Appendix:

Kidney Stone Recurrence Management

KNOWLEDGE: Below are a series of questions aimed at assessing your knowledge surrounding management of kidney stone recurrence.

What is the most important inhibitor of stone formation? ❍ Normal urinary citrate concentration ❍ Urinary pyrophosphates ❍ High urine volume ❍ Low urinary calcium ❍ Urinary glycoproteins

Of the following, which type of stone recurs most frequently? ❍ Calcium stones ❍ Oxalate stones ❍ Uric acid stones ❍ Struvite stones

After occurrence of kidney stones, when would you consider detailed work-up to prevent stone recurrence? ❍ After passage of initial stone ❍ If stone recurs within 7 years ❍ If stone recurs within 5 years ❍ If stone recurs within 3 years ❍ If stone recurs within 10 years

All of the following general measures are useful in the prevention of recurrent kidney stones, EXCEPT: ❍ Increase fluid intake to maintain urine output of 2–3L/day ❍ Decrease animal protein intake ❍ Decrease calcium intake ❍ Decrease dietary oxalate ❍ Restrict salt intake

All of the following factors increase the risk of stone formation, EXCEPT: ❍ Family history of kidney stones ❍ Gastric bypass ❍ Obesity ❍ Medullary sponge kidney ❍ Type 1 diabetes mellitus

Which of the following diuretics is the least helpful in controlling urinary calcium excretion in patients with hypercalciuria? ❍ Amiloride ❍ Chlorthalidone ❍ Furosemide ❍ Hydrochlorothiazide ❍ Spironolactone

Thank you for completing the questionnaire. Please provide any comments/suggestions regarding the survey.

PRACTICE PATTERNS: The following questions are to assess the practice patterns and the answers to these questions should reflect what you do in your daily practice, to prevent recurrence of kidney stones.

What do you recommend about fluid intake in patients who suffer from kidney stone disease? ❍ Drink 8 glasses of water a day ❍ Drink liquids 2–3L/day, irrespective of type ❍ Drink enough liquids, so that the urine output is approximately 2–3L/day ❍ Drink plenty of liquids throughout the day, but especially at night, so that the individuals have to urinate at least once during the night ❍ Other, please specify: ____________________

What are your recommendations about protein intake in patients who suffer from kidney stone disease? ❍ Restrict total protein intake ❍ Restrict animal protein intake ❍ Restrict vegetable protein intake ❍ Protein restriction is not important ❍ Other, please specify ____________________

What are your recommendations about calcium intake in patients who suffer from kidney stone disease? ❍ Restrict calcium intake ❍ Maintain normal calcium intake ❍ Increase calcium intake - add calcium supplements - calcium carbonate ❍ Increase dietary calcium ❍ Other, please specify ____________________

What are your practices with regards to stone analysis in prevention of kidney stones? ❍ Complete stone analysis with patients for each stone that is retrieved ❍ Complete stone analysis only with patients who have suffered from multiple stones ❍ Complete stone analysis only if the patient has positive risk factors for kidney stones ❍ Stone analysis is not a routine practice of mine

After the initial presentation of a calcium oxalate stone, I would prescribe _________________ to help with prevention of stone recurrence: ❍ Amiloride ❍ Chlorthalidone ❍ Furosemide ❍ Hydrochlorothiazide ❍ None of the above, I prefer adjusting lifestyle habits

ATTITUDES: Below is a list of statements that are to assess your attitudes surrounding the management of recurrent kidney stones.
	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
I feel that it is important to maintain normal calcium intake is an effective way to prevent stone formation.	❍	❍	❍	❍	❍
I have confidence that decreasing dietary oxalate (i.e. spinach, chocolate) is an efficient method in reducing risk of stone recurrence.	❍	❍	❍	❍	❍
Increasing fluid intake is a measure I promote to all patients at risk of kidney stone recurrence.	❍	❍	❍	❍	❍
I believe that restricting salt intake reduces urinary calcium thus preventing recurrent stones.	❍	❍	❍	❍	❍
I believe that cranberry juice intake is a worthwhile treatment option for patients who are at risk of stone recurrence.	❍	❍	❍	❍	❍
I trust that decreasing intake of animal protein is an efficacious treatment option in those at risk for stone recurrence.	❍	❍	❍	❍	❍
I believe stone analysis is important in prevention of recurrent kidney stones.	❍	❍	❍	❍	❍
Medical management to prevent recurrent kidney stones is cost effective, even after the passage of a single stone.	❍	❍	❍	❍	❍

KNOWLEDGE: Below are a series of questions aimed at assessing your knowledge surrounding management of kidney stone recurrence.

What is the most important inhibitor of stone formation? ❍ Normal urinary citrate concentration ❍ Urinary pyrophosphates ❍ High urine volume ❍ Low urinary calcium ❍ Urinary glycoproteins

Of the following, which type of stone recurs most frequently? ❍ Calcium stones ❍ Oxalate stones ❍ Uric acid stones ❍ Struvite stones

After occurrence of kidney stones, when would you consider detailed work-up to prevent stone recurrence? ❍ After passage of initial stone ❍ If stone recurs within 7 years ❍ If stone recurs within 5 years ❍ If stone recurs within 3 years ❍ If stone recurs within 10 years

All of the following general measures are useful in the prevention of recurrent kidney stones, EXCEPT: ❍ Increase fluid intake to maintain urine output of 2–3L/day ❍ Decrease animal protein intake ❍ Decrease calcium intake ❍ Decrease dietary oxalate ❍ Restrict salt intake

All of the following factors increase the risk of stone formation, EXCEPT: ❍ Family history of kidney stones ❍ Gastric bypass ❍ Obesity ❍ Medullary sponge kidney ❍ Type 1 diabetes mellitus

Which of the following diuretics is the least helpful in controlling urinary calcium excretion in patients with hypercalciuria? ❍ Amiloride ❍ Chlorthalidone ❍ Furosemide ❍ Hydrochlorothiazide ❍ Spironolactone

Thank you for completing the questionnaire. Please provide any comments/suggestions regarding the survey.