The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recently conducted 2 symposia addressing kidney stone research. The first, The 2006 Urolithiasis Symposium, was held in Baltimore, MD, on March 9-10, 2006 (http://www.niddk.nih.gov/fund/other/urolithiasis2006). Its agenda covered the entire range of pathophysiology and clinical science of stone disease, from crystal formation to genetics, from proteomics to animal models, and from imaging modalities and surgical care to dietary and pharmacologic preventive strategies. Although this comprehensive review was thorough in offering a timely survey of the latest research, an immediate consequence of the meeting in the ensuing months was not obvious. There was a need to convene again, with a more clinically oriented goal, in order to update the care of recurrent stone formers.
Another symposium, entitled The Urolithiasis Treatment and Outcome Symposium, was held on February 28-29, 2008, in Washington, DC (http://www3.niddk.nih.gov/fund/other/urolithiasis2008). Organized by Drs Margaret Pearle (University of Texas Southwestern Medical Center), Gary Curhan (Brigham and Womens Hospital), and Debuene Chang (NIDDK), the program was restricted to clinical topics emphasizing and recommending future directions for stone disease research in epidemiology, medical and surgical management, imaging, and pediatrics. The organizers wanted to emphasize the development of clinical trials and new technologies rather than review prior work with which the majority of participants and attendees were familiar. In turn, we hope this issue's multidisciplinary content will bring new information to our readers.
All of the articles presented in this issue of Advances in Chronic Kidney Disease are based on lectures delivered by the authors at this recent NIDDK symposium. Space limitations preclude the inclusion of all of the presentations. Therefore, this issue does not constitute “the proceedings” of the meeting. Consequently, we regret that some outstanding contributions to the meeting cannot be transmitted here. However, several features of the meeting's transactions should be mentioned. First, strong opinions and debate were offered in an edifying (and entertaining) manner. Second, breakout sessions, attended democratically by all participants, permitted a free-flowing dialog, which encompassed a broad variety of exchange between nephrologists, urologists, dieticians, pediatricians, epidemiologists, and radiologists (and 1 physicist). Third, a memorable highlight was the impromptu and informal convening of an intense postdinner planning session, which attempted to design several randomized controlled clinical trials for the prevention of recurrent stones. Several new ideas for testing dietary and pharmacologic interventions sprang from this spontaneous session.
The meeting's interdisciplinary approach, like other kidney stone conferences, stands in contrast to the field's completed research. Despite the relatively high and growing prevalence of stone disease, the opportunities in this field have not been fulfilled by the academic community. Given the sizable prevalence, patients are not lacking. The root causes of this relative paucity of tested hypotheses can be speculated on and debated. Rather than offering such debate, the authors of this issue prefer to publicize “the brain work” accomplished at the meeting within the fine offerings presented here and to move forward with several collaborative proposals.
Thus, we have attempted to include a representative aliquot of the topics that were reviewed. Under the general heading of epidemiology, Dr Yair Lotan reviews the economics and costs of care, whereas advances in imaging are covered by Dr Ronald Zagoria and Drs John Denstedt and Mrinal Dhar. Surgical management is reviewed by Drs Jim Lingeman, Brian Matlaga, Michael Ferrandino, Manoj Monga, and Glenn Preminger, after which Dr Frank Keeley examines future surgically oriented clinical trials for stone disease. Preventive dietary modification proposals are presented by Dr David Goldfarb and pharmacologic manipulation by Dr Khashayar Sakhaee. The latest observations on the effects of bariatric surgery are surveyed by Dr John Asplin. If the meeting's ample ideas become the basis for further studies, advances in imaging will allow more accurate stone diagnosis and measurement, elucidation of pathophysiology will lead to more focused studies, and the combination of medical therapy with urologic interventions will further help alleviate the suffering of recurrent stone formers.
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