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Kidney Stones
Treatment |
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Treatment for
Kidney Stones
Treatment depends on the size and type of kidney stone, the
underlying cause, the presence of urinary infection, and
whether the condition recurs. Stones 4 mm and smaller (less
than 1/4 inch in diameter) pass without intervention in 90% of
cases; those 5 – 7 mm do so in 50% of cases; and those larger
than 7 mm rarely pass without intervention. Patients are
advised to avoid becoming sedentary, because physical
activity, especially walking, can help move a stone.
If possible, the kidney stone is allowed to pass naturally and
is collected for analysis. The patient is instructed to strain
their urine to obtain the stone(s) for analysis. It is
important to analyze the chemical composition of kidney stones
to determine how to prevent recurrent stone formation. The
urine may be strained using an aquarium net or another device.
Each voiding should be strained until the physician instructs
the patient otherwise.
Dietary changes may be required and fluid intake should be
increased. Patients with kidney stones must increase their urinary
output. Generally, 2000 cc of urine per day (slightly more
than 1/2 gallon) is recommended and patients should drink
enough water to produce this amount of urine daily. In some
cases (e.g., some cystine stone formers), even higher levels
of fluid intake are required.
Dietary calcium usually should not be severely restricted.
Reducing calcium intake often causes problems with other
minerals (e.g., oxalate) and may result in a higher risk for
calcium stone disease.
Hypercalciuria
Thiazides, water pills (diuretics), are sometimes prescribed
to reduce high levels of urinary calcium (hypercalciuria) and
to increase urinary volume. Patients with hypercalciuria who
do not respond to thiazide therapy may be prescribed
orthophosphates to reduce calcium absorption and may be given
dietary calcium restrictions. Patients should not reduce their
calcium intake unless their physicians advise them to do so.
Hyperuricosuria
Patients with elevated uric acid levels (hyperuricosuria) are
advised to drink 3 liters of water a day and reduce excessive
dietary protein. Potassium citrate (medication that maintains
the antacid level in urine) or allopurinol (medication that
stops the production of uric acid) may also be prescribed.
Hyperoxaluria
Hyperoxaluria (high levels of urinary oxalate) may be mild,
enteric, or primary. Mild hyperoxaluria is usually caused by
an excess of dietary oxalate (found in tea, chocolate, cola,
nuts, and green leafy vegetables). Prevention consists of
daily doses of pyridoxine (vitamin B-6), which reduces oxalate
excretion, increased fluids, phosphate therapy, and sometimes,
calcium citrate supplementation.
A low-oxalate, low-fat diet, increased fluid intake, and
calcium supplementation is prescribed for enteric
hyperoxaluria. This rare condition is often severe and is
usually caused by an intestinal disorder (e.g., Crohn’s
disease, colitis). Calcium citrate, magnesium, iron, and
cholestyramine may be given to reduce oxalate levels.
Primary hyperoxaluria is rare, severe, and caused by an
inherited liver disorder. Primary hyperoxaluria requires
aggressive treatment to prevent severe renal stone disease and
kidney failure. High doses of vitamin B-6, orthophosphates,
magnesium supplements, and increased fluid intake (to produce
2 liters of urine/day) are prescribed. Rarely, kidney and
liver transplants are necessary.
Hypocitraturia
Hypocitraturia (low level of urinary citrate) usually requires
a prescribed supplement, such as potassium citrate. The dosage
depends on the level of urinary citrate, which is determined
by the 24-hour urine test. Patients with renal tubular
acidosis usually respond well to treatment with potassium
citrate supplements. Citrus fruits and lemon juice also can be
used as supplements.
Cystinuria
Treatment for high cystine levels in the urine (cystinura)
includes increasing fluid intake and raising the pH of the
urine (usually with bicarbonate). Penicillamine (Cuprimine®)
and tiopronine (Thiola®) may also be prescribed.
Medication
Over-the-counter pain relievers (e.g., aspirin, Tylenol®,
Advil®) usually are not effective for severe pain caused by
kidney stones. Oral analgesics such as acetaminophen/codeine
(Tylenol with Codeine&174), propoxyphene HCL (Darvon®), and
oxycodone/acetaminophen (Percocet®) may be prescribed to
minimize moderate pain associated with stones.
Injectable medications such as morphine sulfate (Duramorph
PF®), meperidine HCL (Demerol®), and tramadol HCL (Ultram®)
may be administered intravenously (IV) or intramuscularly (by
injection) for severe pain. There is a risk for dependency
with oral narcotic analgesics and a risk for accidental
overdose if injectable medications are given directly into a
vein. Side effects of these medications include the following:
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Constipation
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Drowsiness
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Nausea
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Slowed
breathing (respiration)
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Vomiting
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Nausea and vomiting can be reduced using
medications such as prochlorperazine edisylate (Compazine®),
promethazine HCL (Phenergan®), and metoclopramide HCL (Reglan®).
Pentosan polysulfate sodium (Elmiron®) may be prescribed in
severe cases to prevent kidney stone formation by blocking crystal
formation.
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