Hyaluronan Biology and Regulation in Renal Tubular Epithelial Cells and its Role in Kidney Stone Disease

Renal stone disease is a widespread problem afflicting more and more people throughout the world. Epidemiological studies show an increase in incidence and prevalence rates. In North America and Europe the yearly incidence is estimated to be about 0.5% 1, 2. The prevalence of kidney stones in the USA has risen in two decades from 3.2% to 5.2% 3. The lifetime risk is about 10-15% in the developed world, but can be as high as 20-25% in the middle east 1, 2. Kidney stone disease often presents as an episode of acute renal colic with characteristic severe intermittent pain in the flank or lower abdomen, vomiting and haematuria caused by a calculus obstructing the ureter 4. Renal stone disease has a substantial impact on the health care system. For example, the total annual cost for urolithiasis in the United States in 1995 was estimated to be $1.83 billion 5. Nephrolithiasis is likely to recur and recurrence rates are reported to be 50% in 10 years and 75% in 20 years 1. Apparently the development of minimal invasive techniques for stone removal, such as extracorporal shock-wave lithotripsy (ESWL), ureterorenoscopy (URS) and percutaneous nephrolitholapaxy (PCNL) together with current standards to avoid stone recurrence such as general measures and metabolic therapy have not resolved the increasing problem of (recurrent) stone formation 4, 6, 7. Therefore scientific research is warranted to better understand the etiology of stone disease aimed at preventing kidney stone formation in healthy people or stone recurrence in patients.

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