From the Guidelines
The most effective treatment for nephrolithiasis (kidney stones) involves a combination of increased fluid intake, dietary changes, and pharmacologic management, with the goal of preventing recurrent stone formation and reducing morbidity, mortality, and improving quality of life. According to the American College of Physicians (ACP) guideline 1, increased fluid intake spread throughout the day to achieve at least 2 L of urine per day is recommended to prevent recurrent nephrolithiasis. Additionally, 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. Some key points to consider in the treatment of nephrolithiasis include:
- Increasing water intake to reduce the concentration of stone-forming substances in the urine
- Reducing dietary oxalate, animal protein, and other purines to decrease the risk of stone formation
- Maintaining normal dietary calcium intake to inhibit stone formation
- Using medications such as thiazide diuretics, potassium citrate, or allopurinol to prevent recurrent stones based on stone composition
- Considering medical procedures such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, or percutaneous nephrolithotomy for larger stones or those that do not pass on their own 1. It's worth noting that the treatment approach may vary depending on the size and type of stone, as well as the individual patient's needs and medical history. For example, for symptomatic patients with a total non-lower pole renal stone burden ≤ 20 mm, clinicians may offer SWL or URS 1, while for symptomatic patients with a total renal stone burden >20 mm, clinicians should offer PCNL as first-line therapy 1. Overall, the goal of treatment is to prevent recurrent stone formation, reduce morbidity and mortality, and improve quality of life for patients with nephrolithiasis.
From the Research
Treatment Options for Nephrolithiasis (Kidney Stones)
- The primary treatment options for kidney stones include extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and flexible ureterorenoscopy (FURS) with laser lithotripsy 2.
- ESWL is a non-invasive procedure that uses shockwaves to break up stones, and its effectiveness can be optimized by considering technical factors such as the type of lithotripsy device and patient-related factors like stone size and density 3.
- PCNL is a more invasive procedure that involves making a small incision in the back to insert a scope and remove the stone, and it is often used for larger stones 2, 4.
- FURS is a minimally invasive procedure that involves inserting a flexible scope through the urethra and bladder to remove the stone, and it is often used for stones in the lower pole of the kidney 2, 4.
- Medical expulsive therapy with an alpha blocker may also be used to help pass ureteral stones, especially for stones larger than 10mm 3, 5.
- Dietary recommendations, such as increasing fluid intake and calcium consumption, can also help prevent the formation of kidney stones 6.
Considerations for Treatment
- The choice of treatment depends on the size and location of the stone, as well as the patient's overall health and medical history 2, 4, 5.
- For smaller stones (≤10mm), ESWL or FURS may be effective, while larger stones (>10mm) may require PCNL or a combination of treatments 4.
- The effectiveness of treatment can be influenced by factors such as stone density, skin-to-stone distance, and anatomy of the excretory path 3.