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Calcium stones; Nephrolithiasis
When tests show there is a kidney stone, the next step is to determine treatment. The patient should be admitted to the emergency room if they have severe vomiting, fever, or symptoms of infection.
Strong opioid painkillers are often required for a severe kidney stone attack. However, doctors will usually not give such drugs until they confirm the presence of a kidney stone on an x-ray.
In about 85% of patients, the kidney stones are small enough that they pass through normal urination, usually within 2 - 3 days. In some cases, a stone may take weeks to months to pass, although pain usually goes away before that.
The patient should drink plenty of water (two to three quarts a day) to help move the stone along, and take painkillers as needed. The doctor usually provides a collection kit with a filter and asks the patient to save any passed stones for testing.
If the stone has not passed in 2 - 3 days, the patient will need additional treatments. In some severe cases, hospitalization may be necessary.
Medical expulsion therapy. Alpha blockers (such as tamsulosin) can relax muscles in the urinary tract, helping kidney stone pass.
See "Other Treatments" section for more information on kidney stone surgery.
Treatment by Stone Type | |||
Stone Type | Diet and Lifestyle | Medications | Procedures |
Calcium Oxalate | Plenty of fluids. (Choose water, lemon juice. Avoid grapefruit, apple, and cranberry juice.) Limit the amount of protein and salt in the diet. Increase fiber. Limit the amount of fats in the diet, particularly in people who have short bowel syndrome. Balance normal calcium intake with potassium- and phosphate-rich foods. Limit the amount of calcium in the diet (only in people who have genetic abnormalities that cause high intestinal absorption of calcium). Limit the amount of foods high in oxalates (only in patients with rare intestinal conditions that cause hyperoxaluria). | Diuretics ("water pills"), citrate salts, phosphates, cholestyramine. | Lithotripsy, uteroscopy, percutaneous nephrolithotomy, open surgery. |
Uric Acid | Plenty of fluids. (Choose water, blackcurrant juice. Avoid cranberry juice.) Increase calcium intake (be sure it is well-balanced with potassium and phosphates). Reduce protein and other foods with high-purine content. | Potassium citrate, sodium bicarbonate, allopurinol. | Lithotripsy, uteroscopy, percutaneous nephrolithotomy, open surgery. |
Struvite stones | Plenty of fluids (water, cranberry juice). Reduce proteins. | Antibiotics to eliminate any infection. Acetohydroxamic acid (AHA) may be helpful in combination with antibiotics. In some cases, organic acids are given through the urinary tract. | May respond poorly to most lithotripsy procedures and require open surgery. Newer procedures may be helpful. |
Cystine stones | Very high fluid intake (four quarts a day). Limit the amount of protein in the diet. | Alkalizing agents (such as bicarbonate). Sometimes d-penicillamine, tiopronin, or captopril is useful for lowering cystine levels. | May respond poorly to most lithotripsy procedures and require open surgery. Newer procedures may be helpful. |
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