From the Guidelines
Treatment for kidney stones depends on their size, location, and composition, with options including watchful waiting, pain management, and medical intervention such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, or percutaneous nephrolithotomy. For small stones (less than 4mm), watchful waiting with increased fluid intake (2-3 liters daily) is often recommended as they may pass naturally 1. Pain management typically includes NSAIDs like ibuprofen (600-800mg every 6-8 hours) or prescription medications such as ketorolac. Alpha blockers like tamsulosin (0.4mg daily) can relax ureter muscles, facilitating stone passage. For larger stones or those causing severe symptoms, medical intervention becomes necessary. Extracorporeal shock wave lithotripsy (ESWL) uses sound waves to break stones into smaller fragments. Ureteroscopy involves inserting a thin scope through the urinary tract to remove or break stones using laser. Percutaneous nephrolithotomy is used for very large stones, requiring a small incision in the back. Prevention strategies include drinking plenty of water, limiting sodium and animal protein intake, and sometimes medications like thiazide diuretics, allopurinol, or potassium citrate depending on stone composition 1. Prompt treatment is important as kidney stones can cause urinary tract infections, kidney damage, or urinary tract obstruction if left untreated. The most recent guidelines from 2018 recommend active surveillance of asymptomatic, non-obstructing caliceal stones, and surgical treatment for symptomatic stones and/or obstruction 1. The choice of treatment depends on the size and location of the stone, as well as the patient's overall health and preferences. It is essential to consult with a healthcare professional to determine the best course of treatment for kidney stones. Some key points to consider when treating kidney stones include:
- Increasing fluid intake to help pass small stones
- Managing pain with NSAIDs or prescription medications
- Using alpha blockers to relax ureter muscles
- Considering medical intervention such as ESWL, ureteroscopy, or percutaneous nephrolithotomy for larger stones or those causing severe symptoms
- Implementing prevention strategies such as drinking plenty of water and limiting sodium and animal protein intake.
From the FDA Drug Label
The dose of allopurinol tablets recommended for management of recurrent calcium oxalate stones in hyperuricosuric patients is 200 to 300 mg/day in divided doses or as the single equivalent Clinical experience suggests that patients with recurrent calcium oxalate stones may also benefit from dietary changes such as the reduction of animal protein, sodium, refined sugars, oxalate-rich foods, and excessive calcium intake, as well as an increase in oral fluids and dietary fiber
To treat kidney stones, specifically recurrent calcium oxalate stones in hyperuricosuric patients, you can use allopurinol tablets at a dose of 200 to 300 mg/day in divided doses or as a single equivalent 2. Additionally, dietary changes may also be beneficial, including:
- Reduction of animal protein
- Reduction of sodium
- Reduction of refined sugars
- Reduction of oxalate-rich foods
- Reduction of excessive calcium intake
- Increase in oral fluids
- Increase in dietary fiber
From the Research
Treatment Options for Kidney Stones
The treatment options for kidney stones include:
- Medical expulsive therapy with alpha-blockers to help pass the stones 3, 4, 5
- Pain management with nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, or paracetamol 6
- Shock wave lithotripsy (SWL) to break up the stones into smaller pieces that can pass more easily 4
- Surgical intervention for larger stones or those that do not respond to other treatments 5
Alpha-Blockers for Kidney Stones
Alpha-blockers, such as tamsulosin, silodosin, and alfuzosin, have been shown to be effective in increasing stone clearance rates and reducing the need for auxiliary treatments 3, 4, 5
- A study found that alpha-blockers increased stone clearance rates by 16% compared to control 4
- Another study found that alpha-blockers reduced the need for auxiliary treatments by 33% compared to control 4
Pain Management for Kidney Stones
NSAIDs, opioids, and paracetamol are commonly used to manage pain associated with kidney stones 6
- A systematic review and meta-analysis found that NSAIDs were equivalent to opioids and paracetamol in relieving acute renal colic pain, but had fewer side effects and required less rescue analgesia 6
Prevention of Kidney Stones
Lifestyle modifications, such as increased fluid intake, and medications like thiazide diuretics, allopurinol, or citrates, can help prevent recurrent kidney stones 7
- A study found that patients with kidney stones should be screened for risk of stone recurrence and undergo metabolic assessment to guide preventive measures 7