Kidney stone medical therapy

Kidney stone Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Kidney stone from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
Ultrasonography
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Kidney stone medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Kidney stone medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
National Guidelines Clearinghouse
NICE Guidance
FDA on Kidney stone medical therapy
CDC on Kidney stone medical therapy
Kidney stone medical therapy in the news
Blogs onKidney stone medical therapy
Directions to Hospitals Treating Kidney stone
Risk calculators and risk factors for Kidney stone medical therapy

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.

Pharmacological measures

• Both NSAIDS and opiods are seen efficacious for the pain relief related to nephrolithiasis.
• The combination works in effective pain relief.
• 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
  • 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.

Passage of stone

• The passage of stones depend on the size and location of the stone.
• 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
  • Preferred regimen (2):Used as adjuvant in Extracorporeal shockwave lithotripsy; Tamsulosin 0.4 mg PO q24h for 14 days to 3 months