From the Guidelines
The patient with nephrolithiasis without hydronephrosis should be managed conservatively with pain control, increased fluid intake, and medical expulsive therapy if the stone is small enough to pass. Given the absence of hydronephrosis, the risk of complications such as infection or severe obstruction is lower, but still, careful monitoring and follow-up are necessary. For pain management, options include ibuprofen 400-600mg every 6-8 hours or acetaminophen 650-1000mg every 6 hours as needed 1. Alpha-blockers like tamsulosin 0.4mg daily can be considered to help facilitate stone passage by relaxing ureter muscles, especially if the stone is in the ureter 1. The patient should be advised to strain all urine to catch passed stones for analysis, which can help in determining the composition of the stone and guide future preventive measures. Prevention of future stones involves maintaining high fluid intake, limiting sodium and animal protein consumption, and possibly taking medications like potassium citrate or thiazide diuretics depending on stone composition 1. Follow-up imaging in 4-6 weeks is recommended to ensure stone passage or to determine if urological intervention (like lithotripsy or ureteroscopy) is needed for stones that don't pass spontaneously. Key points to consider in management include:
- Pain control with NSAIDs or acetaminophen
- Increased fluid intake to help pass the stone
- Medical expulsive therapy with alpha-blockers for suitable stones
- Straining urine to catch and analyze passed stones
- Dietary modifications and possibly medications to prevent future stones
- Follow-up imaging to assess stone passage or need for intervention. It's also important to note that while CT scans are useful for diagnosing nephrolithiasis, the absence of hydronephrosis does not rule out the need for careful monitoring and potential intervention if symptoms worsen or if there are signs of complications 1.
From the Research
Nephrolithiasis Diagnosis and Treatment
- The patient's CT results show nephrolithiasis without hydronephrosis, indicating the presence of kidney stones without any obstruction or swelling in the kidney 2.
- The treatment options for nephrolithiasis in children include observation, medical expulsive therapy, extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, percutaneous nephrolithotomy, and open or laparoscopic stone surgery 2.
- The choice of treatment depends on the size and location of the stone, as well as the patient's symptoms and overall health 2.
Relevant Studies
- A study published in 2020 discusses the urologic treatment of nephrolithiasis in children, highlighting the various options available and the importance of a shared decision-making process between patients, families, and healthcare providers 2.
- There is no relevant information in the study published in 1985, as it focuses on the primary structure of the 5' non-coding and capsid protein-coding regions of the coxsackievirus B3 genome, which is unrelated to nephrolithiasis 3.