Approach to the patient with the first episode of nephrolithiasis

Nephrolithiasis is very common. It typically presents with a single episode of renal colic and may not recur. There are patients, however, who are at risk for recurring stone disease after the first episode. Such patients are identified from family history, personal medical history, and urinary and stone analysis. Identification of secondary causes is the key to this differentiation. Medical therapy is the major therapeutic option. This approach includes attention to hydration and dietary constituents such as protein, sodium, and calcium. Depending on other findings, dietary adjustment for oxalate, citric acid, and the like, may also be needed.