Stone size and location determine the likelihood of spontaneous passage: Stones ≤ 5 mm tend to pass spontaneously, while stones ≥ 10 mm are unlikely to do so, especially if located in the pyelon or proximal ureter. [8]
50% of patients may have a new episode of nephrolithiasis within 10 years. [1]
Hydration: sufficient fluid intake (≥ 2.5 L/day) [31]
Diet
For calcium stones:
Reduced consumption of salt and animal protein [31]
Reduced consumption of oxalate-rich foods and supplemental vitamin C: for oxalate stones [32][33]
Calcium intake should not be restricted (restriction increases risk of hyperoxaluria, and thereby, the risk for osteoporosis)
For uric acid stones: low in purine
For cystine stones: low in sodium
Chemoprophylaxis
Calcium stones
Thiazide diuretic for recurrent calcium-containing stones with idiopathic hypercalciuria (i.e., no hypercalcemia) [31][34]
Allopurinol in the case of high urine uric acid
Uric acid stones: allopurinol [31]
Cystine stones: tiopronin
Struvite stones: antibiotic treatment for UTI
Change urinary pH: depends on stone composition
Urine alkalinization: a treatment regimen to raise urinary pH to 6.5–7.5
Achieved via diet rich in fruits and vegetables or supplementation of potassium citrate
Used to prevent recurrence of calcium oxalate, uric acid, and cystine stones
Urine acidification: a treatment regimen to lower the urinary pH to ≤ 7
Achieved via intake of cranberry juice or betaine or a diet rich in dairy products, grains, or meat
Used to prevent recurrence of calcium phosphate and struvite stones
Low calcium diets increase the risk of calcium-containing stone formation because they increase oxalate reabsorption
06/06/2024
Status post successful ureteroscopy laser lithotripsy 4 mm obstructing distal ureteral stone
Stone size and location determine the likelihood of spontaneous passage: Stones ≤ 5 mm tend to pass spontaneously, while stones ≥ 10 mm are unlikely to do so, especially if located in the pyelon or proximal ureter. [8]
50% of patients may have a new episode of nephrolithiasis within 10 years. [1]
Hydration: sufficient fluid intake (≥ 2.5 L/day) [31]
Diet
For calcium stones:
Reduced consumption of salt and animal protein [31]
Reduced consumption of oxalate-rich foods and supplemental vitamin C: for oxalate stones [32][33]
Calcium intake should not be restricted (restriction increases risk of hyperoxaluria, and thereby, the risk for osteoporosis)
For uric acid stones: low in purine
For cystine stones: low in sodium
Chemoprophylaxis
Calcium stones
Thiazide diuretic for recurrent calcium-containing stones with idiopathic hypercalciuria (i.e., no hypercalcemia) [31][34]
Allopurinol in the case of high urine uric acid
Uric acid stones: allopurinol [31]
Cystine stones: tiopronin
Struvite stones: antibiotic treatment for UTI
Change urinary pH: depends on stone composition
Urine alkalinization: a treatment regimen to raise urinary pH to 6.5–7.5
Achieved via diet rich in fruits and vegetables or supplementation of potassium citrate
Used to prevent recurrence of calcium oxalate, uric acid, and cystine stones
Urine acidification: a treatment regimen to lower the urinary pH to ≤ 7
Achieved via intake of cranberry juice or betaine or a diet rich in dairy products, grains, or meat
Used to prevent recurrence of calcium phosphate and struvite stones
Low calcium diets increase the risk of calcium-containing stone formation because they increase oxalate reabsorption
06/06/2024
Status post successful ureteroscopy laser lithotripsy 4 mm obstructing distal ureteral stone
stones)
- encourage copious hydration
- RTC in 4-6 weeks for discussion of stone prevention if passed, and discussion of URS/LL if not
1 in 6 americans will develop stones
Once you develop a stone there is a 50% chance in 5 years where you will develop another stone
Kidney stones
4, 4, 3, 10
UPJ UVJ, Cystitis
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