From the Guidelines
The treatment for nephrolithiasis (kidney stones) should prioritize increased fluid intake to achieve at least 2 L of urine per day, as recommended by the American College of Physicians (ACP) 1.
Key Recommendations
- Increased fluid intake is associated with a reduction in stone recurrence, with a target of at least 2 L of urine per day 1.
- Pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol may be recommended for patients with active disease in which increased fluid intake fails to reduce the formation of stones 1.
Prevention Strategies
- Maintaining hydration through increased fluid intake is crucial in preventing recurrent nephrolithiasis 1.
- Dietary modifications, such as reducing sodium, animal protein, and oxalate-rich foods, may also be beneficial in preventing stone recurrence 1.
Medications
- Thiazide diuretics, such as hydrochlorothiazide, may be prescribed to reduce the risk of stone recurrence 1.
- Potassium citrate or allopurinol may also be recommended depending on stone composition 1.
From the Research
Medical Treatment of Nephrolithiasis
The medical treatment of nephrolithiasis is aimed at preventing relapses and dissolving calculi in some cases, such as cystine or uric acid lithiasis 2. The treatment relies on understanding the underlying pathophysiological processes, which can be achieved through stone analysis and minimal biological assessment, including urine crystal research 3.
Dietary Rules
Simple dietary rules can help prevent nephrolithiasis, including:
- Non-alkaline hyperdiuresis (>2 liters/day)
- Calcium intake normalization (1 gram per day divided between the three principal meals)
- Normalization of sodium (6 to 7 grams per day) and protein intake (1g/kg of theoretical body weight/day)
- Eviction of foods rich in oxalate 3
Medical Treatment
The medical treatment of nephrolithiasis depends on the subtype:
- Calcic nephrolithiasis: thiazide diuretic can be started in case of persistent hypercalciuria (>0.1mmol/kg of theoretical body weight/day on free diet) 3
- Uric acid nephrolithiasis: alkaline hyperdiuresis (goal of urine pH: 6.2 to 6.8) and allopurinol if urine uric acid is over 4mmol/day 3
Urologic Treatment
The urologic treatment of nephrolithiasis ranges from observation to medical expulsive therapy with an alpha blocker for a stone in a ureter to a variety of procedures for stone removal 4. Alpha-blockers have been found to be beneficial without lithotripsy for ureteral stones 5 to 10 mm and post-lithotripsy for renal or ureteral stones >10 mm 5.
Key Points
- Nephrolithiasis is a common and recurrent disorder that can be prevented with proper medical treatment 3
- The medical treatment of nephrolithiasis depends on the subtype and underlying pathophysiological processes 3, 2
- Dietary rules and medical treatment can help prevent relapses and dissolve calculi in some cases 3, 2
- Urologic treatment options are available for patients who require more invasive procedures 4, 5