From the Guidelines
Nephrolithiasis patients should prioritize increased fluid intake to achieve at least 2 L of urine per day to prevent recurrent stone formation, as recommended by the American College of Physicians 1. When experiencing symptoms of nephrolithiasis, such as severe pain, fever, vomiting, or inability to urinate, it is crucial to seek immediate medical attention. Some key emergency precautions for nephrolithiasis include:
- Drinking plenty of fluids (2-3 liters daily) to help flush out smaller stones and prevent dehydration
- Taking over-the-counter medications like ibuprofen (400-600mg every 6 hours) or acetaminophen (500-1000mg every 6 hours) for pain management, unless contraindicated
- Avoiding high-sodium foods, excessive animal protein, and oxalate-rich foods (spinach, nuts, chocolate) during an acute episode
- Straining all urine through a fine mesh to catch any passed stones for analysis If symptoms worsen or if the patient develops fever above 101°F, chills, or notices blood in their urine, they should seek emergency care immediately, as these may indicate infection 1. After the acute episode, following up with a urologist to determine stone composition and develop a prevention plan is essential. Pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol may be recommended to prevent recurrent nephrolithiasis in patients with active disease in which increased fluid intake fails to reduce the formation of stones, as suggested by the American College of Physicians 1.
From the Research
Nephrolithiasis Emergency Precautions
- Recognition of nephrolithiasis symptoms, such as acute abdominal or flank pain, nausea, and emesis, is crucial for prompt treatment 2
- Primary care physicians play a key role in managing nephrolithiasis, and referral to nephrology or urology may be necessary in certain cases 3
- Acute renal colic should be treated with fluids and analgesics, and patients should strain their urine to recover the stone for analysis 4
- High-grade obstruction or failure of oral analgesics to relieve pain may require hospitalization, and a urinary tract infection in the setting of an obstruction is a urologic emergency requiring immediate drainage 4
Prevention and Management
- High fluid intake is a mainstay of prevention, and metabolic evaluation may indicate other appropriate preventive measures, such as dietary salt and protein restriction, and use of thiazide diuretics, neutral phosphate, potassium citrate, allopurinol, and magnesium salts 4, 5
- Medical management of nephrolithiasis aims to attenuate pain, favor progression and spontaneous expulsion of stones, and prevent obstructive and infectious complications 5
- Correction of metabolic abnormalities, such as hypercalciuria, hyperoxaluria, and hypocitraturia, can help prevent new stone formation 5