Prevention and treatment of nephrolithiasis: a review on the role of spa therapy

Authors: Mennuni G (1) , Serio A (2) , Fontana M (1) , Nocchi S (1) , Costantino C (1) , Tanzi G (3) , Stornelli G (3) , Fraioli A (1)
(1) UOC Medicina Interna E, Terapia Medica e Medicina Termale - Scuola di Specializzazione di Medicina Termale - Dipartimento di Medicina Interna e Specialità Mediche - Sapienza Università di Roma, Azienda Policlinico Umberto I (2) Università Campus Bio-Medico di Roma (3) ASL RMA
Source: Clin Ter. 2015;166(5):e344-56
DOI: 10.7417/T.2015.1890 Publication date: 2015 E-Publication date: Not specified Availability: abstract Copyright: Not specified
Language: English Countries: Not specified Location: Not specified Correspondence address: Not specified


Article abstract

The prevalence and incidence of nephrolithiasis is reported to be increasing across the world. It is a disease of increased urinary concentration of stone-forming salts. The physicochemical mechanism of stone formation includes precipitation, homogenous/heterogeneous nucleation, growth, aggregation and concretion of various modulators in urine. Necessary condition to develop stones is urinary supersaturation, due to reduced urinary volume or to an excesses solutes. Fluid intake is the main determinant of urine volume. Urine dilution can significantly decrease both the crystallization rate of the urinary salts and the aggregation of the crystals. A correct fluid intake can act on different effects: urinary tract washing, urinary volume increasing and dilution of solutes. In addition mineral waters have other particular features: greater diuretic effect, more important urinary dilution with solutes and microbial concentration reduction, urinary pH changes, superior washout effect due to mechanical effects and ureteral contractions. Adequate water intake is the most important conservative strategy in urolithiasis prevention; particularly hydropinotherapy with oligomineral water should be considered as an important instrument to prevent stones in subjects predisposed to the disease (family members of people suffering from kidney stones), to reduce relapses, and can help to eliminate residual fragments also after extracorporeal shock wave lithotripsy. It is recommended a management with increased mineral water intake to promote urine volume of at least 2.5L each day to prevent stone formation. Obviously water intake shall be varied in relation to the presence of contraindications or any diseases.

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