WHAT IS THE TREATMENT FOR KIDNEY STONES (NEPHROLITHIASIS)?
* Be aware that the recommended treatments of illnesses are always being improved. This website was last update on 11/1/2024. The best treatment option MIGHT have changed since that time.
MEDICATIONS:
1. Tylenol if a person has no known liver problems
2. NSAIDS (non-steroidal anti-inflammatory drugs) if a person has no known kidney problems, stomach problems, or is not in the third trimester or pregnancy
A. Indomethacin *
B. Diclofenac sodium *
C. Ketorolac *
D. Ibuprofen
E. Acetaminophen
3. Tamsulosin 0.4 mg / day helps to dilate the ureters and urethra to allow stones that are 0.4 mm or smaller to pass through the urinary canal
4. Morphine for severe pain
5. Fentanyl for severe pain
6. Ketorolac * 30 mg IV is rapidly effective and nonsedating pain reliever
7. Ondansetron (Zofran) 10 mg IV for nausea and vomiting
8. Antibiotic treatment of kidney infection—if infection exist
Prevention
1. Hydration (This can be a bad treatment if a stone is blocking a urine passage)
2. Potassium citrate * 20 mEq (20 mmol/L) orally 2 to 3 times a day (But this works only for Uric Acid Stones)
3. Avoid foods that increase the chance of kidney "oxalate" stones (the most common type of stones):
A. chocolate
B. spinach
C. beets
D. rhubarb
E. nuts
F. teas
4. Allopurinol (for people who have uric acid stones)
5. Febuxostat *
PROCEDURES THAT CAN BE DONE:
1. A urethral stent that is placed via cystoscope
2. Percutaneous nephrostomy tube: a tube directly into the kidney
3. Ureteroscopes (endoscopes) and, fragmentation with some sort of lithotripsy device (eg, pneumatic, ultrasonic, laser), or both.
4. Removal of stone through an endoscope inserted anterograde through the kidney
5. For renal stones > 2 cm, percutaneous nephrolithotomy, with insertion of a nephroscope directly into the kidney
PREVENTION OF KIDNEY STONES:
1. Drinking large amounts of fluids—about 2.5 to 3 Liters a day is recommended for all patient who have passed stones. Patients should drink enough fluid to produce at least 2.5 liters of urine daily.
2. For Patient with excessive urine Calcium:
A. Thiazide diuretics (Chlorthalidone 25 mg once a day
or
B. Indapamide 1.25 mg daily
and
C. Potassium citrate * (for uric acid stones)
D. A diet that is low in sodium and high in potassium is recommended.
E. Restriction of dietary animal protein is also recommended.
For patients with Hypocitruria (low citrate in the urine)
A. Potassium Citrate (20 mEq [20 mol/L] orally twice a day) enhances citrate excretion.
B. A normal calcium intake (eg, 1000 mg/day — or about 2 to 3 dairy servings per day) is recommended. Calcium restriction is NOT recommended.
C. Sodium bicarbonate “Baking soda” or potassium bicarbonate can be used to enhance citrate excretion if potassium citrate cannot be tolerated.
For Patient with Hyperoxaluria prevention varies.
A. Patients with small-bowel disease can be treated with a combination of high fluid intake, calcium loading (usually in the form of Calcium Citrate 400 mg orally twice a day with meals), Cholestyramine, and a low-oxalate, low-fat diet.
B. Patient with Hyperoxaluria may also respond to Pyridoxine 100 to 200 mg orally once a day.
For patient with Hyperuricosuria stones (Hyperoxaluria is a condition that occurs when there is too much oxalate in your urine):
A. Reduce the intake of animal protein.
For Patient with Hyper Uric Acid Calculi:
A. Potassium Citrate 20 mEq should be given increased urine acidity to between a pH 6 and pH 6.5
B. Allopurinol 300 mg each morning lowers uric acid production.
For Struvite Stone Patients:
A. Culture-specific antibiotics
B. Complete removal of all calculi.
B. If eradication of infection is impossible, long-term suppressive therapy (eg, with nitrofurantoin) may be necessary.
C. In addition, acetohydroxamic acid can be used to reduce the recurrence of struvite calculi.
For Cystine Stone Patients:
A. Urinary cystine levels must be reduced to < 250 mg cystine/L of urine.
B. Increasing urine volume
C. Cystine excretion-agents: Tiopronin or Penicillamine should be taken to reduce the urinary cystine concentration
CAUTION:
1. Severe symptoms of a Kidney Stone should be treated in the hospital Emergency Room—and not at home.
2. Difficulty passing urine is an emergency that needs to treated in an Emergency Room as soon as possible.
3. All medication, including all antibiotics, have a risk of side effects.
4. Possible Severe side effects are a severe skin rash, an anaphylactic allergic reaction (leading to the inability to breathe and subsequent death if not treated rapidly), and Clostridioides difficile infection (C. Diff.) of the colon.
5. Medications such as creams, lotions, and gels should be tested in small dosages in areas of the body that are not easily seen.
WHAT ARE THE SYMPTOMS OF KIDNEY STONES (Kidney Calculi, Nephrolithiais)?
The primary symptoms of kidney stones (calculi) are severe sharp pain in the lower back (in the area of the kidneys) that radiates around the back and sides (in the location of the ureters) toward the front of the body, that comes and goes in waves. Other symptoms that may accompany these symptoms are the following: pain or burning sensation while urinating; pink, red or brown urine; cloudy or foul-smelling urine; a persistent need to urinate; urinating frequently and in small amounts; nausea and vomiting; fever and chills.
WHAT CAUSES KIDNEY STONES (NEPHROLITHIASIS?
There are four different causes for Kidney Stones. Most of these causes have a genetic part, making these people more likely to get Kidney Stones simply because of their genes.
Most of the stones that are made are composed partially of Calcium, either Calcium Oxalate— or Calcium Phosphate; however, this is not because these people eat too much calcium. It is, however, partially due to excreting too much Calcium in their urine. In addition, many of these people also manufacture too little Citrate in their urine. Citrate normally inhibits the sticking together of chemicals in the urine, so when it is too low, Calcium sticks with other chemicals in the urine and forms either Calcium Oxalate—or Calcium Phosphate. The calcium stones make up 85% of stones.
About 10% of stones occur as a result of the body manufacturing excessive uric acid. Too much uric acid causes an increase in ammonia in the urine, this causes the urine to be less acid. Therefore, even though there is more uric acid in the blood, the urine is less acid. And since acid usually inhibits stones, when acid decreases below its normal level, it allows more stones to form.
About 3% of stones are called Strive, which are a cluster of magnesium, ammonium, and phosphate. These stones also related to related to uric acid and amonia levels. However, this increase in uric acid, and subsequent higher levels of ammonia in the urine, and lower levels of acid in the urine occurs because a person has an increase number of Urinary Tract Infections that are caused by Proteus and Klebsiela bacteria. These bacteria cause the urea in urine to break apart, which then increases uric acid, which consequently increases ammonia, and this decreases the acidity of urine. By decreasing the acidity of urine, it allows magnesium, ammonium, and phosphate to stick together, making magnesium ammonium phosphate stones (Struvite).
The last 2% of calculi are made from excessive amino acids (called Cysteine) sticking together. This is a genetic condition that allows too many Amino Acids through the kidney, and when this happens some of them stick together causing cystine stones.
HOW ARE KIDNEY STONES DIAGNOSED?
There are a variety of ways that Kidney Stones are diagnosed. First, the symptoms of extreme pain radiating from the back to the front often in waves is a strong indicator that someone has a kidney stone. In addition to these classic symptoms, there are various tests to find stones in the body. A very common imaging test is a helical CT scan. Other test such an ultrasound and a plain abdominal x-ray can also confirm the presence of a calculi.