What is the treatment for kidney stones?

From the Guidelines

The treatment for kidney stones depends on their size, location, and composition, with small stones often managed with watchful waiting and increased fluid intake, while larger stones may require medical intervention such as extracorporeal shock wave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy. For small stones (less than 4mm), watchful waiting with increased fluid intake (2-3 liters of water daily) is often recommended as they may pass naturally 1. Pain management typically includes NSAIDs like ibuprofen (400-800mg every 6-8 hours) or prescription medications such as ketorolac. Alpha-blockers like tamsulosin (0.4mg daily) can relax ureter muscles to help stones pass more easily. Prevention strategies include drinking plenty of water, limiting sodium and animal protein intake, and sometimes medications like thiazide diuretics, potassium citrate, or allopurinol depending on stone composition 1. Some key considerations in the management of kidney stones include:

• Increased fluid intake to achieve at least 2 L of urine per day to prevent recurrent nephrolithiasis 1
• Pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol to prevent recurrent nephrolithiasis in patients with active disease in which increased fluid intake fails to reduce the formation of stones 1
• Dietary changes including reducing dietary oxalate, reducing dietary animal protein and other purines, and maintaining normal dietary calcium 1
• The use of cystine-binding thiol drugs, such as alpha-mercaptopropionylglycine (tiopronin), for patients with cystine stones who are unresponsive to dietary modifications and urinary alkalinization, or have large recurrent stone burdens 1. These treatments work by either facilitating natural passage of stones, breaking them into manageable pieces, or directly removing them from the urinary tract. It's essential to note that the management of kidney stones should be individualized based on the specific characteristics of the stone and the patient's overall health status.

From the FDA Drug Label

The effect of oral Potassium Citrate therapy in a non-randomized, non-placebo controlled clinical study of five men and four women with calcium oxalate/calcium phosphate nephrolithiasis and documented incomplete distal renal tubular acidosis was examined Potassium Citrate therapy was associated with inhibition of new stone formation in patients with distal tubular acidosis. The stone-passage remission rate was 67%. All patients had a reduced stone formation rate. Over the first 2 years of treatment, the on-treatment stone formation rate was reduced from 13±27 to 1±2 per year.

The treatment for kidney stones with Potassium Citrate involves:

• Dietary management: sodium restricted diet (100 mEq/day) and reduction of oxalate intake
• Potassium Citrate dosage: 60-80 mEq daily in 3 or 4 divided doses
• Calcium restriction: moderate restriction (400-800 mg/day) for patients with hypercalciuria The treatment is associated with a reduced stone formation rate and a stone-passage remission rate of 67% 2.

From the Research

Treatment for Kidney Stones

• The treatment for kidney stones involves several approaches, including pain management, medical expulsive therapy, and surgical intervention, depending on the size and location of the stone 3.
• For small stones, conservative management with pain control and medical expulsive therapy using alpha-blockers may be sufficient 4, 5.
• Alpha-blockers have been shown to improve stone clearance, reduce the need for auxiliary treatments, and decrease major adverse events after shock wave lithotripsy 4.
• Surgical intervention may be necessary for larger stones or those that cause obstruction or infection 3, 5.

Prevention of Kidney Stone Recurrence

• Increasing fluid intake is a key recommendation for reducing the risk of kidney stone recurrence 3, 6, 7, 5.
• The type of fluid consumed may also play a role, with some studies suggesting that fluids low in calcium and certain types of juice, such as grapefruit and apple juice, may be beneficial 6.
• Lifestyle modifications, such as dietary changes and increased fluid intake, should be recommended for all patients with kidney stones 5.
• Patients at high risk of stone recurrence may require additional metabolic assessment and tailored preventive measures, including medication such as thiazide diuretics, allopurinol, or citrates 5.

Management of Kidney Stones

• The management of kidney stones involves a comprehensive approach, including diagnostic imaging, urinalysis, and urine culture to confirm the diagnosis and assess for conditions requiring active stone removal 3, 5.
• Follow-up imaging is necessary to monitor stone position and assess for hydronephrosis 5.
• Asymptomatic kidney stones should be followed with serial imaging, and removed if they grow, cause symptoms, or lead to urinary obstruction or recurrent infections 5.