Kidney stones on the rise: Where are the specialists?

Diagnosing the root cause

Getting to the root cause of how further kidney stones can be prevented usually requires a nephrologist, according to Dr. Jaeger.

“As a urologist, 90% of what we do is surgery,” she said.

Although urologists are trained in analyzing 24-hour urine tests, which can reveal risks that can be addressed by preventive changes, many urologists tap a specialized nephrologist, who may analyze the samples with a keener eye. 

“When individuals pass a stone, fewer than 10% seek care with a specialist after that and that’s a missed opportunity to prevent future stones,” Dr. Tasian said. 

Not all nephrologists specialize in stones, but they may be better equipped to recognize when a patient needs to see someone who does. Failing to involve a nephrologist who specializes in kidney stones can have grave consequences for patient health. 

Dr. Goldfarb is currently caring for a patient with a kidney transplant that had begun to lose function. Clinicians who originally cared for the patient took a kidney biopsy, which showed fragments of calcium oxalate, a common type of kidney stone, in her native kidneys.

After receiving a kidney transplant, her health began to decline again and a second biopsy found that the new kidney was forming the same type of stones. Her nephrologist knew this meant she likely had a genetic disorder and referred her to Dr. Goldfarb, who specializes in underlying genetic causes of kidney stones. A genetic test revealed that the patient had primary hyperoxaluria. 

“She would have been treated completely differently if that had been recognized as the cause of her original kidney disease,” Dr. Goldfarb said. “Now her kidney transplant is getting kidney stones and I’m working with her to prevent that.”

Under Dr. Goldfarb, the patient will have access to a new experimental drug, called nedosiran, currently in clinical trials. It is specifically for primary hyperoxaluria. 

“The kidney doctor that made the diagnosis correctly and referred her to me isn’t a kidney stone specialist; he is a general nephrologist who has taken an interest in the topic of kidney stones, recognizing there is sometimes some nuance and specialty of issues related to this,” Dr. Goldfarb said.
 

A version of this article appeared on Medscape.com.