Physicochemical considerations in the development and prevention of calcium oxalate urolithiasis.

Calcium oxalate urolithiasis is very common in western societies. In recent years significant progress has been made in identifying and quantitating physico-chemical processes involved in calcium oxalate urinary stone formation. The ability of urine to inhibit the agglomeration of calcium oxalate crystals is an important protective mechanism against stone formation. The process of crystal agglomeration is modulated to a large extent by citrate and it is disturbed in patients with hypocitraturia. Dietary factors, in particular high animal protein intake appear to affect adversely the ability of urine to inhibit calcium oxalate crystal agglomeration. Effective prevention of calcium oxalate urolithiasis should aim at restoring the urine's ability to inhibit the agglomeration of crystals and more emphasis should be given to dietary measures.