Clinical approach to adults

Acute episodes of renal colic are associated with severe pain and often necessitate invasive procedures and costly absences from work. A medical approach to evaluate all patients with kidney stones is generally recommended to detect underlying systemic disorders associated with nephrolithiasis and prevent further stone formation. patients with a single stone require a limited evaluation, whereas those with metabolically active stones, stones not composed of calcium oxalate, all children, and patients in demographic groups not commonly associated with nephrolithiasis should undergo a more extensive workup. The major classes of stones formed are calcium oxalate, calcium phosphate, uric acid, struvite, and cystine. This article focuses on etiologic factors that predispose to nephrolithiasis in general, as well as to specific stone types. A thorough review of the evaluation and therapy required for all stones is presented.