Nephrolithiasis: stones in a long road to be discovered

Abstract

Nephrolithiasis, or kidney stone disease, is a growing public health problem, with a global prevalence ranging between 1-20% and continuing to increase. Kidney stones are mineral concretions at the kidney level that are formed by the precipitation of mineral salts in supersaturated urine. According to their composition, the most common types are calcium stones, both oxalate and phosphate. Stone formation is explained by two main pathophysiological approaches: the free particle theory and the fixed particle theory. Independently of these mechanisms, the stones follow a process of nucleation, retention, growth and aggregation, in a medium of high concentration of ions. Regarding the most prominent risk factors, they include a low urinary volume (≤2 L/day), Western diet, dietary calcium restriction, consumption of foods rich in oxalate, ratio of proteins of animal and plant origin, high intake sodium, sugar consumption, presence of metabolic syndrome, use of certain drugs, distal renal tubular acidosis and alteration of the intestinal microbiome. Among the protective factors we have an adequate fluid intake of at least 2.5 L/day, a diet abundant in fruits, dietary fiber and vegetables, vitamin B12, citrate supplements, some medications and appropriate lifestyles.