From the Guidelines
Treatment for 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 1. This approach is supported by low-quality evidence showing that increased fluid intake is associated with a reduction in stone recurrence. For patients with active disease where increased fluid intake fails to reduce stone formation, pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol is recommended 1. Moderate-quality evidence indicates that these medications can reduce the risk of recurrence of composite calcium stones. Some key points to consider in the management of kidney stones include:
- Increased fluid intake to achieve at least 2 L of urine per day
- Dietary changes such as reducing dietary oxalate, reducing dietary animal protein and other purines, and maintaining normal dietary calcium
- Pharmacologic therapies like thiazide diuretics, citrates, or allopurinol for patients with active disease
- Monitoring for complications such as severe pain, fever, chills, or inability to urinate, which may require urgent medical attention. It's also important to note that for specific types of stones, such as cystine stones, cystine-binding thiol drugs like alpha-mercaptopropionylglycine (tiopronin) may be offered to patients unresponsive to dietary modifications and urinary alkalinization 1. Overall, the management of kidney stones should be tailored to the individual patient's needs, taking into account the size, location, and composition of the stone, as well as the patient's overall health and medical history.
From the FDA Drug Label
In patients with renal tubular acidosis in whom urinary pH may be high, Potassium Citrate produces a relatively small rise in urinary pH. 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 medical treatment options for kidney stones include Potassium Citrate. The treatment is associated with:
- Inhibition of new stone formation in patients with distal tubular acidosis
- Reduced stone formation rate
- Increased urinary citrate excretion
- Increased urinary pH The recommended dosage of Potassium Citrate ranges from 30 to 100 mEq per day, usually administered orally 3 times daily 2.
From the Research
Medical Treatment of Kidney Stones
The medical treatment of kidney stones involves various approaches, including:
- Fluid intake to promote urine volume of at least 2.5 L each day to prevent stone formation 3
- Dietary recommendations adjusted based on individual metabolic abnormalities 3
- Medical expulsive therapy to aid in spontaneous stone passage 3, 4
- Pharmacotherapy to prevent stone recurrence, such as thiazide treatment for calcium stone formers with idiopathic hypercalciuria 3
- Potassium alkali therapy for hypocitraturia, with caution to prevent potential risk of calcium phosphate stone formation 3
- Low oxalate diet and increased dietary calcium intake for absorptive hyperoxaluria 3
- Pyridoxine for some cases of primary hyperoxaluria type I 3
- Allopurinol for calcium oxalate stone formers with hyperuricosuria 3
- Tiopronin for cystine stones if urinary alkalinization and adequate fluid intake are insufficient 3
- Complete surgical removal coupled with appropriate antibiotic therapy for struvite stones 3, 5
Prevention of Kidney Stones
Prevention of kidney stones is largely specific to the type of stone and may involve:
- High fluid intake to prevent stone formation 3, 6
- Dietary modifications, such as a diet high in fruits and vegetables to alkalinize urine for prevention of calcium oxalate, cystine, and uric acid stones 7
- Acidification of urine for prevention of calcium phosphate and struvite stones, using cranberry juice or betaine 7
- Metabolic evaluation to guide preventive measures, such as dietary salt and protein restriction, and use of thiazide diuretics, neutral phosphate, potassium citrate, allopurinol, and magnesium salts 6
Management of Acute Renal Colic
Management of acute renal colic may involve:
- Treatment with fluids and analgesics 6
- Straining urine to recover stone for analysis 6
- Hospitalization for high-grade obstruction or failure of oral analgesics to relieve pain 6
- Ureteral stent for urinary tract infection in the setting of an obstruction 6
- Extracorporeal shock wave lithotripsy, percutaneous lithotripsy, or ureteroscopic laser lithotripsy for stones that do not pass spontaneously 6, 4