of stone management is an “orphan” field. It requires administration and titration of medications, which is not something that urologists commonly do, but it also entails an understanding of surgical stone management, which is not something that nephrologists commonly do.

The document provides detailed guidelines for the metabolic evaluation and medical management of stone patients, with associated levels of evidence (eg, treatment “standards” based on higher level of evidence vs “expert opinion”) to enable the reader to understand the basis for the recommendations. The detailed literature review combined with professional opinion provides recommendations for initial evaluation, dietary therapies, pharmacologic therapies, and follow-up of newly diagnosed patients and those with recurrent disease.

These guidelines are most welcome, as they demystify and organize the approach to the management of patients with this complex problem. While treating a stone surgically is in the purview of most urologists, employing dietary and pharmacological means to reduce recurrence is a less comfortable task for many. The latter is particularly important given the high recidivism of stone formers, the quality-of-life concerns associated with recurrent symptomatic disease, and the significant financial costs associated with this disease.

The lack of level 1 evidence in the guidelines is apparent and calls for more rigorous, prospective study of the prevention and management of stone disease. The take-away point is that there is good evidence for prevention that is already available and underutilized, and these guidelines should provide a digestible means for practitioners to work on prevention rather than simply treatment.

Kidney Stones: New Tool May Predict Recurrence


A new tool may predict the likelihood that a patient who has a first kidney stone may have a second, according to a study published online August 7 in the Journal of the American Society of Nephrology.

The Recurrence of Kidney Stone (ROKS) nomogram may help physicians determine which patients are at high risk for recurrence and would most likely benefit from medication, radiographic monitoring, or restrictive diets to prevent painful episodes and long-term complications such as kidney failure. At the same time, this knowledge could spare low-risk patients the cost of tests, potential harm from medications, and onerous limitations on what they can eat.

The tool, developed by Andrew Rule, MD, from the Division of Nephrology and Hypertension, Department of Medicine and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, and colleagues, evaluates several factors including patient characteristics and the stone’s composition and location.

The authors analyzed medical records from all 2239 adults treated for their first stone in Olmstead County, Minnesota, between 1984 and 2003 who had evidence of a passed, obstructing, or infected stone causing pain or gross hematuria.

Of those individuals, 707 patients had a recurrence during the study period, which continued through 2012. Recurrence rates at 2, 5, 10, and 15 years were 11%, 20%, 31%, and 39%, respectively.

First-time stone-formers were more likely to have another episode if they were young, white males with a family history of kidney stones, had blood in their urine, had stones made of uric acid, had an obstructing stone in the renal pelvis, or had additional nonobstructing stones.

Because many who have a first stone have a relatively low risk for a second symptomatic episode, tests and treatment are often limited, and many patients do not get 24-hour urine studies or medications until they have several painful episodes, researchers said. They hope ROKS will help the high-risk patients receive appropriate treatment sooner.

Tests in Warmer Climate Will Be Important

In an accompanying editorial, Brian Eisner, MD, from Massachusetts General Hospital in Boston, and David Goldfarb, MD, from the New York Harbor Veterans Affairs Healthcare System and New York University School of Medicine, New York City, said the nomogram gives valuable data and should be tested prospectively in warmer climates.

“Kidney stone prevalence is greater in warmer climates presumably because higher ambient temperature leads to reduced urine volume and higher concentrations of stone-forming salts,” Dr. Goldfarb told Medscape Medical News. “On the basis of previously published data and the current nomogram, it follows that stone recurrence in Rochester, Minnesota, where monthly average high temperatures are <4.4°C for 7 months per year, may actually underestimate recurrence rates in lower latitudes and warmer climates.”

He noted that the ROKS nomogram may help motivate first-time stone-formers to drink more liquids, increase dairy consumption (if needed), and reduce salt intake.

He likened the potential benefit to that of FRAX, the World Health Organization’s bone nomogram that helps target treatment for osteoporosis.

“It’s too early to expect ROKS to be the equivalent, because it will have to be tested prospectively and in populations other than that of Olmsted County,” Dr. Goldfarb said. “But I think it’s a useful beginning.”

History of Kidney Stones and the Risk of Coronary Heart Disease.


Importance  Kidney stone disease is common and may be associated with an increased risk of coronary heart disease (CHD). Previous studies of the association between kidney stones and CHD have often not controlled for important risk factors, and the results have been inconsistent.

Objective  To examine the association between a history of kidney stones and the risk of CHD in 3 large prospective cohorts.

Design, Setting, and Participants  A prospective study of 45 748 men and 196 357 women in the United States without a history of CHD at baseline who were participants in the Health Professionals Follow-up Study (HPFS) (45 748 men aged 40-75 years; follow-up from 1986 to 2010), Nurses’ Health Study I (NHS I) (90 235 women aged 30-55 years; follow-up from 1992 to 2010), and Nurses’ Health Study II (NHS II) (106 122 women aged 25-42 years; follow-up from 1991 to 2009). The diagnoses of kidney stones and CHD were updated biennially during follow-up.

Main Outcomes and Measures  Coronary heart disease was defined as fatal or nonfatal myocardial infarction (MI) or coronary revascularization. The outcome was identified by biennial questionnaires and confirmed through review of medical records.

Results  Of a total of 242 105 participants, 19 678 reported a history of kidney stones. After up to 24 years of follow-up in men and 18 years in women, 16 838 incident cases of CHD occurred. After adjusting for potential confounders, among women, those with a reported history of kidney stones had an increased risk of CHD than those without a history of kidney stones in NHS I (incidence rate [IR], 754 vs 514 per 100 000 person-years; multivariable hazard ratio [HR], 1.18 [95% CI, 1.08-1.28]) and NHS II (IR, 144 vs 55 per 100 000 person-years; multivariable HR, 1.48 [95% CI, 1.23-1.78]). There was no significant association in men (IR, 1355 vs 1022 per 100 000 person-years; multivariable HR, 1.06 [95% CI, 0.99-1.13]). Similar results were found when analyzing the individual end points (fatal and nonfatal MI and revascularization).

Conclusions and Relevance  Among the 2 cohorts of women, a history of kidney stones was associated with a modest but statistically significantly increased risk of CHD; there was no significant association in a separate cohort of men. Further research is needed to determine whether the association is sex-specific.

Souirce: JAMA

Amazing healing power of lemons


  • Lemon
  • Lemons contain citric acid which can help to dissolve calcium deposits, kidney stones, and gallstones.
  • Lemons are rich in vitamin C which is regarded s the detox vitamin that removes free radicals that cause inflammation and pain and helps with illnesses as well.
  • Lemons contain hesperetin which could help with diabetes as it lowers blood sugar levels.
  • Helps restore the body’s PH and makes you more alkaline.
  • The peel of the lemon contains a phtyonutrient called tangeretin which has been proven to be helpful for brain disorders.
  • Rutin can be found in lemons and has been found to relieve the symptoms of eye disorders.
  • Lemon contains terpene limonoids which have proven antiviral effects.
  • The hesperetin found in lemons helps with allergy symptoms.