A REVIEW OF NEW CONCEPTS IN RENAL STONE RESEARCH

Clinical and basic research in the field of urolithiasis has developed rapidly in recent years. Progress in extracorporeal shock wave lithot ripsy (ESWL) and percutaneous nephrolithotomy (PNL) has brought about a revolution in the surgical treatment of urolithiasis and research at the cellular and molecular level is now expanding. In spite of these advances, however, clinical treatment of urolithiasis remains far from satisfactory. Stone recurrence in many patients cannot be predicted a nd is beyond control of urologists mainly because the mechanisms of st one formation are still not fully understood. It is necessary to study the process of stone-formation more intensely at the cellular and mol ecular level, and to strengthen the links between basic and clinical r esearch in the field. In this review, the processes involved in the fo rmation of stones are compared with those involved in normal bio-miner alization and a model of urolithiasis is put forward based on modern s ystems science. Attention is concentrated on: (a) Directions of resear ch based on physico-chemical theories of stone formation; (b) The role of renal tubular defects in urolithiasis; (c) The role of free radica l reactions in stone formation; and (d) Macromolecular abnormalities a nd their correction.