What are the types of kidney stones and their respective treatments?

From the Guidelines

Kidney stones are primarily categorized into four types: calcium, uric acid, struvite, and cystine stones, each requiring distinct treatment approaches to minimize morbidity, mortality, and improve quality of life. The treatment for these stones can be broken down as follows:

• Calcium stones, which include calcium oxalate and calcium phosphate stones, are typically treated with thiazide diuretics like hydrochlorothiazide (25-50mg daily) and dietary modifications to reduce oxalate intake, as supported by 1.
• Uric acid stones form in acidic urine and are treated by alkalinizing the urine with potassium citrate (10-15 mEq three times daily), and allopurinol (100-300mg daily) may be considered if uric acid levels are high, but not as first-line therapy according to 1.
• Struvite stones, associated with urinary tract infections, require antibiotics to treat the infection and sometimes surgical removal.
• Cystine stones, caused by a genetic disorder, are managed with high fluid intake, urine alkalinization, and medications like tiopronin (250-500mg three times daily) or penicillamine to reduce cystine levels.
• Drug-induced stones require discontinuation of the causative medication. General treatment for all stones includes:
• Increasing fluid intake to 2-3 liters daily
• Pain management with NSAIDs like ibuprofen (400-800mg every 6-8 hours) or narcotics for severe pain
• Medical expulsive therapy with alpha-blockers like tamsulosin (0.4mg daily) to help pass smaller stones Larger stones may require interventional procedures such as extracorporeal shock wave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy. Prevention strategies should be tailored to the specific stone type to reduce recurrence risk, considering the use of thiazide diuretics, citrates, and allopurinol for calcium stones as indicated by 1.

From the FDA Drug Label

Six of the 7 other patients also received allopurinol for hyperuricemia with gouty arthritis, symptomatic hyperuricemia, or hyperuricosuria. One patient also received hydrochlorothiazide because of unclassified hypercalciuria. The main inclusion criterion was a history of stone passage or surgical removal of stones during the 3 years prior to initiation of Potassium Citrate therapy 14. 1 Renal tubular acidosis (RTA) with calcium stones 14. 2 Hypocitraturic calcium oxalate nephrolithiasis of any etiology 14. 3 Uric acid lithiasis with or without calcium stones

The types of kidney stones mentioned are:

• Calcium stones: associated with renal tubular acidosis (RTA) and hypocitraturic calcium oxalate nephrolithiasis
• Uric acid stones: with or without calcium stones
• Calcium oxalate stones: associated with hypocitraturic calcium oxalate nephrolithiasis
• Calcium phosphate stones: associated with renal tubular acidosis (RTA)
• Mixed stones: containing both uric acid and calcium salts

Treatment options mentioned are:

• Potassium citrate: to increase urinary citrate excretion and urinary pH
• Allopurinol: for hyperuricemia with gouty arthritis, symptomatic hyperuricemia, or hyperuricosuria
• Hydrochlorothiazide: for unclassified hypercalciuria
• Sodium restricted diet: to reduce sodium intake
• Oxalate restricted diet: to reduce oxalate intake
• Calcium restricted diet: to reduce calcium intake in patients with hypercalciuria 2

From the Research

Types of Kidney Stones

• Calcium oxalate stones 3, 4, 5, 6
• Calcium phosphate stones 3, 4, 5, 6
• Cystine stones 3, 4, 6
• Struvite stones (magnesium ammonium phosphate) 3, 4, 6
• Uric acid stones 3, 4, 5, 6

Treatment of Kidney Stones

• Medications:
  • Thiazide diuretics for calcium oxalate and calcium phosphate stones 4, 5
  • Allopurinol for calcium oxalate and uric acid stones 4, 5
  • Potassium citrate for calcium oxalate and uric acid stones 3, 4, 5
  • Alpha blockers for medical expulsive therapy 5
• Dietary modifications:
  • Increased fluid intake for all patients 5
  • Diet high in fruits and vegetables to alkalinize urine for calcium oxalate, cystine, and uric acid stones 3
  • Diet low in salt and protein, rich in calcium and magnesium for calcium oxalate and calcium phosphate stones 4
• Surgical interventions:
  • Ureteroscopy for stone removal 3
  • Active stone removal for stones larger than 10 mm or with urinary infection 5
• Lifestyle modifications:
  • Weight loss with careful consideration of diet and hydration to prevent stone formation 3
  • Avoidance of medications that increase the risk of kidney stones, such as protease inhibitors, antibiotics, and some diuretics 3