Current Approaches to the Etiology, Prevention, Diagnosis and Treatment of Nephrolithiasis: A Review of Recent Literature

Abstract

Nephrolithiasis is a multifactorial disease arising from the interaction of biochemical, metabolic, genetic, environmental, and lifestyle factors. Urinary supersaturation with calcium, oxalate, phosphate, or uric acid promotes crystal nucleation, growth, and aggregation, while imbalances in natural inhibitors (e.g., citrate, magnesium) as well as epithelial injury and oxidative stress enhance crystal retention. Metabolic abnormalities such as hypercalciuria, hyperoxaluria, hypocitraturia, and hyperuricosuria often underlie stone formation; in children, the contribution of hereditary disorders is more prominent. Prevention emphasizes increased hydration (target urine output ≈2–2.5 L/day), adequate dietary calcium with sodium and animal protein restriction, increased fruit and vegetable consumption to increase urinary citrate, and population education, which has proven cost-effective. Diagnosis integrates history, urinalysis, and metabolic evaluation (24-hour urine collection), and imaging ultrasound as the initial modality in selected situations, with non-contrast CT as the gold standard when necessary. Acute management includes analgesia, hydration, and medical expelling therapy for small stones; minimally invasive interventions ESWL, ureteroscopy, or PNL are chosen based on stone size/location and clinical condition. Preventive pharmacological therapy is tailored to the metabolic abnormality (thiazides, potassium citrate, allopurinol) and combined with dietary modification and regular follow-up to suppress recurrence and improve long-term renal outcomes.