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Kidney stone burden is rising globally, contributing to emergency visits, work loss, psychological distress, and an increased CKD risk. Stones in CKD of unknown cause may signal inherited disorders, making accurate diagnosis essential for preventing further kidney deterioration and recurrence after transplant. The review provides 10 practical tips for clinicians.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/ten-tips-on-the-work-up-and-management-of-ckd-patients-with-nephrolithiasis/434770/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/ten-tips-on-the-work-up-and-management-of-ckd-patients-with-nephrolithiasis/434770.png","ImageObject",300,407,{"name":92,"@type":93},"Nguyễn Văn Học","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is nephrolithiasis management important in CKD patients?","Question",{"text":113,"@type":114},"Kidney stones increase emergency visits and can worsen outcomes by contributing to CKD risk. 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In recent decades nephrologists have had an increasing role in caring for these patients not only in advanced stages of chronic kidney disease (CKD) but also in the diagnosis and management of underlying systemic disease, and metabolic and genetic risk factors. Globally the burden of kidney stone disease has been increasing, with metabolic disorders strongly associated with nephrolithiasis and stone-promoting urinary risk factors, including hypercalciuria, hyperoxaluria and hypocitraturia. At a healthcare level, kidney stones account for a relatively large number of emergency department visits, while individually the impact of kidney stones and the fear of recurrence often result in loss of work and high levels of psychological distress, in addition to an increased CKD risk. Kidney stones in the context of CKD of unknown cause can be the signature of an inherited disorder such as Dent disease, primary hyperoxaluria or adenine phosphoribosyltransferase deficiency (among others) . Diagnosing these diseases is imperative in the current age of new treatments (e.g. small interfering RNA therapies), to avoid further deterioration of kidney function and disease recurrence post-transplantation. We outline 10 practical tips to guide clinicians in the diagnostic evaluation and management of nephrolithiasis in CKD.  \nKeywords: calcium, CKD, metabolic acidosis, nephrolithiasis, proximal tubule  \nINTRODUCTION  \nPopulation studies have indicated that recurrent kidney stone episodes can contribute to an increased likelihood of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) [1– 4]; it is clear that recurrent symptomatic nephrolithiasis is likely to be far more influential for risk of ESKD than a one-off stone episode [2] . Nephrolithiasis-related injury may be mediated through the consequences of urinary obstruction and intervention (repeated shock wave lithotripsy), or inflammation and tubular damage (activation of the NLRP3 inflammasome), therefore stone type and associated comorbidities also influence the ESKD risk [5]. Paradoxically, with dropping estimated glomerular filtration rate (GFR) the risk of stones actually decreases, likely  \ndue to more dilute urine, lower calcium excretion and calcium oxalate/calcium phosphate supersaturation [6] .  \nGlobally, nephrolithiasis has a growing prevalence frequently quoted at 10%, which may be partly explained by increased access to advanced diagnostic imaging; with contribution from associated risk factors such as obesity, diabetes mellitus, high salt intake, high intake of animal protein and/or sugary drinks and global warming [7, 8] .  \nRisk factors for symptomatic kidney stone recurrence include younger age, male gender, family history of stones, obesity, pregnancy, rarer stone compositions, higher radiographic kidney stone burden, number of past symptomatic episodes and fewer years since the last kidney stone episode. The risk of recurrence is highest early after each episode, but decreases over time [9] .  \nReceived: 21.7.2025; accepted: 4.11.2025  \n© The Author(s) 2025. Published by Oxford University Press on behalf of the ER","cbCaigMRmRlLX7En","https://ap.wps.com/l/cbCaigMRmRlLX7En","pdf",509510,"English","# Abstract\n# Introduction\n# TIP 1: DO TAKE A DETAILED HISTORY\n# TIP 2\n# TIP 3\n# TIP 4\n# TIP 5\n# TIP 6\n# TIP 7\n# TIP 8\n# TIP 9\n# TIP 10","[{\"question\":\"Why is nephrolithiasis management important in CKD patients?\",\"answer\":\"Kidney stones increase emergency visits and can worsen outcomes by contributing to CKD risk. In CKD, stone disease may also reflect underlying systemic metabolic or genetic disorders.\"},{\"question\":\"What underlying causes should clinicians consider when stones occur in CKD of unknown origin?\",\"answer\":\"The review highlights inherited disorders such as Dent disease, primary hyperoxaluria, and adenine phosphoribosyltransferase deficiency, among others. Identifying these conditions is emphasized to guide diagnosis and treatment.\"},{\"question\":\"What does the article aim to provide to clinicians?\",\"answer\":\"It outlines 10 practical tips to guide clinicians in the diagnostic evaluation and management of nephrolithiasis in patients with CKD.\"}]","Ten tips on the work-up and management of CKD patients with nephrolithiasis | PDF",1790670532]