Kidney stone medical therapy: Difference between revisions

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==== '''Pharmacological measures''' ====
==== '''Pharmacological measures''' ====
* Both NSAIDS and opiods are seen efficacious for the pain relief related to nephrolithiasis.<ref name="pmid15178585">{{cite journal |vauthors=Holdgate A, Pollock T |title=Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic |journal=BMJ |volume=328 |issue=7453 |pages=1401 |date=June 2004 |pmid=15178585 |pmc=421776 |doi=10.1136/bmj.38119.581991.55 |url=}}</ref>
* Both NSAIDS and opiods are seen efficacious for the pain relief related to nephrolithiasis.<ref name="pmid15178585">{{cite journal |vauthors=Holdgate A, Pollock T |title=Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic |journal=BMJ |volume=328 |issue=7453 |pages=1401 |date=June 2004 |pmid=15178585 |pmc=421776 |doi=10.1136/bmj.38119.581991.55 |url=}}</ref>
* The combination works in effective pain relief.<ref name="pmid8759578">{{cite journal |vauthors=Cordell WH, Wright SW, Wolfson AB, Timerding BL, Maneatis TJ, Lewis RH, Bynum L, Nelson DR |title=Comparison of intravenous ketorolac, meperidine, and both (balanced analgesia) for renal colic |journal=Ann Emerg Med |volume=28 |issue=2 |pages=151–8 |date=August 1996 |pmid=8759578 |doi= |url=}}</ref>
* NSAIDS  should be stopped before undergoing [[Extracorporeal shockwave lithotripsy]] to reduce the risk of bleeding.


====== Non steroidal anti inflammatory drugs (NSAIDS) ======
====== Non steroidal anti inflammatory drugs (NSAIDS) ======
Line 51: Line 53:
* Oral regimen
* Oral regimen
** Preferred regimen (1): [[Ketorolac]] 20 mg, followed by 10 mg q4-6 h as needed; maximum: 40 mg/day; follows the parenteral dose ('''contraindicated''' in patients with [[renal failure]])  
** Preferred regimen (1): [[Ketorolac]] 20 mg, followed by 10 mg q4-6 h as needed; maximum: 40 mg/day; follows the parenteral dose ('''contraindicated''' in patients with [[renal failure]])  
** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days  
** Alternative regimen (1):[[Indomethacin]] 20 mg PO q8h  
* 2.1.2 '''Pediatric'''
** Alternative regimen (2):[[Indomethacin]] 40 mg PO q8-12h  
** Parenteral regimen
'''Opioids'''
*** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
* Parenteral regimen
*** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
** Preferred regimen (1): [[Morphine]] 5 mg IV q4h as needed.
*** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
** Oral regimen
*** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
*** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
*** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
*** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
*** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
*** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


* 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
*: '''Note (1):'''
*: '''Note (2)''':
*: '''Note (3):'''
** 2.2.1 '''Adult'''
*** Parenteral regimen
**** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
**** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
**** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
*** Oral regimen
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
**** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
**** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
** 2.2.2 '''Pediatric'''
*** Parenteral regimen
**** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
**** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
**** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
*** Oral regimen
**** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
**** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
**** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
**** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
**** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
**** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==

Revision as of 20:05, 15 June 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR   The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

Medical Therapy

Nephroliithiasis

Non pharmacological measures

Straining
  • Stone ≤5 mm can pass spontaneously.
  • Passage of stone also depends on the site of stone.[1]

Pharmacological measures

  • Both NSAIDS and opiods are seen efficacious for the pain relief related to nephrolithiasis.[2]
  • The combination works in effective pain relief.[3]
  • NSAIDS should be stopped before undergoing Extracorporeal shockwave lithotripsy to reduce the risk of bleeding.
Non steroidal anti inflammatory drugs (NSAIDS)
  • Parenteral regimen
    • Preferred regimen (1): Ketorolac 60 mg as a single dose or 30 mg IM q6h
    • Alternative regimen (1): Ketorolac 10 to 30 mg (as single dose) IM and then q4-6 h as needed (maximum: 120 mg/day)
    • Alternative regimen (2): Ketorolac 30 mg as a single dose or 30 mg IV q6h (maximum: 120 mg/day)
  • Oral regimen
    • Preferred regimen (1): Ketorolac 20 mg, followed by 10 mg q4-6 h as needed; maximum: 40 mg/day; follows the parenteral dose (contraindicated in patients with renal failure)
    • Alternative regimen (1):Indomethacin 20 mg PO q8h
    • Alternative regimen (2):Indomethacin 40 mg PO q8-12h

Opioids

  • Parenteral regimen
    • Preferred regimen (1): Morphine 5 mg IV q4h as needed.


References

  1. ↑ Miller OF, Kane CJ (September 1999). "Time to stone passage for observed ureteral calculi: a guide for patient education". J. Urol. 162 (3 Pt 1): 688–90, discussion 690–1. PMID 10458343.
  2. ↑ Holdgate A, Pollock T (June 2004). "Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic". BMJ. 328 (7453): 1401. doi:10.1136/bmj.38119.581991.55. PMC 421776. PMID 15178585.
  3. ↑ Cordell WH, Wright SW, Wolfson AB, Timerding BL, Maneatis TJ, Lewis RH, Bynum L, Nelson DR (August 1996). "Comparison of intravenous ketorolac, meperidine, and both (balanced analgesia) for renal colic". Ann Emerg Med. 28 (2): 151–8. PMID 8759578.

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