Course of calcium stone disease without treatment. What can we expect?

Objectives: The knowledge of the natural history (i.e. the course of the di sease without metaphylaxis is the base for establishing rational guidelines for metaphylaxis in urolithiasis. Methods: This review is based on a Medline(TM) Search (1966-1999) and the p roceedings of the Bonn-Vienna and European symposia on urolithiasis. Only 3 1 references were sufficient for the purpose of this review. Results: in idiopathic ca Ici um stone disease, stone frequency without met aphylaxis is 0.10-0.15 stones per patient per year. The average recurrence rate is 30-40%. Recurrence rate increases with age and observation time. Ri sk for recurrence is highest during the first 4 years after the first stone episode. More than 50% of all recurrent stone formers have only one recurr ence during their lives. 10% of recurrent stone formers have more than 3 re currences. Risk factors for recurrence are: male sex, multiple and lower ca lyx stones, early onset, familiar history, complications after stone remova l. Metabolic evaluation is a poor predictor of the risk for recurrence. Conclusions: Renunciation of metaphylaxis is justified in first stone forme rs with idiopathic calcium oxalate and apatite stones. All patients, howeve r, should be advised to increase their fluid intake. Copyright (C) 2000 S. Karger AG, Basel.