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Thursday, 13 April 2006 |
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Acute Renal Colic
- Aggressive intravenous fluid hydration (if the patient is dehydrated and unable to take fluid orally)
- Parenteral analgesic
- There is no benefit from using smooth muscle relaxants such as nifedipine
Medical Treatment of Nephrolithiasis
- General conservative measures
- High fluid intake of at least 8 to 10 (10 oz) glasses per day
- Relatively low animal protein diet (0.8 to 1.0 g/kg/d)
- A low-sodium diet (2 to 3 g/d or 80 to 100 mEq/d)
- Dietary calcium restrictions
- Avoid stone provoking drugs i.e., Calcitrol, calcium supplements, loop diuretics, Probenicid
- Medical therapy of different stone types
- Calcium stones
- Absorptive hypercalciuria type L Thiazide diuretics
- Absorptive hypercalcemia type II
- Absorptive hypercalciuria type III
- Renal hypercalciuria. Thiazide
- Hyperuricosuric calcium oxalate nephrolithiasis
- Hypocitrauria
- Enteric hyperoxaluria. i
Phase I
- Treat underlying disease
- Increase fluid intake
- Low dietary fat (50 g/d) and oxalate
- Calcium supplementation
- Cholestyramine
Phase II
- Added to phase I after it has been unsuccessful
- Potassium citrate
- Magnesium supplement with magnesium gluconate
- Allopurinol (if the stones contain uric acid)
- Pyridoxine (Vitamin 136)
- Primary hyperoxaluria. Pyridoxine (vitamin 136)
- Uric acid stones
- Increase fluid intake
- Decrease dietary animal protein
- Decrease dietary purine
- Urinary alkalinization with potassium citrate
- Acetazolamide (Diamox)
- Allopurinol
- Cystine stones
- If urine cystine is below 500 mg/L increase fluid intake to maintain urine output more than 3 L a day. Urinary alkalinization with potassium citrate is used to keep urine pH 7.0 to 7.5.
- If urine cystine is above 500 mg/L or the above measures are ineffective, D-penicillamine, Tiopronin (Thiola, mercaptopropionylglycine) or Captopril
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