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          • Cysto, L stent w/o RPG
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Stone Evaluation

HISTORY AND PHYSICAL KEY PARTS
  • Diet : Salt, calcium, animal protein, VitD exposure
  • Screen for PTH: GI, psychiatric, bone pain
  • Meds: lithium, corticosteroids, loop diuretic exposure

LABORATORY
For 1st time stone formers:
  • Serum Ca++, Cr, uric acid, electrolytes
    1. ​​If hypercalceima: repeat with albumin, globulin, electrolytes, BUN, Cr and PO4
    2. If persistent elevation, perform ionized Ca++
  • Only screen for PTH if suspected and with elevated or high normal serum Ca++

Don't screen for VitD unless suspect VitD toxicity. If testing, test 25-OH-VitD b/c not as highly regulated and longer half life (2-3 weeks)
​- Hypercalciuria
  • Defined as 24-hr >250mg/day in women or 300mg/day in men or 4mg/kg/day in either sex (1) 
  • Also defined as 24 hour urine calcium exceeding 200mg/day on a diet restricted in calcium, sodium and animal protein (2)
  • If unable to collect 24 hr urine, a spot urine calcium-to-creatinine ration can be used, but this is inferior.
  • Should be repeated in 6 months after initiating therapy to evaluate for changes


​​
Picture
Picture
  1. ​Worcester, Elaine M., and Fredric L. Coe. "New insights into the pathogenesis of idiopathic hypercalciuria." Seminars in nephrology. Vol. 28. No. 2. Elsevier, 2008.
  2. Pak, Charles YC, et al. "Defining hypercalciuria in nephrolithiasis." Kidney international 80.7 (2011): 777-782.
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