Kidney Stone Evaluation and Treatment Program
Founded in 1969 by Dr Fredric L Coe, the University of Chicago Kidney Stone Evaluation and Treatment Program has provided care for over 5,000 patients, many of whom have remained under treatment and stone free for decades. Through its many scientific publications, reviews, chapters and books, the program has influenced medical practice throughout the world, and the achievements of Dr Coe and his colleagues have been recognized by many honors as well as sustained National Institutes of Health research grants totaling, to date, over $20,000,000. Presently, Dr Coe is joined by two outstanding physicians, Drs Elaine Worcester and Anna Zisman, both of whom are recognized experts in management of patients with kidney stones. The program runs its own specialized laboratory to assure that measurements essential for diagnosis are made at the highest level of precision and accuracy.
Kidney stone disease often affects individuals who are in their prime working years, and because of this untreated stone disease is costly in terms of time lost from work, school, and raising a family. It is possible to prevent repeated stone episodes with appropriate therapy, which can decrease need for hospitalization and surgery. In some cases, stones may lead to loss of kidney function, which is preventable with proper treatment.
The commonest kidney stones are made of calcium oxalate, and are caused mainly by a familial trait called hypercalciuria, in which patients excrete abnormal amounts of calcium in their urine. This trait can lead to bone disease if not properly managed. The trait interacts with diet in complex ways and treated with medications; when this is done properly, stone production is greatly lessened. In some cases, stones convert to calcium phosphate; such patients deposit crystals in their kidney tissues, and prevention is even more urgent than in calcium oxalate stone formers. Not rarely, stones arise from systemic diseases, like primary hyperparathyroidism, or bowel diseases such as ulcerative colitis, Crohn’s disease, surgical loss of bowel, and altered bowel function from bariatric surgery for obesity. In each situation, evaluation and treatment need to be detailed and thoughtful to prevent kidney disease and stone formation. Less common stones include those of uric acid and cystine, the latter because of an inherited disorder of kidney function. They, too, require exact diagnosis of cause and management.
A refined laboratory is crucial, but so is clinical experience. The causes of stones involve effects of diet, vocation, habits, travel, virtually every aspect of life, many of which are not apparent to patients until discovered by physicians who are skilled enough to find in what appear to be simple matters of daily living the principle cause of stone formation. The tempo of stones, is also seemingly easy to document, but in fact it requires a detailed and thoughtful interpretation of clinical history along with radiological studies like CT scans to determine if a patient is really forming new stones, for example, or passing old ones that formed because of conditions no longer in effect. This kind of clinical skill is rare and difficult to acquire except in a very large clinical center specialized for care of stone forming patients.
Because of their vast experience, the physicians in the University of Chicago Kidney Stone Evaluation and Treatment Program and able to diagnose and manage virtually all known causes of stones. In a recent publication, the program demonstrated that over even 40 years stones and stone related complications can be successfully managed. This kind of experience, over time and thousands of patients cannot be matched anywhere else in the US, and is a reason why this program is recognized for its remarkable achievements world wide.