Developments in stone prevention.

Abstract

PURPOSE OF REVIEW: This review focuses on new developments in stone prevention. Unfortunately, no major progress in this field has happened. There is a worldwide lack of randomized and controlled trials, which could confirm our theoretical assumptions and preventive concepts in stone disease. With these preconditions in mind, this review presents the current knowledge of metabolic influences causing the symptom "stone" and the effective measures against it. RECENT FINDINGS: Modern lifestyle, dietary habits and obesity emerge to be the promoters of idiopathic stone disease. Cross-sectional studies showed significant correlations between these factors and kidney stones with direct implications on our preventive concepts: normalization of body mass index, adequate physical activity, balanced nutrition and sufficient circadian fluid intake. Modern diets containing a lot of animal protein, refined carbohydrates and salt act on the metabolism like an acid load. To overcome these disadvantageous effects, a sufficient supply of potassium and alkali is required. Last but not least, calcium should not be restricted. There is clear evidence from clinical and experimental research that a normal or a high calcium supply is appropriate in calcium stone disease. Only in absorptive hypercalciuria calcium restriction remains beneficial in combination with thiazide and citrate therapy. SUMMARY: Up to 85% of all stone patients could anticipate lower risk of stone recurrence with elementary reorientation of their lifestyle and dietary habits. Normalizing the major risk factors is easy and cheap. About 15% of patients forming stones require additional specific pharmacological prevention. The specific measures to avoid recurrence of the stone disease are precisely defined.