Effectiveness of Treatment Modalities on Kidney Stone Recurrence

Abstract

Nephrolithiasis is highly prevalent across all demographic groups in the Western world and beyond, and its incidence rates are rising. In addition to the morbidity of the acute event, stone disease often becomes a lifelong problem that requires preventative therapy to diminish ongoing morbidity. Across the majority of stone types, increased fluid intake and targeted dietary modifications are mainstays of therapy. Specific dietary interventions associated with reduced calcium stone risk include adequate dietary calcium intake and restriction of sodium, protein, and oxalate intake, among others. Pharmaceutical therapy may be required if lifestyle changes are insufficient to minimize risk of stone recurrence, and must be targeted to the specific metabolic abnormalities portending risk for a given patient. Therapeutic options for idiopathic calcium stone disease include thiazides, citrate salts, and uric acid-lowering agents. Alkali salts are also the treatment of choice for uric acid stone disease. Management of struvite stone disease is largely surgical, but acetohydroxamic acid is a proven second line therapy. Cystinuria requires lifestyle modifications and may call for thiol-binding agents. Significant heterogeneity of the clinical population with stone disease has previously limited opportunities for large randomized controlled trials. However, as clinical phenotypes and genotypes are increasingly clarified, there are mounting opportunities for targeted randomized controlled trials in stone prevention. In the meantime, the currently available evidence for both lifestyle and pharmacologic interventions is reviewed herein.

Pathogenesis of Proteus mirabilis Infection

“…AHA is the only analog to have been tested in clinical trials and be approved by the Food and Drug Administration. However, while it showed efficacy for preventing urolithiasis (198–200), it has potentially severe side effects that limit its clinical use (201). Thus, further research is necessary to identify safe and effective urease inhibitors.…”

The Role of Imaging in Diagnosis of Urolithiasis and Nephrolithiasis—A Literature Review Article

“…THERAPY: The biggest part of treatment for nephrolithiasis is pain management and hydration these people come in a lot of pain and that's the most important thing to take care of especially as most of them are not in any kind of urgent danger. hydration also helps to dilute the urine which can in some case lead to the dissolving of stones overtime and prevention of increased stones and the most important thing is just to take care of whatever is causing the stones to begin with there are some cases where you want to get urgent urologic consult if there's evidence of urosepsis or renal failure or if the patient is just really sick then you want to get a urologic consult these patients should be staining their urine in order to help identify the stones if we don't know what kind of stone it is and help us to prevent in the future and in some case we do need to facilitate the passage of stones you can get these stone to pass in a number of different ways if they're not passing all by themselves medically you can give anti-spasmodic in order to allow the smooth muscle to relax in the ureter to make more space for the stone to pass through calcium channel blockers [20] and steroids have a similar effect there's different types of lithotripsy which break up the stones a shock wave lithotripsy or ureteroscopic lithotripsy and with ureteroscopic lithotripsy you can use either a laser or hydraulic pulse lithotripsy and in some cases rare cases then you got to go in and get this stone with surgery.…”

Ex vivo stone surgery in donor kidneys at renal transplantation

“…Hypercalcemia, hyperparathyroidism, and hypocitraturia are metabolic factors that are known to cause stone formation, and stones of metabolic origin are known to have a higher recurrence rate . According to previously published series on ex vivo bench surgery, no stone recurrence was observed during the follow‐up period.…”