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How to Treat Kidney Stones?


Things to note:
Acute stage
  • Oral fluids administered liberally.
  • Intravenous fluids to ensure adequate hydration and urine flow.
  • Surgical procedures, if required.
Maintenance therapy, for the prevention of recurrence
Fluid intake of at least 2.5-3.5 L daily, especially in warm climates

Medical Treatment:
Analgesia for pain, if needed:
* Morphine, IM/slow IV, 10-15 mg.
For hypocitraturia:
* potassium citrate mixture BP, oral, 10-15 mL 8 hourly for 10 days.
  • Dilute in a glaBeta of water.
  • Repeat as necessary.
For uric acid stones:
* potassium citrate mixture BP, oral, 10-15 mL 8 hourly for 10 days.
  • Dilute in a glass of water.
  • Repeat as necessary.
PLUS
* Allopurinol, oral, daily.
  • Starting dose: 100 mg.
  • Titrate up to 300 mg.
The treatment is long-term to prevent recurrence.
For mild metabolic hyperoxaluria:
* Pyridoxine, oral, 25-75 mg daily.
PLUS
* Calcium carbonate, oral, equivalent to 500 1000 mg/day of elemental calcium.
  • Take 8 hourly with meals for 4 weeks.
For renal hypercalciuria (absorptive type):
* Hydrochlorothiazide, oral, 50 mg daily for 1 month.
  • May be repeated.

When to refer:
  • In acute setting for suspected or diagnosed obstruction and/or ongoing pain.
  • Complicating urinary tract sepsis.
  • Renal damage or insufficiency, i.e. presence of CKD at the time of diagnosis or afterwards.
  • Recurrent calculi.
  • If medical problem is suspected to be the cause e.g. chronic UTI and Crohns disease and unable to make the diagnosis at secondary hospital level.