[Metabolic evaluation of urinary calculi. What is a reasonable limitation? 2: Practical approach]

There appears to be little justification for conducting major metabolic screening for all cases of urinary calculi, both because of the cost, and the weak therapeutic advantages faced with the increased urine output. It is more logical to use simple methods to distinguish two groups of patients: Those in whom the affection is easily curable: dietary excess, abuse of therapeutic means, hyperparathyroidism, uric acid stones. Those in whom the affection may become worse: cystinuria, urinary malformations, recurrent calculi. Simple investigations in all patients should be: Antecedents, regimens, drugs. Radiography, analysis of stones, allowing for errors. Cystinuria, urinary pH. Creatininemia, uricemia, calcemia. Examinations must be performed effectively, even in outpatients, and the results read (not always the case). For patients at risk, discovered initially or only after this first selection, excretion anomalies are investigated, only a few of them being submitted to a Pak's test.