Metabolic stone evaluation and recurrence prevention

What is a metabolic stone?

Metabolic syndrome is associated with an increased risk of uric acid stone formation caused by the associated unduly acid urine. These disorders might also be associated with more calcium oxalate stones because a greater body mass index is associated with greater urinary oxalate excretion. The renal stone disease continues to a medical problem, often causing significant patient morbidity. Dr. Rajesh Dhake gives you proper kidney stone treatment in Pune.

Types of metabolic stone:

There are 2 ways to perform a metabolic evaluation of a stone former: limited evaluation or comprehensive evaluation. Components of the limited evaluation include serum electrolytes, creatinine, calcium, uric acid, phosphorus, stone analysis, and urinalysis, including urine pH.

Conservative Medical and precautions need to take:

1. Fluid recommendations

• Water hardness – water hardness does not play a significant role in recurrence risk because of hardness can alter urinary parameters.
• Carbonated Beverages – carbonated water protects against recurrent stone formation because of the increase in urinary citrate levels.
• Citrus Juices – Citrus juices i.e. lemon and orange both juices may be useful in stone prevention.

2. Dietary Recommendations :

• Protein Restriction – Excess intake of animal protein can increase the risk of renal stone. Protein intake increases urinary calcium, uric acid excretion and hence increase the probability of stone recurrence.
• Sodium Restriction -A high sodium intake increases calcium excretion, pH of urine and decreases citrate excretion.
• Vitamin D supplementation – Vitamin D repletion is likely safe for stone formers. During vitamin D therapy urine calcium should be monitored.
• Oxalate Avoidance
• Vitamin C limited dose – Large dose of Vitamin C increase the risk of stone recurrence.

3. Obesity :

• Metabolic syndrome
• Impact of weight-loss diets – Low carbohydrate and high protein diet put an acid load to the kidney and this load increases the risk of stone formation and bone loss.
• Impact of bariatric surgery – Bariatric surgery may significantly increase the overall risk of stone formation.

Why it needs an evaluation?

The main goal is –

1. To prevent recurrent stone formation in high-risk stone producers.
2. To prevent further growth of any existing stones.

3 To prevent extra-renal complications in associated systemic disorders.

When metabolic evaluation needed?

At least one month after stone passage or stone removal and stone evaluation, allowing the patient to return to their normal routine and continue the normal activities.

Indications for metabolic stone evaluation?

• Recurrent Stone former
• Strong family history of stone
• Intestinal disease (particularly chronic diarrhea)
• Pathologic skeletal fractures
• Osteoporosis
• History of urinary tracts infection with calculi
• Personal history of gout
• Infirm health (unable to tolerate repeat stone episodes)
• Solitary kidney
• Anatomic abnormalities
• Renal insufficiency
• Stones composed of cysteine, uric acid, struvite
• Children

Dr. Rajesh Dhake is the best Uro surgeon in Pune and Dhake Urology Clinic ranked as one of the best hospitals in the Pune for urology. The goal of the clinic is to provide skillful, compassionate and innovative care. We provide diagnosis and expert treatment for diseases of the urinary tract, including cancers, male sexual dysfunction, urinary incontinence, pelvic pain, urinary stone disease, male infertility, and prostate disease.