Initial Management of Kidney Stone Patients

Initial Assessment

The American Urological Association recommends obtaining a detailed medical and dietary history to identify conditions, habits, or medications that may predispose to stone disease, and ordering serum chemistries including electrolytes, calcium, creatinine, and uric acid to identify underlying medical conditions associated with stone disease, as well as performing urinalysis including dipstick and microscopic evaluation to assess urine pH, indicators of infection, and identify crystals pathognomonic of stone type 1, 2
The American Urological Association suggests obtaining urine culture if urinalysis suggests urinary tract infection or if the patient has a history of recurrent UTIs 1, 2

Imaging studies should be obtained to quantify stone burden and guide treatment decisions, according to the American Urological Association 1

Stone analysis should be obtained at least once, as the stone composition may implicate specific metabolic or genetic abnormalities, and high-risk or recurrent stone formers should consider additional metabolic testing, as recommended by the American Urological Association 1
The American Urological Association recommends providing prevention strategies including increased fluid intake to achieve urine volume of at least 2.5 liters daily 1

The American Urological Association recommends scheduling follow-up with urology or nephrology for comprehensive stone management, and considering 24-hour urine collection for metabolic evaluation for patients with recurrent stones 1
Patients with struvite stones should be monitored for reinfection, as recommended by the American Urological Association 3