From the Guidelines
Inpatient treatment for kidney stones should prioritize pain management, hydration, and procedures to remove the stones if necessary, with a focus on minimizing morbidity, mortality, and improving quality of life. According to the most recent guidelines, pain control can be achieved with medications like ketorolac or morphine, as needed 1. IV fluids are administered to maintain hydration and help flush out smaller stones.
Key Considerations
- Stone size and location are crucial determinants in stone passage and the need for invasive management, with larger and more proximally located stones being associated with lower rates of spontaneous passage 1.
- Medical expulsive therapy with tamsulosin may be used to facilitate stone passage for stones less than 10mm in the ureter.
- For stones that cannot pass spontaneously, urological interventions are required, including extracorporeal shock wave lithotripsy (ESWL) for stones <2cm, ureteroscopy with laser lithotripsy for ureteral stones, or percutaneous nephrolithotomy for larger stones (>2cm).
Treatment Approach
- Patients should be monitored for complications like infection, which may require antibiotics.
- The choice of treatment depends on stone size, location, composition, and patient factors.
- Understanding the stone composition helps guide prevention strategies for recurrence once the acute episode is resolved.
Important Factors
- Imaging plays a crucial role in the diagnosis of stones, assessment of alternative diagnoses, complications, and appropriateness of potential therapies 1.
- The incidence of kidney stones increases with age, and men are more commonly affected than women 1.
From the Research
Treatment Options for Inpatient Kidney Stones
- Endoscopic surgical techniques, such as semirigid or flexible ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL), are major therapeutic modalities for upper urinary tract stones 2
- Pharmacologic treatment is a more affordable, readily available, and less invasive option for patients, and includes regulation of factors such as urine pH, stone crystallization, and patient metabolics 3
- Conservative management consists of pain control, medical expulsive therapy with an alpha blocker, and follow-up imaging within 14 days to monitor stone position and assess for hydronephrosis 4
Pain Management for Inpatient Kidney Stones
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are preferred for pain control during an episode of renal colic 4
- Combining opioids with NSAIDs is the optimal evidence-based regimen to treat severe symptoms 5
- However, the use of opioids should be done responsibly and with caution due to the risk of overprescription and overuse 6