Here, stones are due to some serious systemic disease. We need to prevent them, but that invariably requires we cope with the disease that causes them.

One could rightly say that uric acid stones fall in this category in that the low urine pH that drives them arises usually from obesity, diabetes, gout, or at least metabolic syndrome. But in all cases treatment devolves into simple increase of urine pH, and one does not cope with the underlying disease.

Likewise for cystinuria. It arises from inherited transport abnormalities in the kidney proximal tubule. Once again, we cannot treat those abnormalities but only the final urine cystine concentration and therefore supersaturation. Even so, renal function tends to fall more in cystinuria than most other forms of stone disease, so I list it here.

Medullary sponge kidney is also hard to be sure about. A developmental renal malformation, it nevertheless has been described in association with other diseases and so is included here, as well.

The lovely painting by Jan Steen (1625-1679) hangs in Apsley House, London. 

Systemic Stone Disease

Chapter 12: Distal renal tubular acidosis – Detailed, but also clinically useful

Chapter 7: Primary Hyperparathyroidism – Covers diagnosis and treatment

Primary HyperparathyroidismA detailed review including familial disease

Chapter 10: Bariatric surgery and kidney stones – Mechanisms and treatment

Case 6: Bariatric surgery and kidney injury – How to protect against oxalate kidney injury

The diagnostic dilemma of medullary sponge kidney – Stones occur because of abnormal kidney structure

Chapter 9: Cystinuria: An Introduction for Patients

Chapter 11: Ileostomy Kidney Stones – Mechanisms of stones and treatment

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