Acute pancreatitis, hypercalcemia, and kidney stones: True incidence or unveiled prevalence?

Table 2 Distinguishing true incident nephrolithiasis from unveiled prevalent microlithiasis in acute pancreatitis

Domain	True incident nephrolithiasis	Unveiled prevalent microlithiasis
Biological premise	New crystal nucleation, aggregation, retention, and growth produce a genuinely new stone	Previously silent crystals or microliths become detectable during acute evaluation
Expected time course	Usually, weeks to months before a clinically meaningful calculus becomes evident	Detection may shift from hours to days without implying new stone formation
Baseline imaging expectation	No renal deposit should be present on high-quality baseline computed tomography	Small pre-existing deposits may be missed on ultrasound, yet still be present at baseline
Urinary evidence needed	Persistent lithogenic profile on 24-hour urine supports causal inference	Acute metabolic disturbance may transiently increase visibility without proving chronic stone disease
Short-term behavior	Lesion persists or enlarges on follow-up imaging	Focus may regress after hydration and recovery from inflammatory-metabolic stress
Clinical implication	Long-term stone prevention and metabolic evaluation are usually warranted	Repeat post-recovery assessment is needed before labeling chronic nephrolithiasis