Clinical Case 70: Answers and Summary

A 31 Y OLD MALE WAS FOUND TO HAVE 6MM KIDNEY STONE INCIDENTALLY ON RENAL SONOGRAM? WHAT DO YOU DO NEXT?

Urology referral

  10 (18%)

Observe with no further imaging

  20 (37%)

Stone workup

  14 (25%)

Start Potassium citrate

  1 (1%)

Observe with frequent imaging yearly

  9 (16%)

What do you do with a 6mm stone incident finding? Varied answers from majority saying do nothing and observe and second highest saying stone workup and then urology referral. One study of 107 such patients for a mean of 32 months. The likelihood of developing symptoms was approximately 32 percent at 2.5 years and 49 percent at 5 years; the risk was lowest in patients who had no history of previous stones.  Wait and watch approach may be a reasonable in asymptomatic patients with small, non-infected calculi, without evidence of obstruction. Based on stone experts, certain asymptomatic patients, depending upon their occupation (airline pilots, frequent business travelers) or having anatomic consideration( solitary kidney, diversions) should consider undergoing evaluation and treatment to reduce the risk of recurrent stone formation or growth of existing stones with perhaps options that we listed above. Tough question and practices might be varied depending on nephrology or urology. Not much data to support either way.