Course of calcium stone disease without treatment. What can we expect?

Abstract

Objectives: The knowledge of the natural history (i.e. the course of the disease without metaphylaxis is the base for establishing rational guidelines for metaphylaxis in urolithiasis.

Methods: This review is based on a Medlinetrade mark Search (1966-1999) and the proceedings of the Bonn-Vienna and European symposia on urolithiasis. Only 31 references were sufficient for the purpose of this review.

Results: In idiopathic calcium stone disease, stone frequency without metaphylaxis is 0.10-0.15 stones per patient per year. The average recurrence rate is 30-40%. Recurrence rate increases with age and observation time. Risk for recurrence is highest during the first 4 years after the first stone episode. More than 50% of all recurrent stone formers have only one recurrence during their lives. 10% of recurrent stone formers have more than 3 recurrences. Risk factors for recurrence are: male sex, multiple and lower calyx stones, early onset, familial history, complications after stone removal. Metabolic evaluation is a poor predictor of the risk for recurrence.

Conclusions: Renunciation of metaphylaxis is justified in first stone formers with idiopathic calcium oxalate and apatite stones. All patients, however, should be advised to increase their fluid intake.