Am Fam Physician. 2012 Jun 15;85(12):1127.
Original Article: Treatment and Prevention of Kidney Stones: An Update
Issue Date: December 1, 2011
Available at: http://www.aafp.org/afp/2011/1201/p1234.html
to the editor: Drs. Frassetto and Kohlstadt provide a useful summary of kidney stone management. However, their discussion of pain control is limited to opioid analgesics and suggests avoiding nonsteroidal anti-inflammatory drugs (NSAIDs) because of their effects on renal blood flow and glomerular filtration rate. Although there are patients in whom NSAIDs should be used with caution or avoided (e.g., patients with chronic kidney disease), there is inadequate evidence demonstrating significant harms from NSAIDs in patients with renal colic.
A Cochrane review concluded that both NSAIDs and opioids provide effective relief from renal colic. Some evidence suggested that NSAIDs were more effective, and that opioid use was associated with more adverse effects, mainly vomiting.1 Trials included in this Cochrane review did not directly assess gastrointestinal bleeding or worsening of renal function. However, these potential adverse effects were infrequent in the Cochrane review and in a previously published meta-analysis of NSAIDs for renal colic.2
Treatment harms are important, and trials designed to show if NSAIDs pose a risk in kidney stone treatment would be helpful. However, based on a paucity of evidence that NSAIDs are harmful in most patients with kidney stones, physicians should not exclude NSAIDs as an option for relieving renal colic.
Author disclosure: No relevant financial affiliations to disclose.
1. Holdgate A, Pollock T. Nonsteroidal anti-inflammatory drugs (NSAIDs) versus opioids for acute renal colic. Cochrane Database Syst Rev. 2005(2):CD004137.
2. Labrecque M, Dostaler LP, Rousselle R, Nguyen T, Poirier S. Efficacy of nonsteroidal anti-inflammatory drugs in the treatment of acute renal colic: a meta-analysis. Arch Intern Med. 1994;154(12):1381–1387.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: email@example.com, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 2012 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions