What can help dissolve kidney stones?

Treatment Options for Dissolving Kidney Stones

Potassium citrate is the most effective medication for dissolving uric acid and cystine kidney stones by raising urinary pH to optimal levels. 1

Stone-Specific Dissolution Approaches

Uric Acid Stones

Uric acid stones are among the most readily dissolvable types of kidney stones. The treatment approach should follow this algorithm:

1. First-line therapy: Potassium citrate

   • Raises urinary pH to 6.0-6.5 1, 2
   • Typical dosage: 30-80 mEq per day in 3-4 divided doses 3
   • Preferred over sodium citrate as sodium can increase urinary calcium excretion 1

2. Hydration

   • Increase fluid intake to achieve urine volume >2000 mL daily 4
   • Helps reduce concentration of stone-forming substances

3. Diet modification

   • Low-purine diet to reduce urinary uric acid excretion 4

4. NOT first-line: Allopurinol

   • Should not be routinely offered as first-line therapy 1
   • Only appropriate for patients with hyperuricosuria when other treatments fail
   • Most uric acid stones form due to low urinary pH rather than excessive uric acid excretion

Cystine Stones

For cystine stones, a stepwise approach is recommended:

1. First-line therapy:

   • Potassium citrate to raise urinary pH to 7.0 1
   • Increased fluid intake
   • Sodium and protein restriction

2. Second-line therapy:

   • Cystine-binding thiol drugs (e.g., tiopronin) for patients unresponsive to first-line therapy 1
   • Tiopronin is preferred over d-penicillamine due to fewer adverse effects

Calcium Stones

For calcium stones with hypocitraturia:

1. Potassium citrate therapy

   • Increases urinary citrate, a natural inhibitor of calcium stone formation 1, 3
   • Clinical trials show reduced stone formation rates 3
   • Dosage: 30-100 mEq per day, typically 20 mEq three times daily 3

2. Adjunctive therapies:

   • Thiazide diuretics for hypercalciuria 1
   • Allopurinol for hyperuricosuria with normal urinary calcium 1

Monitoring and Follow-up

• Check urinary pH regularly using pH paper to ensure target pH is maintained 5
• Obtain 24-hour urine specimen within 6 months of starting treatment 1
• Annual 24-hour urine testing thereafter 1
• Periodic blood testing to monitor for adverse effects 1

Clinical Efficacy

• Potassium citrate has shown impressive results in clinical studies:
  • Complete dissolution of radiolucent stones in multiple patients after 6 weeks of treatment 2
  • Stone formation rate reduced from 4.3 to 0.6 stones per year across multiple patient groups 3
  • 80% remission rate (patients remaining free of newly formed stones) 3

Important Caveats

• Potassium citrate is contraindicated in patients with hyperkalemia or severe renal impairment
• Tablets should be taken without crushing, chewing or sucking 3
• Monitor for gastrointestinal bleeding, especially in patients with history of ulcers
• Sodium bicarbonate is an alternative alkalizing agent but less preferred due to sodium load 5
• Novel options like high-citrate beverages (e.g., Moonstone) show promise but have less evidence than established medications 6

By following these evidence-based approaches, most uric acid stones can be dissolved, and recurrence of various stone types can be significantly reduced.