Linthicum, MD, May 14, 2014 — With nearly one in 11 individuals within the United States affected by kidney stone disease, the American Urological Association (AUA) released its first evidence-based clinical guideline to improve the evaluation, treatment and follow-up of first-time and recurrent kidney stone formers.
Kidney stone disease is a common condition. Unlike other conditions, such as appendicitis, for which the diagnosis is readily apparent and can be confirmed by a pathology report, stone disease can be asymptomatic and occur intermittently and repeatedly. Some individuals require no medical attention for their stones, while others require repeated medical encounters for a single stone. For those who have experienced a stone or undergone surgical intervention for a stone, there is strong motivation to avoid a repeat episode. Consequently, these patients often seek advice from a variety of practitioners on how to prevent recurrent stones. However, misinformation exists within the lay community and on the internet; even medical providers often disseminate recommendations contrary to evidence-based medicine.
“Each year, more than half a million people go to emergency rooms for kidney stone problems,” said Margaret S. Pearle, MD, PhD, chair of the guideline development panel. “This new guideline offers practitioners a standardized medical plan for diagnosing and treating kidney stones including analyzing blood and urine specimens to measure for substances that positively or negatively affect stone formation, and recommending dietary changes and medication, if needed.”
According to the National Health and Nutrition Examination Survey (NHANES), the prevalence of kidney stones has increased 70 percent since 1994. Historically, kidney stones have occurred more often in men than in women; however, the most recent NHANES shows the gender gap in stone disease is closing with a slightly higher prevalence among men (10.6 percent) than among women (7.1 percent). The reasons for the observed rise in stone disease among women are not certain, but diet and lifestyle are likely an impact as obesity, a known risk factor for kidney stones, was found to be greater in women than in men.
The clinical guideline for the Medical Management of Kidney Stones makes 27 recommendations in total. Performing additional metabolic testing in high-risk stone formers, recommending a fluid intake to achieve at least 2.5 liters of urine per day and obtaining periodic blood testing to assess for adverse effects in patients on pharmacological therapy are among the recommendations made. This guideline was created by a panel with specific expertise in regard to the guideline subject. The members included a dietician, representatives of the Endourological Society and several nephrologists. Dr. David Goldfarb, vice chair of the panel, was one of several representatives of the American Society of Nephrology. Additionally the guideline was distributed to 107 peer reviewers of varying backgrounds before being reviewed and approved by the AUA Board of Directors.
“The AUA has more than 20-years’ experience in researching, treating and developing clinical guidance for urologists and practitioners of varying disciplines. Our work benefits not only the urologic community, but the entire medical community as well,” said Pearle who is professor of urology at the University of Texas Southwestern Medical Center and the Mineral Metabolism Center.
NOTE TO REPORTERS: Experts are available to discuss this study. To arrange an interview with an expert, please contact the AUA Communications Office at 410-689-3932 or e-mail cfrey@AUAnet.org.
About the American Urological Association: The 109th Annual Meeting of the American Urological Association takes place May 16 – 21 at the Orange County Convention Center in Orlando, FL.
Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is a leading advocate for the specialty of urology, and has more than 20,000 members throughout the world. The AUA is a premier urologic association, providing invaluable support to the urologic community as it pursues its mission of fostering the highest standards of urologic care through education, research and the formulation of health policy.
Christine Frey, AUA