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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