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Background: Prevention is a cornerstone for management of recurrent urinary stone disease. Current guidelines recommend metabolic evaluation, lifestyle modification, and medical treatment for patients with urinary stone disease. Nephrologists are uniquely qualified to evaluate stone risk and formulate treatment strategies to reduce that risk. The objective of this study was to determine the frequency of nephrology visits after a urinary stone diagnosis, a key window of opportunity to assess stone risk., Methods: We used nationwide data from the United States Veterans Health Administration to identify patients who had an incident stone diagnosis between 2016 and 2018. We examined the proportion of patients who visited a nephrology clinic within 6 months of stone diagnosis., Results: We identified 42,927 Veterans with urinary stone disease. Only 2432 (5.6%) visited a nephrology clinic within six months of the index diagnosis. The proportion of patients who visited a nephrology clinic after their stone diagnosis ranged between 0.7 and 20.7% across 104 VHA sites, with a median of 4.6% (25%, 75% range 3.4-7.0%). The median rate ratio for a nephrology follow-up visit after a stone diagnosis was 1.72. Veterans with chronic kidney disease were significantly more likely to visit a nephrology clinic relative to Veterans without chronic kidney disease (OR 5.19; 95% CI 4.69, 5.74)., Conclusions: Nephrologists are infrequently and variably involved in the care of patients after a urinary stone diagnosis, suggesting potential for quality improvement., (Copyright © 2024 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

The comparative effectiveness of partial nephrectomy versus radical nephrectomy to preserve kidney function has not been well established. We determined the risk of clinically significant (stage 4 and higher) CKD after radical or partial nephrectomy among veterans treated for kidney cancer in the Veterans Health Administration (2001-2013). Among patients with preoperative eGFR≥30 ml/min per 1.73 m 2 , the incidence of CKD stage 4 or higher after radical ( n =9759) or partial nephrectomy ( n =4370) was 7.9% overall. The median time to stage 4 or higher CKD after surgery was 5 months, after which few patients progressed. In propensity score-matched cohorts, partial nephrectomy associated with a significantly lower relative risk of incident CKD stage 4 or higher (hazard ratio, 0.34; 95% confidence interval [95% CI], 0.26 to 0.43, versus radical nephrectomy). In a parallel analysis of patients with normal or near-normal preoperative kidney function (eGFR≥60 ml/min per 1.73 m 2 ), partial nephrectomy was also associated with a significantly lower relative risk of incident CKD stage 3b or higher (hazard ratio, 0.15; 95% CI, 0.11 to 0.19, versus radical nephrectomy) in propensity score-matched cohorts. Competing risk regression models produced consistent results. Finally, patients treated with a partial nephrectomy had reduced risk of mortality (hazard ratio, 0.55; 95% CI, 0.49 to 0.62). In conclusion, compared with radical nephrectomy, partial nephrectomy was associated with a marked reduction in the incidence of clinically significant CKD and with enhanced survival. Postoperative decline in kidney function occurred mainly in the first year after surgery and appeared stable over time., (Copyright © 2018 by the American Society of Nephrology.)