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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.
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.
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).
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...
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.
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.
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.
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...
What are the potential benefits and adverse effects associated with dietary and pharmacologic interventions to prevent recurrence of kidney stones in adults 18 years and older?
Increased fluid intake or decreased soft drink intake may prevent further kidney stones in patients with a single episode of a calcium stone, but other dietary interventions are not effective. Thiazides and citrates with increased fluid intake decrease recurrence in patients with multiple past stone...