Nephrolithiasis: A Comprehensive Review of Pathophysiology, Clinical Presentation, and Management

Abstract

Nephrolithiasis affects approximately 12% of the global population with increasing prevalence linked to obesity, metabolic syndrome, and dietary factors. Calcium oxalate and calcium phosphate stones comprise 70–80% of cases, followed by uric acid (10–15%), struvite (10–15%), and cystine stones (<1%). Stone formation involves complex physicochemical processes including supersaturation, nucleation, crystal growth, and retention, with Randall's plaque serving as a critical nucleation site. Clinical presentation typically includes severe colicky pain, hematuria, and urinary symptoms, though asymptomatic cases occur. Non-contrast helical CT represents the diagnostic gold standard with 98% sensitivity. Management has evolved from open surgery to minimally invasive approaches including extracorporeal shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. Medical expulsive therapy with alpha-blockers facilitates spontaneous passage of ureteral stones ≤5 mm. Prevention strategies emphasize adequate hydration (≥2 L/day), dietary modifications including normal calcium intake with sodium restriction, and pharmacological interventions such as thiazide diuretics and potassium citrate based on stone composition and metabolic abnormalities. Emerging evidence demonstrates strong associations between metabolic syndrome components—obesity, diabetes, hypertension, and dyslipidemia—and increased nephrolithiasis risk, highlighting the importance of comprehensive metabolic evaluation and lifestyle modifications in preventing recurrence. Understanding these multifactorial aspects enables individualized treatment approaches and reduces the 50% recurrence rate observed within 5–10 years