Cystinuria (OMIM 220100) is an autosomal recessive hereditary disorder in which high urinary
cystine excretion leads to the formation of
cystine stones because of the low solubility of
cystine at normal urinary pH. We developed clinical practice recommendation for diagnosis, surgical and medical treatment, and follow-up of patients with
cystinuria. Elaboration of these clinical practice recommendations spanned from June 2018 to December 2019 with a consensus conference in January 2019. Selected topic areas were chosen by the co-chairs of the conference. Working groups focusing on specific topics were formed. Group members performed systematic literature review using MEDLINE, drafted the statements, and discussed them. They included geneticists, medical biochemists, pediatric and adult nephrologists, pediatric and adult urologists experts in
cystinuria, and the Metabolic Nephropathy Joint Working Group of the European Reference Network for Rare
Kidney Diseases (ERKNet) and eUROGEN members. Overall 20 statements were produced to provide guidance on diagnosis, genetic analysis, imaging techniques, surgical treatment (indication and modalities),
conservative treatment (hydration, dietetic, alkalinization, and
cystine-binding drugs), follow-up, self-monitoring, complications (
renal failure and
hypertension), and impact on quality of life. Because of the rarity of the disease and the poor level of evidence in the literature, these statements could not be graded. This clinical practice recommendation provides guidance on all aspects of the management of both adults and children with
cystinuria, including diagnosis, surgery, and medical treatment.