Diagnosing and managing renal and ureteric stones

Kidney stone disease (or nephrolithiasis) has an increasing incidence associated with higher incomes and rising global temperatures. Kidney stones are common with as many as 1 in 10 people developing a symptomatic stone. Up to 50% of stone formers will have at least one further symptomatic stone in their lifetime. Stone disease most commonly presents between 30 – 60 years of age. Men are more likely to have kidney stones but the gender gap is narrowing due to a recent and disproportionate rise in female prevalence (7.1% versus 10.6% for men). An increased incidence in children is reported and referral to a paediatrician with interest in stone disease is recommended. Increased ambulatory management in the UK has reduced the number of bed-days used by stone patients by up to 15%, but waiting times are increasing. The number of hospital episodes for kidney stones continues to rise with the biggest increase observed in persons ≥75 years. GPs are often the first point of contact for patients presenting with kidney stones. Once imaging is completed and complications excluded, most are managed in primary care with lifestyle advice and pharmacological agents. Additional biochemical analysis of stones can help inform personalised treatment plans to reduce recurrence and improve quality of life.