Kidney stone medical therapy: Difference between revisions
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==== '''Non pharmacological measures''' ==== | ==== '''Non pharmacological measures''' ==== | ||
* Increased fluid intake | |||
* Straining | |||
** Stone ≤5 mm can pass spontaneously. | |||
* Stone ≤5 mm can pass spontaneously. | ** Passage of stone also depends on the site of stone.<ref name="pmid10458343">{{cite journal |vauthors=Miller OF, Kane CJ |title=Time to stone passage for observed ureteral calculi: a guide for patient education |journal=J. Urol. |volume=162 |issue=3 Pt 1 |pages=688–90; discussion 690–1 |date=September 1999 |pmid=10458343 |doi= |url=}}</ref> | ||
* Passage of stone also depends on the site of stone.<ref name="pmid10458343">{{cite journal |vauthors=Miller OF, Kane CJ |title=Time to stone passage for observed ureteral calculi: a guide for patient education |journal=J. Urol. |volume=162 |issue=3 Pt 1 |pages=688–90; discussion 690–1 |date=September 1999 |pmid=10458343 |doi= |url=}}</ref> | * Evaluating diet. | ||
** For example, diet containing excess proteins can precipitate uric acid stones. | |||
* | |||
==== '''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> | ||
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** Preferred regimen (2):Used as adjuvant in [[Extracorporeal shockwave lithotripsy]]; [[Tamsulosin]] 0.4 mg PO q24h for 14 days to 3 months<ref name="pmid21802124">{{cite journal |vauthors=Vicentini FC, Mazzucchi E, Brito AH, Chedid Neto EA, Danilovic A, Srougi M |title=Adjuvant tamsulosin or nifedipine after extracorporeal shock wave lithotripsy for renal stones: a double blind, randomized, placebo-controlled trial |journal=Urology |volume=78 |issue=5 |pages=1016–21 |date=November 2011 |pmid=21802124 |doi=10.1016/j.urology.2011.04.062 |url=}}</ref> | ** Preferred regimen (2):Used as adjuvant in [[Extracorporeal shockwave lithotripsy]]; [[Tamsulosin]] 0.4 mg PO q24h for 14 days to 3 months<ref name="pmid21802124">{{cite journal |vauthors=Vicentini FC, Mazzucchi E, Brito AH, Chedid Neto EA, Danilovic A, Srougi M |title=Adjuvant tamsulosin or nifedipine after extracorporeal shock wave lithotripsy for renal stones: a double blind, randomized, placebo-controlled trial |journal=Urology |volume=78 |issue=5 |pages=1016–21 |date=November 2011 |pmid=21802124 |doi=10.1016/j.urology.2011.04.062 |url=}}</ref> | ||
** Preferred regimen (3): [[Nifedipine]] 10-30 mg PO q8h for up to 4 weeks or until expulsion of lower stones<ref name="pmid21083640">{{cite journal |vauthors=Ye Z, Yang H, Li H, Zhang X, Deng Y, Zeng G, Chen L, Cheng Y, Yang J, Mi Q, Zhang Y, Chen Z, Guo H, He W, Chen Z |title=A multicentre, prospective, randomized trial: comparative efficacy of tamsulosin and nifedipine in medical expulsive therapy for distal ureteric stones with renal colic |journal=BJU Int. |volume=108 |issue=2 |pages=276–9 |date=July 2011 |pmid=21083640 |doi=10.1111/j.1464-410X.2010.09801.x |url=}}</ref> | ** Preferred regimen (3): [[Nifedipine]] 10-30 mg PO q8h for up to 4 weeks or until expulsion of lower stones<ref name="pmid21083640">{{cite journal |vauthors=Ye Z, Yang H, Li H, Zhang X, Deng Y, Zeng G, Chen L, Cheng Y, Yang J, Mi Q, Zhang Y, Chen Z, Guo H, He W, Chen Z |title=A multicentre, prospective, randomized trial: comparative efficacy of tamsulosin and nifedipine in medical expulsive therapy for distal ureteric stones with renal colic |journal=BJU Int. |volume=108 |issue=2 |pages=276–9 |date=July 2011 |pmid=21083640 |doi=10.1111/j.1464-410X.2010.09801.x |url=}}</ref> | ||
===== Type specific treatment ===== | |||
===== Urologic consult ===== | ===== Urologic consult ===== | ||
Revision as of 00:02, 18 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
- Increased fluid intake
- Straining
- Stone ≤5 mm can pass spontaneously.
- Passage of stone also depends on the site of stone.[1]
- Evaluating diet.
- For example, diet containing excess proteins can precipitate uric acid stones.
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.
Pain relief
Non steroidal anti inflammatory drugs (NSAIDS)
- Parenteral 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)
- 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
Passage of stone
- The passage of stones depend on the size and location of the stone.[4][5][6]
- Stones ≤5 mm in diameter pass spontaneously.
- It decrease as the size grows and not likely for sizes ≥10 mm in diameter.
- Stones which are proximal are less likely to pass spontaneously.
- Oral regimen
- Preferred regimen (1):Tamsulosin 0.4 mg PO q24h until stone passage occurs or for up to 30 days[7]
- Preferred regimen (2):Used as adjuvant in Extracorporeal shockwave lithotripsy; Tamsulosin 0.4 mg PO q24h for 14 days to 3 months[8]
- Preferred regimen (3): Nifedipine 10-30 mg PO q8h for up to 4 weeks or until expulsion of lower stones[9]
Type specific treatment
Urologic consult
- The Urological consult is needed in the following:[10][11]
- Stone >10 mm in diameter
- Uncontrolled pain
- Anuria
- Acute kidney injury
- Acute abdomen features like nausea and vomiting
- Signs of sepsis
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Parekattil SJ, Kumar U, Hegarty NJ, Williams C, Allen T, Teloken P, Leitão VA, Netto NR, Haber GP, Ballereau C, Villers A, Streem SB, White MD, Moran ME (February 2006). "External validation of outcome prediction model for ureteral/renal calculi". J. Urol. 175 (2): 575–9. doi:10.1016/S0022-5347(05)00244-2. PMID 16406999.
- ↑ Coll DM, Varanelli MJ, Smith RC (January 2002). "Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT". AJR Am J Roentgenol. 178 (1): 101–3. doi:10.2214/ajr.178.1.1780101. PMID 11756098.
- ↑ Ahmed AF, Al-Sayed AY (March 2010). "Tamsulosin versus Alfuzosin in the Treatment of Patients with Distal Ureteral Stones: Prospective, Randomized, Comparative Study". Korean J Urol. 51 (3): 193–7. doi:10.4111/kju.2010.51.3.193. PMC 2855456. PMID 20414396.
- ↑ Vicentini FC, Mazzucchi E, Brito AH, Chedid Neto EA, Danilovic A, Srougi M (November 2011). "Adjuvant tamsulosin or nifedipine after extracorporeal shock wave lithotripsy for renal stones: a double blind, randomized, placebo-controlled trial". Urology. 78 (5): 1016–21. doi:10.1016/j.urology.2011.04.062. PMID 21802124.
- ↑ Ye Z, Yang H, Li H, Zhang X, Deng Y, Zeng G, Chen L, Cheng Y, Yang J, Mi Q, Zhang Y, Chen Z, Guo H, He W, Chen Z (July 2011). "A multicentre, prospective, randomized trial: comparative efficacy of tamsulosin and nifedipine in medical expulsive therapy for distal ureteric stones with renal colic". BJU Int. 108 (2): 276–9. doi:10.1111/j.1464-410X.2010.09801.x. PMID 21083640.
- ↑ Portis AJ, Sundaram CP (April 2001). "Diagnosis and initial management of kidney stones". Am Fam Physician. 63 (7): 1329–38. PMID 11310648.
- ↑ Teichman JM (February 2004). "Clinical practice. Acute renal colic from ureteral calculus". N. Engl. J. Med. 350 (7): 684–93. doi:10.1056/NEJMcp030813. PMID 14960744.