SMART Stone Multidisciplinary Team (MDT) and patient care: recommendations for the adult high-risk kidney stone patient pathway
By
Bhaskar Somani
Esteban Emiliani
Thomas Knoll
Giorgia Mandrile
Gill Rumsby
Cecile Acquaviva
Naeem Bhojani
Saeed Bin Hamri
Ewa Bres-Niewada
Niall F. Davis
Daniel G. Fuster
Sander F. Garrelfs
Vineet Gauhar
Shuzo Hamamoto
Patrick Juliebø-Jones
Marta Leporati
Emmanuel Letavernier
Tatsuya Takayama
Lazaros Tzelves
Steffi Kar Kei Yuen
Pietro Manuel Ferraro
April 22, 2025
Clinical Scorecard: Guidelines for Managing Adult High-Risk Kidney Stone Patients: Insights from the SMART Stone Multidisciplinary Team Approach
At a Glance
Category Detail
Condition High-risk recurrent kidney stone disease Key Mechanisms Multifactorial disease requiring interplay of medical, surgical, biochemical, and genetic management Target Population Adults with complex or recurrent kidney stone disease Care Setting Multidisciplinary team (MDT) coordinated healthcare settings
Key Highlights
Multidisciplinary teams improve diagnosis accuracy, treatment outcomes, and patient journey in complex kidney stone cases. A total of 44 MDT recommendations were developed and validated with ≥70% consensus among international experts. Core recommendations emphasize early identification, referral, patient assessment, communication, and care integration. Guideline-Based Recommendations
Diagnosis
Use MDT approach for early identification and referral of high-risk recurrent kidney stone formers. Incorporate biochemical and genetic analysis alongside medical and surgical evaluation. Management
Establish MDTs including urologists, nephrologists, biochemists/geneticists for coordinated care. Implement MDT decision-making to optimize therapeutic management and patient outcomes. Monitoring & Follow-up
Regular MDT meetings to review patient progress and adjust management plans accordingly. Ensure ongoing communication and care integration across specialties. Risks
Consider patient comorbidities and complex medical backgrounds in MDT planning. Account for healthcare setting, infrastructure, and resource availability when implementing MDT. Patient & Prescribing Data
Adults with high-risk recurrent kidney stones requiring multidisciplinary care
MDT involvement improves adherence, reduces time to diagnosis, and enhances treatment outcomes.
Clinical Best Practices
Form MDTs with clearly defined roles including urologists, nephrologists, and biochemists/geneticists. Use consensus-based recommendations to guide MDT implementation and patient management. Adapt MDT processes to local healthcare infrastructure and resource availability. Engage patients in decision-making to align care with preferences and clinical scenarios. Prioritize communication, coordination, and care integration within the MDT. References
