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An update and practical guide to renal stone management.
[cystinuria]
Renal
stone
disease
covers
kidney
and
lower
urinary
tract
stones
caused
by
a
variety
of
conditions
,
including
metabolic
and
inherited
disorders
,
and
anatomical
defects
with
or
without
chronic
urinary
infection
.
Most
cases
are
idiopathic
,
in
which
there
is
undoubtedly
a
genetic
predisposition
,
but
where
environmental
and
lifestyle
factors
play
an
important
role
.
Indeed
,
it
is
becoming
apparent
that
renal
stone
disease
is
often
part
of
a
larger
'
metabolic
picture
'
commonly
associated
with
type
2
diabetes
,
obesity
,
dyslipidaemia
,
and
hypertension
.
Renal
stone
disease
is
a
growing
problem
in
the
UK
(
and
other
developed
and
developing
populations
)
with
a
cross-sectional
prevalence
of
∼
1
.
2
%
.
This
means
that
there
are
currently
∼
720
,
000
individuals
with
a
history
of
kidney
stones
in
the
UK
.
Almost
40
%
of
first
-time
stone
formers
will
form
a
second
stone
within
3
years
of
the
first
episode
if
no
prophylactic
measures
are
instituted
to
prevent
stone
recurrence
,
since
removal
or
disintegration
of
the
first
stone
does
not
treat
the
underlying
cause
of
stones
in
the
majority
of
patients
.
The
age
of
onset
is
getting
younger
and
the
sex
ratio
(
until
recently
more
men
than
women
)
is
becoming
almost
even
.
Metabolic
screening
remains
an
important
part
of
investigating
renal
stone
disease
,
but
to
the
disappointment
and
frustration
of
many
doctors
,
medical
treatment
is
still
essentially
pragmatic
,
except
perhaps
in
cystinuria
,
and
to
a
limited
extent
in
primary
hyperoxaluria
(
if
pyridoxine-sensitive
)
;
although
newer
treatments
may
be
emerging
.
This
review
summarizes
current
thinking
and
provides
a
practical
basis
for
the
management
of
renal
stone
disease
.
Diseases
Validation
Diseases presenting
"and to a limited extent in primary hyperoxaluria"
symptom
cystinuria
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