One in 11 United States adults will be diagnosed with a kidney stone in his or her lifetime. As the prevalence of stone disease rises, the associated morbidity and attendant costs to individuals and the healthcare system mount. Prevention of stone disease is the key to breaking the cycle of recurrence, patient suffering, and mounting costs. Knowledge of the physiochemistry and the pathophysiologic theories of kidney stone formation provides the foundation for understanding the rationale behind prevention and treatment strategies. Nephrolithiasis is recognized as a chronic, systemic medical condition affected by genetics, dietary factors, and systemic comorbid conditions. Metabolic stone evaluation and directed medical therapy are recommended for patients with risk factors for stone recurrence. In this section the epidemiology, pathophysiology, and metabolic evaluation of nephrolithiasis will be reviewed.
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