Management of urolithiasis with chronic renal failure

PURPOSE OF REVIEW: Epidemiological trends of urolithiasis and the prevalence of renal failure in patients with stones have changed. This is the era of minimally invasive therapy for stone disease. We review the impact of minimally invasive therapy on the management of urolithiasis in patients with renal failure and its outcome. RECENT FINDINGS: The prevalence of urolithiasis has reached its peak and plateaued in Europe and North America while it is still rising in the underdeveloped countries. The prevalence of renal failure in patients with chronic renal failure has reduced by half over the last decade. Minimally invasive therapy like percutaneous nephrolithotripsy has fared better than open stone surgery in all respects. Patients with kidney stones do not have normal renal function. Recently, cystine stones, and stones in patients with renal tubular acidosis and bowel disease were shown to affect renal function significantly. SUMMARY: Management of stones in chronic renal failure is challenging. Efforts should be made to minimize renal injury. Once a 'stone-free' kidney is achieved, steps should be taken to conserve renal function and address the issue of recurrence.