Renal calculi articles within Nature Reviews Urology

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  • Clinical Outlook |

    Monogenic causes account for up to 20% of nephrolithiasis instances and are crucial for developing targeted treatments. Whole-exome sequencing, genome-wide association, candidate gene, and in vitro and animal functional studies are crucial to identify these mutations. Therapies targeting monogenic variants, such as RNA-interference-based treatments, have been successfully used to treat monogenic disorders.

    • Chen-Han Wilfred Wu
    • , Yu-Ren Huang
    •  & Friedhelm Hildebrandt

  • Review Article |

    The ureter has mechanical properties that vary along the anatomical length and change with age. In this Review, the authors provide an overview of ureter properties and discuss how understanding the mechanical forces that the ureter is exposed to during clinical interventions can be leveraged to improve surgical outcomes.

    • Sorcha O’Meara
    • , Eoghan M. Cunnane
    •  & Niall F. Davis

  • Review Article |

    Evidence has suggested that the intestinal microbiome might have a role in maintaining oxalate homeostasis and kidney stone disease and that the urinary microbiome might also influence the induction of crystal formation and stone growth directly in the kidney. In this Review, the authors discuss the mechanisms by which these microbial populations contribute to stone disease and how they might be therapeutically targeted.

    • Aaron W. Miller
    • , Kristina L. Penniston
    •  & Dirk Lange

  • Review Article |

    The formation of kidney stones is governed by the same principles as other stone systems. These ‘diagenetic phase transitions’ that create human kidney stones reflect the environment within the kidney during stone formation and could, therefore, improve understanding of urolithiasis and enable future treatment development. In this wide-ranging and unique Review, the authors explain how kidney stone formation parallels that of other stone systems such as stony corals, travertine in Roman aqueducts, stalactites and agates, and describe how the new field of GeoBioMed could be harnessed to improve patient care.

    • Mayandi Sivaguru
    • , Jessica J. Saw
    •  & Bruce W. Fouke

  • Consensus Statement
    | Open Access

    Metagenome-wide association studies have led to the discovery of potential interactions between the microbiome and urolithiasis, but a lack of standardization has raised questions about the reproducibility, applicability and physiological relevance of metagenome-wide association study data. This Consensus Statement describes the formation of the first international consortium for microbiome in urinary stone disease — MICROCOSM — and the outcomes of a consensus meeting to develop standardized protocols for microbiome studies and generate a data repository, which are both publicly available via a secure online server.

    • Naveen Kachroo
    • , Dirk Lange
    •  & Aaron W. Miller

  • Review Article |

    Animal models that naturally and spontaneously form uroliths — including domestic dogs and cats, and a variety of other captive and wild species, such as otters, dolphins and ferrets — are an underused resource in the study of human stone disease and offer many potential opportunities for improving insight into stone pathogenesis. Improved collaboration between urologists, basic scientists and veterinarians is warranted to further our understanding of how stones form and to consider possible new preventive and therapeutic treatment options.

    • Ashley Alford
    • , Eva Furrow
    •  & Jody Lulich

  • Review Article |

    Kidney stone disease is common and can be associated with alterations in urinary solute composition. Here, the authors outline general approaches for stone prevention, describe current understanding of the genetic influences underlying kidney stone formation and discuss the implications of a correct diagnosis for the clinical management of recurrent stone formers.

    • Sarah A. Howles
    •  & Rajesh V. Thakker

  • Comment |

    Technology for the treatment of stone disease has rapidly advanced, but a common nomenclature to communicate research and high-quality studies to assess treatment outcomes are lacking. Thus, guidelines are based on low-grade evidence and cannot make definitive recommendations in many scenarios. To improve clinical practice and patient outcomes, the endourology community must unite to address these inadequacies.

    • Charles Upshur Nottingham
    •  & Amy Elizabeth Krambeck

  • Year in Review |

    In 2019, quality improvement has been a central theme throughout leading articles on nephrolithiasis. Real-world outcomes were published on the natural history of stones and residual fragments, patient compliance with medical therapy and treatment-related opioid use. In-depth review of these topics will enhance provider–patient counselling and shape future paradigms in stone disease.

    • Jonathan G. Pavlinec
    •  & Benjamin K. Canales

  • Comment |

    GeoBioMed, a new multidisciplinary approach, combines geology, biology, urology and microscopy to discover unorthodox treatments. Results indicate that calcium oxalate kidney stones undergo previously unforeseen cycles of repeated crystallization, dissolution, fracturing and faulting. GeoBioMed challenges clinical paradigms for in vivo stone formation and treatment as well as biomineralization in natural and engineered environments.

    • Mayandi Sivaguru
    • , John C. Lieske
    •  & Bruce W. Fouke

  • Review Article |

    Investigation of nephrourological diseases is a common indication for CT examination. However, concerns remain regarding the potential risks associated with exposure to ionizing radiation despite a lack of convincing evidence for any such effect at the low doses used for CT scanning. In this Review, experts in the field explain the data in this area and consider how elimination of unnecessary imaging and optimization of medically justified imaging must remain the basis of clinical decision-making.

    • Andrea Ferrero
    • , Naoki Takahashi
    •  & Cynthia H. McCollough

  • Review Article |

    In this Review, the authors describe the current mechanistic understanding of infection stone formation and growth, including the influence of the organic matrix, microorganisms, and biofilms, highlighting the medical implications of these insights and the importance of multidisciplinary management approaches.

    • Erika J. Espinosa-Ortiz
    • , Brian H. Eisner
    •  & Robin Gerlach

  • Comment |

    Kidney stones are currently managed using laser lithotripsy and the most recent generation of laser generators have enabled the possibility of the dusting technique. Dusting avoids the use of a basket, as stone fragments are spontaneously evacuated; however, no consensus on the definition of dust currently exists.

    • Steeve Doizi
    • , Etienne Xavier Keller
    •  & Olivier Traxer

  • Review Article |

    The holmium:yttrium–aluminium–garnet (YAG) laser has been a standard of care for treating renal stones for the past 20 years. However, it is not without its limitations. In this Review, Fried and Irby discuss new laser technologies that offer an alternative to the holmium:YAG laser and consider fibre-optic approaches for delivery of the laser energy inside the urinary tract.

    • Nathaniel M. Fried
    •  & Pierce B. Irby

  • News & Views |

    Results of two large randomized controlled trials have challenged the use of medical expulsive therapy for the management of ureteral calculi. A new trial now shows that tamsulosin is effective in patients with distal calculi >5 mm in size, demonstrating that the effectiveness of MET depends on stone size and location.

    • Kelly A. Healy
    •  & Ojas Shah

  • News & Views |

    Cystine capacity is an assay for assessing urinary cystine saturation and risk of a stone episode in patients with cystinuria. Lowering the threshold for this test improves its sensitivity, potentially enabling relaxation of follow-up regimens for patients at lowest risk of stone episodes and dose modification of medications for those at highest risk.

    • Matthew Bultitude
    •  & Kay Thomas

  • Review Article |

    Wu and Okeke review studies of the major validated scoring systems for outcomes of percutaneous nephrolithotomy, highlighting their performance in predicting stone-free rates and complications. They discuss the advantages and disadvantages of each system, provide suggestions for their applicability and propose requirements for a future unified scoring system.

    • Wayland J. Wu
    •  & Zeph Okeke

  • Review Article |

    The management of upper-tract urinary stones has dramatically changed towards an increase in the use of ureteroscopic treatment, driven by technological advances. In this Review, Weiss and Shah discuss the unique advantages and disadvantages of the two basic principles for treating stones ureteroscopically — dusting and basketing.

    • Brian Weiss
    •  & Ojas Shah

  • Review Article |

    Imaging is an important diagnostic tool and initial step in deciding which therapeutic options to use for the management of kidney stones and guidelines differ regarding the optimal initial imaging modality. In this Review, Brisbane and colleagues discuss the advantages and disadvantages of CT, ultrasonography, MRI and kidney, ureter, bladder (KUB) plain film radiography for stone imaging and propose an algorithm for imaging patients with acute stones.

    • Wayne Brisbane
    • , Michael R. Bailey
    •  & Mathew D. Sorensen

  • Opinion |

    Despite large numbers of patients being affected by stones, a surprising lack of knowledge exists on the relevance of stone compositions and pathological features to the outcomes of patients with stones. Here authors describe the potential of new technologies such as high-resolution endoscopes, and micro-CT imaging to address this lack of knowledge.

    • Michael S. Borofsky
    • , Casey A. Dauw
    •  & James E. Lingeman

  • Review Article |

    Medical expulsive therapy (MET) has been widely used for the management of ureteral stones for the past two decades, despite limited evidence on the effectiveness of this approach. In the past year, data from two clinical trials has called the continued use of MET into question. Here, the authors consider the role of MET in the managment of ureteral stones, in light of this improved level of evidence.

    • Bhaskar K. Somani
    • , Omar Aboumarzouk
    •  & Jean de la Rosette

  • News & Views |

    A study investigating the mortality attributed to urolithiasis over a 15-year period has noted an increasing rate of death with a simultaneous rise in stone prevalence. However, the exact mechanisms by which nephrolithiasis causes death remains unclear.

    • Marcelino Rivera
    •  & Amy Krambeck

  • News & Views |

    Tolvaptan, an arginine vasopressin receptor antagonist, decreases urinary supersaturation in kidney stone formers by considerably increasing diuresis, suggesting that this drug might be an effective therapy for reducing the risk of developing kidney stones in these patients.

    • Emmanuel Letavernier
    •  & Michel Daudon

  • Year in Review |

    In 2015, population-based studies in patients with urinary stones informed us of the changing trends in contemporary stone management and identified areas for improvement. Although meta-analyses aim to provide the highest level of evidence, a randomized controlled trial of medical expulsive therapy challenged current paradigms and was the defining publication of the year.

    • Sapan N. Ambani
    •  & Khurshid R. Ghani

  • Review Article |

    The development of the ureteral access sheath (UAS) has enabled substantially greater use of ureteroscopy for minimally invasive management of diseases of the upper urinary tract. Here, the authors describe the advantages and risks associated with the routine use of UAS, and the potential for use of UAS by endourologists for a wider range of applications.

    • Adam G. Kaplan
    • , Michael E. Lipkin
    •  & Glenn M. Preminger

  • Review Article |

    The elementome—the full spectrum of elemental content—of urinary calculi is emerging as a new concept in stone research. Here, Ramaswamy et al. summarize current knowledge of the elementome of calcium-based urinary calculi and highlight study results of clinical relevance that could be shaping future therapeutic strategies in urolithiasis.

    • Krishna Ramaswamy
    • , David W. Killilea
    •  & Marshall L. Stoller

  • Review Article |

    Most kidney and ureteral stones can be considered for treatment with a noninvasive or minimally invasive approach, with improved safety and morbidity compared with traditional open surgical approaches. However, improvements in laparoscopic surgical techniques mean that nearly any open surgery can be performed in a minimally invasive fashion. Here, Borofsky and Lingeman discuss the role of these techniques in modern stone surgery.

    • Michael S. Borofsky
    •  & James E. Lingeman

  • Review Article |

    Patients with spinal dysraphism can have a large variety of different urological manifestations, thus, effective clinical management of these patients can involve a range of different approaches. Here, authors describe the management of the full range of urological manifestations observed in patients with spinal dysraphism and the future challenges posed by the changing demographics of this patient population.

    • Paul W. Veenboer
    • , Laetitia M. O. de Kort
    •  & Tom P. V. M. de Jong

  • Review Article |

    Flexible ureteroscopy is increasingly being used as the first-line therapy for renal stones. Although the precise stone-free rates acheived with this procedure are unknown, largely as a result of variations in stone and patient characteristics, and the choice and timing of follow-up imaging. In this Review, authors describe the effects of these variable on stone-free outcomes, and discuss the evidence surrounding active retrieval of fragments during ureteroscopy.

    • Khurshid R. Ghani
    •  & J. Stuart Wolf Jr

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