From the Guidelines
The treatment of calcium oxalate kidney stones involves increasing fluid intake to 2-3 liters daily to dilute urine and prevent crystal formation, along with dietary modifications such as reducing oxalate-rich foods, limiting sodium, and moderating animal protein intake. Medications may include thiazide diuretics like hydrochlorothiazide (12.5-50 mg daily) to reduce urinary calcium excretion, potassium citrate (10-15 mEq two to three times daily) to increase urine pH and inhibit stone formation, or allopurinol for patients with hyperuricosuria.
Key Recommendations
- Increased fluid intake is associated with a reduction in stone recurrence, with a goal of at least 2 L of urine per day 1.
- Pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol can be used to prevent recurrent nephrolithiasis in patients with active disease in which increased fluid intake fails to reduce the formation of stones 1.
Lifestyle Modifications
- Reducing oxalate-rich foods (spinach, rhubarb, chocolate)
- Limiting sodium
- Moderating animal protein intake
Medications
- Thiazide diuretics like hydrochlorothiazide (12.5-50 mg daily)
- Potassium citrate (10-15 mEq two to three times daily)
- Allopurinol for patients with hyperuricosuria
Surgical Intervention
- Stones larger than 10 mm typically require surgical intervention such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, or percutaneous nephrolithotomy.
Follow-up
- Regular follow-up with urinalysis and imaging is important to monitor for new stone formation.
From the Research
Treatment for Calcium Oxalate Nephrolithiasis
The treatment for calcium oxalate (CaOx) nephrolithiasis involves a combination of dietary changes, medication, and other interventions. Some key aspects of treatment include:
- Increasing fluid intake to promote urine volume of at least 2.5 L each day 2
- Limiting dietary protein and sodium 3
- Using agents such as sodium cellulose phosphate, thiazides, orthophosphates, oral calcium supplements, pyridoxine, cholestyramine, citrate, magnesium, and allopurinol to manage CaOx stones 3
- Alkaline citrate treatment, which has been shown to be effective in preventing recurrent CaOx stones 4
- Potassium citrate therapy, which is considered for hypocitraturia, but caution should be taken to prevent potential risk of calcium phosphate stone formation 2
Medical Therapy
Medical therapy plays a crucial role in reducing stone recurrence. Some key aspects of medical therapy include:
- Thiazide treatment, which is the standard therapy for calcium stone formers with idiopathic hypercalciuria 2
- Potassium alkali therapy, which is considered for hypocitraturia 2
- Pyridoxine, which has been shown effective in some cases of primary hyperoxaluria type I 2
- Allopurinol, which is used in calcium oxalate stone formers with hyperuricosuria 2
Dietary Recommendations
Dietary recommendations are adjusted based on individual metabolic abnormalities. Some key aspects of dietary recommendations include:
- Increasing dietary calcium intake to reduce urine oxalate excretion in cases of absorptive hyperoxaluria 2
- Restricting dietary oxalate intake if urine oxalate excretion is elevated 5
- Maintaining dietary Ca intake at 600 to 800 mg/day to reduce urinary supersaturation of Ca oxalate 5
Other Interventions
Other interventions, such as shockwave lithotripsy (SWL), percutaneous nephrolithotomy, and ureteroscopic procedures, may be necessary to remove stones that are larger than 2 cm in diameter or located in the lower urinary tract 5. Supplements of potassium citrate and magnesium citrate can help in the prevention of kidney stones of calcium oxalate and can be used in the days before a SWL treatment to make the stones more fragile to the effect of the shock waves 6.