From the Guidelines
Nephrolithiasis, or kidney stones, should be managed with increased fluid intake to achieve at least 2 L of urine per day to prevent recurrent stones, as recommended by the American College of Physicians 1. The causes of nephrolithiasis are multifactorial, involving an interaction between genetics and environmental exposure, with approximately 80% of adults having stones consisting primarily of calcium oxalate, calcium phosphate, or both 1. Key factors in the formation of kidney stones include:
- High urinary concentration of crystal-forming substances such as calcium and oxalate
- Low concentration of substances that inhibit stone formation, such as citrate
- Genetic predisposition
- Environmental factors, including diet and hydration status Treatment of nephrolithiasis depends on the size, location, and composition of the stone, as well as the patient's overall health status. Some key treatment options include:
- Increased fluid intake to achieve at least 2 L of urine per day
- Pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol for patients with active disease who have failed to respond to increased fluid intake 1
- Dietary modifications, such as reducing dietary oxalate, animal protein, and sodium, and maintaining normal dietary calcium Pharmacologic management with a thiazide diuretic, citrate, or allopurinol is recommended for patients with active disease who have failed to respond to increased fluid intake, as it can help prevent recurrent nephrolithiasis 1. It is essential to note that the quality of evidence for these recommendations is generally low to moderate, highlighting the need for further research in this area 1. In clinical practice, the management of nephrolithiasis should prioritize preventing recurrent stones, reducing morbidity, and improving quality of life, while also considering the potential risks and benefits of different treatment strategies.
From the Research
Causes of Nephrolithiasis
- Inadequate fluid intake is a major dietary risk factor for urolithiasis 2
- Dietary factors such as protein, carbohydrates, oxalate, calcium, and sodium chloride can modulate the urinary risk profile and contribute to the risk of kidney stone formation 2
- Urinary tract infections and urosepsis can precede or follow a kidney stone treatment, and infection stones are a source of infection 3
- Genetic predisposition and environmental factors such as lifestyle and dietary habits can influence the development of kidney stone disease 4
Treatments of Nephrolithiasis
- Alpha-blockers may improve clearance of stone fragments after shock wave lithotripsy (SWL) and reduce the need for auxiliary treatments 5
- Boron supplement could be effective as adjuvant medical expulsive therapy after ESWL with no significant side effects in short-term follow-up 6
- Antibiotic therapy should be administered prior to surgical procedure in case of suspected or proven urinary infection, and its duration should be clearly established prior to surgery 3
- Dietary intervention, including elevated fluid intake, dietary restriction of sodium and animal proteins, avoidance of a low calcium diet, and elevated intake of vegetables and fibers, can contribute to the effective prevention of recurrent stones 2, 4
- Calcium supplementation given with meals may protect against the risk for kidney stones by reducing intestinal oxalate availability and its urinary excretion, but calcium supplementation given between meals might increase urinary calcium excretion without the beneficial effect on oxalate 4