Pathophysiology

There are differing theories as to the exact pathophysiology of stone formation.

Free and fixed particle theories of stone formation are still being debated.
Therefore, it is not known whether stones form by deposition of microscopic
crystals in the loop of Henle, distal tubules, or the collecting duct. In one study,
renal papillary plaques were examined in calcium oxalate stone formers. [16]
Plaques were localised to the basement membrane of the thin loop of Henle. Once
these plaques form, they erode through the urothelium and constitute a stable,
anchored surface on which calcium oxalate crystals can nucleate and grow as
attached stones. [16]

Renal colic from nephrolithiasis is secondary to obstruction of the collecting

system from the stone. The stretching of the collecting system or ureter is due to an
increase in intraluminal pressure. This causes nerve endings to stretch and
therefore the sensation of renal colic. [1] Pain from urinary calculi can also be due
to local inflammatory mediators, oedema, hyperperistalsis, and mucosal irritation.
[1]

Nephrolithiasis

Kidney stones result when urine becomes too concentrated and substances in the
urine crystalize to form stones. Symptoms arise when the stones begin to move
down the ureter causing intense pain. Kidney stones may form in the pelvis or
calyces of the kidney or in the ureter.
Abstract

The formation of stones in the urinary tract stems from a wide range of underlying disorders. That clinicians look for

the underlying causes for nephrolithiasis is imperative to direct management. There are many advances in genetics,

pathophysiology, diagnostic imaging, medical treatment, medical prevention, and surgical intervention of

nephrolithiasis. Here, I provide a brief general background and focus mainly on pathophysiology and medical

treatment of kidney stones. Although important advances have been made in understanding nephrolithiasis from

single gene defects, the understanding of polygenetic causes of kidney stones is still largely elusive. A substantial

proportion of data that resulted in new methods of treatment and prevention, which can be empirical or definitive, has

focused on urinary luminal chemical composition of the precipitating solutes. Manipulation of inhibitors and epithelial

factors is important and needs further investigation. Advances in the management of nephrolithiasis depend on

combined efforts of clinicians and scientists to understand the pathophysiology.