Kidney Stones

Dec 1, 2019 Issue
Alpha Blockers for Nephrolithiasis [FPIN's Clinical Inquiries]

The alpha blocker tamsulosin (Flomax) can be used to improve clearance of stones larger than 5 mm, shorten expulsion times, and reduce hospitalization.

Apr 15, 2019 Issue
Kidney Stones: Treatment and Prevention [Article]

The prevalence of kidney stones is increasing, especially in the hot-climate “stone belt” extending from the southeastern United States to northern Australia. Find out which patients should be referred for stone removal and who can be managed conservatively, and learn which lifestyle modifications should be recommended.

May 1, 2017 Issue
Citrate Salts for Preventing and Treating Calcium-Containing Kidney Stones in Adults [Cochrane for Clinicians]

Citrate supplementation reduces stone size to less than 5 mm and prevents new stone formation when compared with placebo or no intervention. Citrate therapy also stabilizes existing stones and decreases the need for retreatment. These benefits come at the expense of upper gastrointestinal disturbances that lead to a higher dropout rate.

Jan 15, 2017 Issue
Tamsulosin Beneficial for Passage of 5- to 10-mm Distal Ureteral Stones [POEMs]

Tamsulosin promotes stone passage of distal ureteral stones that are 5 to 10 mm in size. You would need to treat five such patients to get one stone passage. Smaller stones tend to pass on their own at a rate of 86% in this study.

Oct 15, 2016 Issue
Low-Dose Morphine Less Effective Than Diclofenac or Acetaminophen for Renal Colic [POEMs]

This is a good example of how a well-done study can lead to erroneous conclusions. The comparator most likely to be effective here—titrated morphine—was used at a low dose and found to be less effective than intramuscular diclofenac or intravenous paracetamol (acetaminophen).

Oct 1, 2016 Issue
ACR Appropriateness Criteria for Acute Onset of Flank Pain with Suspicion of Stone Disease [Practice Guidelines]

The American College of Radiology (ACR) has established appropriateness criteria to assist in the selection process. Procedures with a rating of 9 are considered most appropriate, and those with a rating of 1 least appropriate. These guidelines rate the suitability of computed tomography (CT), ultra...

May 1, 2016 Issue
Tamsulosin Effective as Expulsion Therapy for 5- to 10-mm Distal Ureteric Stones [POEMs]

Tamsulosin promotes stone passage of ureteric stones that are 5 to 10 mm. Five patients would need to be treated with tamsulosin to cause the expulsion of one such stone. Stones smaller than 5 mm have a high rate of spontaneous passage without any intervention.

Aug 15, 2015 Issue
Prevention of Recurrent Nephrolithiasis: Dietary and Pharmacologic Options Recommended by the ACP [Practice Guidelines]

Nephrolithiasis occurs in 13% of men and 7% of women; if not managed appropriately, it will typically recur within five years in 35% to 50% of patients. The American College of Physicians (ACP) has provided recommendations regarding management of recurrent nephrolithiasis using diet and medication.

Feb 1, 2015 Issue
Alpha Blockers to Speed Ureteral Stone Passage [Cochrane for Clinicians]

Compared with patients receiving standard therapy (e.g., fluids, analgesics), placebo, or calcium channel blockers, patients receiving alpha blockers had about three fewer days to ureteral stone expulsion and were less likely to be hospitalized. Adverse effects of alpha blocker therapy are generally tolerable.

Jan 15, 2015 Issue
Ultrasonography Is Best Initial Imaging for Suspected Kidney Stones [POEMs]

Initial point-of-care or radiology department ultrasonography is a safe and accurate approach to the patient with clinically suspected kidney stones, which helps reduce radiation exposure. Although computed tomography (CT) remains the most accurate test overall, a strategy beginning with ultrasonogr...

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