From the Guidelines
The most effective treatment for kidney stones is increased fluid intake to achieve at least 2 L of urine per day, as recommended by the American College of Physicians 1. This approach is aimed at preventing recurrent nephrolithiasis and is based on the principle of reducing the concentration of crystal-forming substances in the urine. Key aspects of managing kidney stones include:
- Increasing fluid intake spread throughout the day to achieve at least 2 L of urine per day, as this helps to dilute the urine and reduce the risk of stone formation 1.
- For patients with active disease in which increased fluid intake fails to reduce the formation of stones, pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol may be recommended 1.
- Dietary changes, such as reducing dietary oxalate, reducing dietary animal protein and other purines, and maintaining normal dietary calcium, can also help to prevent the recurrence of nephrolithiasis 1. It is essential to note that the treatment approach may vary depending on the size, location, and composition of the kidney stones, as well as the individual patient's needs and medical history. Some patients may require more invasive procedures, such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopy with laser lithotripsy, or percutaneous nephrolithotomy, especially for larger stones or those causing severe symptoms. However, for most patients, increased fluid intake and dietary changes, along with pharmacologic therapy if necessary, can help to prevent recurrent kidney stones and reduce the risk of complications.
From the Research
Treatment Options for Kidney Stones
- Medical therapy reduces stone recurrence significantly 2
- Fluid intake to promote urine volume of at least 2.5 L each day is essential to prevent stone formation 2, 3, 4, 5
- Dietary recommendations should be adjusted based on individual metabolic abnormalities 2
- Properly dosed thiazide treatment is the standard therapy for calcium stone formers with idiopathic hypercalciuria 2
- Potassium alkali therapy is considered for hypocitraturia, but caution should be taken to prevent potential risk of calcium phosphate stone formation 2
- For absorptive hyperoxaluria, low oxalate diet and increased dietary calcium intake are recommended 2
- Pyridoxine has been shown effective in some cases of primary hyperoxaluria type I 2
- Allopurinol is used in calcium oxalate stone formers with hyperuricosuria 2
- Treatment of cystine stones remains challenging, Tiopronin can be used if urinary alkalinization and adequate fluid intake are insufficient 2
- For struvite stones, complete surgical removal coupled with appropriate antibiotic therapy is necessary 2
Role of Alpha-Blockers in Kidney Stone Treatment
- Alpha-blockers are beneficial without lithotripsy for ureteral stones 5 to 10 mm 6
- They are beneficial post-lithotripsy for renal or ureteral stones >10 mm 6
- They can be considered post-lithotripsy for stones 5 to 10 mm, but little benefit may be seen 6
- Although all uroselective alpha-blockers have been found to be effective, most data are with tamsulosin 0.4 mg daily 6
Fluid Intake and Kidney Stone Prevention
- Higher fluid intake is associated with increased urine output and reduced stone formation 3, 4, 5
- Water with high calcium content seemingly increases the rate of calcium oxalate (CaOx) stone formation 4
- Certain varieties of fluid, such as grapefruit, apple, and orange juices reduce urine CaOx saturation, with a subsequent reduction in stone formation 4
- Fluids low in calcium seem to reduce the risk of KSD 4
- High fluid intake was significantly associated with reduced risk of recurrent kidney stones 5