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GANESH SHIDHAM: The Ohio State University Metabolic Stone Clinic started with a multidisciplinary and collaborative clinic, at one place the urologist, nephrologist, and a dietitian. I think we find that collaborating with urologists and dietitians and a dedicated nephrologist for the care of stone patients is very important. There was no specific kidney stone clinic so far. And now we have an option.

We use a special lab to identify these 24-hour urine tests. We also do stone analysis and a battery of blood tests to identify the metabolic risk factors. 95% of our patients who are recurrent stone formers do have some type of metabolic abnormality in their urine. So we identify a risk factor for that particular patient, and personalize the treatment towards those risk factors.

The patients who have supersaturated urine and have an imbalance of promoters and inhibitors-- unless this imbalance is corrected, they will continue to form recurrent stones. Kidney stone incidents have increased in the last many decades. And the incidence has paralleled with the increasing incidence of obesity, hypertension, and metabolic syndrome. Of course, there is some family inheritability, but most of that is diet, and enrollment, and our dietitian. So I do focus a lot on diet, fluid intake. And we identify some of the medications that may be promoting stone formation.

If we empirically treat all these patients with the number of medications that we have-- remember, this is a lifelong process, so you are committing these patients. Even if it is two medications, and you are trying them empirically doing this, then this becomes a burden on them. And maybe they're not effective, even. So I think using these medications-- whatever we have-- using them wisely to a specific population of patients is, I think, very important.

The studies have shown that if we can correct these risk factors over a period of three or four years, the incidence of recurrence goes down by 70%. So that's a huge improvement in recurrence, if those risk factors could be corrected. And we find many of these patients do not recur.

At least, our success for kidney stone prevention would be-- one, is, of course, not forming new stones, but also, second is not having enlarging stones. If they already have five or six stones in their kidney, our aim is to see they are not enlarging. And that's prevention. Of course, not forming new stones is another endpoint. And we do see a lot of successes in this.

So we have a few clinical trials for the patients who have kidney stones because of what we call enteric hyperoxaluria. It means high levels of oxalates in the urine. We will be starting enrolling these in the next two or three months. These are difficult, very recurrent kidney stone patients, mostly patients who have stones post-bariatric surgery, patients who have Crohn's disease or enteritis, or some type of short bowel syndrome. In those patients, the oxalate levels in the urine go pretty high, and that predisposes to kidney stones. So this type of trial will help these patients to decrease these levels in the urine, and hopefully, prevent their stones.