Book Review

Kidney Stones: Medical and surgical management

N Engl J Med 1996; 335:680-681August 29, 1996

Article

Kidney Stones: Medical and surgical management
Edited by Fredric L. Coe, Murray J. Favus, Charles Y.C. Pak, Joan H. Parks, and Glenn M. Preminger. 1109 pp., illustrated. Philadelphia, Lippincott-Raven, 1996. $275. ISBN: 0-7817-0263-1

On an international scale, the number of scientists interested in research on kidney stones seems to have decreased in recent years. However, those who think that a few minimally invasive methods, such as shock-wave lithotripsy, meant victory over kidney-stone diseases will know better when they read this book of more than 1000 pages, in which quality goes hand in hand with quantity.

We are far from having answered all questions about the mechanism of stone formation. As the book's preface states, “urine of almost everyone who reads this book will be supersaturated with respect to calcium oxalate while reading it,” yet only 4 percent of the population have kidney stones in the course of a lifetime. So, what really counts is nucleation, crystal growth, and agglomeration in urine. Crystallization models can simulate the physiologic process of stone formation. The patient with a kidney stone must avoid saturation conditions that favor that specific type of stone. This goal requires an adequate analysis of the stone by infrared spectroscopy or x-ray diffraction. The development of clinically practical guidelines is impossible without knowledge of the metabolism of stone-forming substances and their integration into the entire metabolic system. The correlation between the formation of calcium-containing stones, on the one hand, and bone and acid–base metabolism, on the other, is of great importance. When kidney stones are due to inborn or acquired metabolic disorders, infections, or malnutrition, various methods of lithotripsy (extracorporeal and intracorporeal), chemolysis, and in rare cases, surgical intervention are indicated. After the stones have been removed, prevention of recurrent stones is necessary.

This book will answer all questions about kidney stones, from basic research to diagnostic problems, the removal of stones, and therapeutic measures, and it does not fail to point out unsettled questions. Fifty-one chapters, each containing a long list of references to literature published as recently as 1994, give an excellent account of the present state of knowledge. The comprehensive index facilitates the search for a particular topic. For many days, I could hardly put the book aside. Preparing this review, I had the feeling of surfing through the Internet of urolithiasis. This book will be indispensable to anyone performing research on kidney stones and especially to centers specializing in the removal of kidney stones.

Albrecht Hesse, Ph.D.
University of Bonn, D-53105 Bonn, Germany