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Acute Stone: Surgical Care versus Medical Care
Winner: Medical Care
Surgical care has long been dominant to the point that conference officials were thinking about removing medical care from nephrologists altogether but stone clinics are gaining ground and frequent stone formers are learning the tricks to helping themselves pass stones without intervention. Teaching a patient about medical stone care is a way to empower them to take ownership of their disease.
Xanthine oxidase inhibitors versus the CT Scan
Winner: CT Scan
Kidney stones are generally a non-lethal condition. When I was a fellow, Fred Coe used to call it civilian nephrology. Well there is nothing civilized about iatrogenic cancer. Over use of radiology is going to be a bigger and bigger issue in medicine due to cost and radiation exposure. Kidney stones are likely to be the canary in the coal mine. This is another issue where properly educated patients can be empowered to advocate their own case. CT scans have among the highest exposures to radiation, yet a KUBs paired with an U/S has similar sensitivity and specificity for clinically relevant stones.
Dr. Pak versus Dr. Coe
Coe versus Pak is a Sophie’s choice. Both are legends and neither would out of place advancing to the next round, however Pak is held back by his classification of hypercalciuria. His focus on different categories hypercalciuria is not clinically useful. Coe wins for defining the natural history of kidney stones.
Oxalobacter formigenes versus Bariatric Surgery
The microbiome will be one of the major themes in the twenty-first century. Medicine will learn to appreciate the prokaryotic population within us and hopefully leverage it for therapeutic benefit. Kidney stones are on the leading edge of this fascinating topic.