Introduction & Objectives
Renal stone disease contributes a large proportion of both elective and emergency urological work. Approximately 30% of stone formers are thought to have an underlying metabolic predisposition. Such patients tended to be evaluated on an ad-hoc basis with the possibility of a predisposing condition inconsistently considered. Here we describe the establishment of a joint urology and nephrology metabolic renal stone clinic to address this concern.
Material & Methods
From October 2015, the service has taken referrals following the acute or elective treatment of renal stones. Although there are no specific referral criteria, younger patients, those with bilateral stones, recurrent stones, or those with a known metabolic condition are reviewed in the joint clinic.
To date, 80 patients have been seen of which 10 were already known to the nephrology service. Fifty (62.5%) patients had their stone composition known at referral with calcium oxalate (21.3%) and calcium phosphate (17.5%) stones being the most common. Six (7.5%) had cystine stones. 24-hour urine collections and blood tests were required in seventy-one (88.9%) patients. Further analysis of these results is ongoing. However, 26 (32.5%) patients had treatment initiated including thiazide diuretics (20%), sodium bicarbonate, potassium citrate, allopurinol, and vitamin D.
This new service has allowed the full evaluation of high risk patients from a urological and nephrological perspective. This has resulted in the initiation of cost-effective treatments in a significant proportion of patients. Provided with the appropriate resources including job planning, we aim to expand this service to manage all high risk renal stone patients, providing a tertiary service where required.