From the Guidelines
Renal calculus IV flush therapy is not a recommended treatment for kidney stones, and instead, patients should undergo evidence-based treatments such as increased fluid intake, pain management, and if necessary, surgical interventions like percutaneous nephrolithotomy (PNL) or extracorporeal shock wave lithotripsy (ESWL). The primary goal in managing kidney stones is to alleviate symptoms, prevent complications, and improve quality of life. According to the American Urological Association (AUA) guideline on management of staghorn calculi 1, percutaneous nephrolithotomy (PNL) is a recommended treatment for large or complex stones, with stone-free rates of 74% to 83%.
For patients with ureteral calculi, the 2007 AUA guideline 1 suggests that SWL can be an effective treatment option, with stone-free rates of 82% in the proximal ureter, 73% in the mid ureter, and 74% in the distal ureter. However, the choice of treatment should be individualized based on stone size, location, composition, and patient factors.
Key considerations in managing kidney stones include:
- Increased fluid intake to help prevent stone formation
- Pain management with medications such as non-steroidal anti-inflammatory drugs (NSAIDs) or opioids
- Medical expulsive therapy with medications like tamsulosin (0.4 mg daily) to help pass small stones
- Surgical interventions like PNL or ESWL for larger or more complex stones
- Prevention of recurrent stones with lifestyle modifications, such as limiting sodium and animal protein intake, and specific medications based on stone composition.
Intravenous fluids may be used in patients with severe dehydration or those unable to maintain oral hydration, but this is supportive care rather than a specific treatment to dissolve or remove stones. The concept of "IV flush therapy" for kidney stones is not supported by medical evidence, and treatment should be guided by a urologist or nephrologist to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Renal Calculus IV Flush Therapy
- The management of acute renal colic involves hydration, imaging, and pain control 2.
- A study comparing forced versus minimal intravenous hydration in patients with acute renal colic found no difference in pain scores, narcotic use, or stone-passage rates between the two groups 2.
- The results suggest that maintenance intravenous fluids are as efficacious as forced hydration with regard to patient pain perception and narcotic use 2.
- Another study reviewed the evidence on the administration of fluids to prevent contrast-associated acute kidney injury (CA-AKI) and found that the more fluid administered, the lower the incidence of CA-AKI 3.
- However, the study also suggested that it is the urine output that most directly affects the incidence of CA-AKI, rather than the type or amount of fluid administered 3.
- There is no direct evidence from the provided studies to support the use of IV flush therapy for renal calculus, as one study focused on hydration in acute renal colic 2 and another on prevention of CA-AKI 3, while the third study is unrelated to the topic 4.