From the Guidelines
Kidney stone treatment should prioritize increased fluid intake and pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol to prevent recurrent nephrolithiasis, as recommended by the American College of Physicians guideline 1.
Treatment Options
- For small stones (less than 5mm), increased fluid intake of 2-3 liters daily is recommended along with pain management using NSAIDs like ibuprofen (400-800mg every 6-8 hours) or prescription medications such as ketorolac.
- Alpha-blockers like tamsulosin (0.4mg daily) may help stones pass more quickly by relaxing ureter muscles.
- For larger stones (>10mm) or those causing severe symptoms, medical procedures are typically needed, including extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, or percutaneous nephrolithotomy.
Prevention
- Long-term prevention involves dietary changes like reducing sodium and animal protein intake, maintaining adequate calcium consumption, and increasing citrate-rich foods like lemons and oranges.
- Specific medications for prevention may be prescribed based on stone composition, such as thiazide diuretics for calcium stones or allopurinol for uric acid stones.
Key Considerations
- Maintaining proper hydration is crucial for both treatment and prevention of kidney stones, as it helps to dilute the concentration of minerals in the urine and reduce the risk of stone formation 1.
- The American College of Physicians guideline recommends pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol to prevent recurrent nephrolithiasis in patients with active disease in which increased fluid intake fails to reduce the formation of stones 1.
- The choice of treatment should be based on the size and type of stone, as well as the patient's overall health and medical history, as outlined in the American Urological Association/Endourological Society guideline 1.
From the Research
Kidney Stone Treatment Options
- Kidney stones can be treated using various methods, including shock wave lithotripsy (SWL) and medical expulsive therapy (MET) with alpha-blockers 2, 3, 4, 5.
- Alpha-blockers, such as tamsulosin, silodosin, and doxazosin, may improve stone clearance rates and reduce the need for auxiliary treatments after SWL 2, 3, 5.
- The use of alpha-blockers as MET for ureteral stones may increase stone clearance rates, reduce stone expulsion time, and decrease the need for hospitalization and surgical intervention 4.
Efficacy of Alpha-Blockers
- Studies have shown that alpha-blockers may be effective in improving stone clearance rates, particularly for stones larger than 5 mm 3, 4.
- A meta-analysis of randomized controlled trials found that alpha-blockers increased stone clearance rates by 16% compared to control groups 5.
- Another study found that alpha-blockers may reduce the need for auxiliary treatments after SWL, with a risk ratio of 0.67 (95% CI 0.45 to 1.00) 2.
Safety and Side Effects
- Alpha-blockers are generally well-tolerated, but may cause side effects such as dizziness, hypotension, and headache 2, 5.
- A study found that alpha-blockers may reduce major adverse events, with a risk ratio of 0.60 (95% CI 0.46 to 0.80) 2.
- However, another study found that alpha-blockers may slightly increase the risk of major adverse events, with a risk ratio of 2.09 (95% CI 1.13 to 3.86) 4.
Prevention and Management
- Patients with kidney stones should be screened for risk of stone recurrence and undergo lifestyle modifications, such as increased fluid intake 6.
- Thiazide diuretics, allopurinol, or citrates may be prescribed for patients with recurrent calcium stones 6.
- Asymptomatic kidney stones should be followed with serial imaging, and removed in case of growth, symptoms, urinary obstruction, recurrent infections, or lack of access to health care 6.