The treatment approach to kidney stones depends on a number of factors and circumstances. For example, asymptomatic stones discovered during diagnostic imaging may not be treated, but an acute symptomatic kidney stone demands an intervention, even if only hydration and painkillers for a small stone (Curhan 2012; UMMC 2013). The high recurrence rate makes long-term prevention a priority for people with a history of kidney stones (Xu 2013).
The most important aspect of treatment and prevention is identifying the type of stone the patient has. A 24-hour urinalysis with saturation can be used to evaluate the tendency of a patient’s urine to form stones. Passed stones can be directly analyzed as well. Unfortunately, the reliability of kidney stone crystal analysis is not perfect; so if you received a diagnosis of a particular stone type, but preventive treatment has failed, it may be worthwhile to ask your doctor about conducting a reanalysis of your stone(s) (UCKSETP 2015; Krambeck 2010; LabCorp 2015).
Stones that do not cause symptoms may be found incidentally during an imaging test (Bansal 2009). Asymptomatic stones under 6 mm are generally left untreated. The approach to larger stones, however, may vary: some practitioners will opt for preventive lithotripsy while others will adopt a wait-and-see approach (Curhan 2012). Other factors may influence the decision to treat asymptomatic kidney stones. For instance, airline pilots are not allowed to fly with asymptomatic kidney stones, due to the possibility of grave consequences of their being incapacitated while on duty (Portis 2001).
Once a diagnosis of acute kidney stones is made, the top treatment priority is usually oral or intravenous pain management. Intravenous hydration may be used, and antibiotics may be necessary when infection is present (Curhan 2012; Frassetto 2011). Infection complicated by obstruction is a medical emergency that requires placement of a drainage device (Curhan 2012).
Medications that relax the ureters and prevent ureteral spasm may be used to promote the passage of stones, a practice called medical expulsive therapy. This approach may include the use of calcium channel blockers like nifedipine (Procardia) and alpha-blockers like tamsulosin (Flomax) for four to six weeks (Antonelli 2015).
Stones larger than 10 mm or that do not respond to conservative treatment may be treated with lithotripsy, ureteroscopy, or rarely, open surgery (Antonelli 2015).
Lithotripsy. Lithotripsy is the least invasive technique for treating kidney stones. In lithotripsy, shock waves are transmitted into the body, focused on the stone. This causes the stone to break into smaller fragments that can then pass more easily. This technique is also called extracorporeal shock wave lithotripsy (Antonelli 2015).
Ureteroscopy. In ureteroscopy a scope is passed through the urethra and bladder and into the ureter. When the scope reaches the stone, the stone can be fragmented with a laser or grasped with a basket and removed (Antonelli 2015).
Nephrolithotomy and nephrolithotripsy. These procedures involve the use of a minimally invasive surgical technique: a small incision is made to access the kidney or upper ureter with a nephroscope, which is then used to fragment (nephrolithotripsy) or remove (nephrolithotomy) the stone (Vicentini 2009; Antonelli 2015).
Laparoscopic and open surgeries. With advances over the past two decades in lithotripsy and other minimally invasive techniques, open surgery is performed far less frequently. These surgical techniques for direct stone removal are reserved for cases, usually with larger stones, when other methods are not appropriate (Antonelli 2015).
Medical Preventive Treatments
About half of all people who have had one episode of kidney stones will have another episode within seven years if no treatment is undertaken (Xu 2013). Preventive strategies depend to a large degree on the type of stone, but for all stones, proper hydration is of the utmost importance (Morton 2002; Sakhaee, Maalouf 2012).
In some cases, preventive treatment entails addressing an underlying condition that predisposes to stone formation. For instance, 10% of calcium-containing stones are caused by medical conditions, including hyperparathyroidism. However, conventional medicine considers the majority of cases idiopathic, meaning the cause is unknown (Marangella 2008; Aliotta 2015; Curhan 2012).
Allopurinol. Allopurinol (Zyloprim) inhibits uric acid production in the body and is used as a treatment for both calcium oxalate and uric acid stones when uric acid is elevated (Sarig 1987; Arrabal-Polo, Arrabal-Martin 2013). Possible side effects of allopurinol include rash, digestive upset, and elevated liver enzymes (Xu 2013).
Thiazide diuretics. Thiazide diuretic medications are typically used to treat high blood pressure, but they also decrease urinary calcium. They have been found to be effective for preventing recurrence of calcium oxalate and calcium phosphate stones in people with high as well as normal urine calcium concentrations (Arrabal-Polo, Arrabal-Martin 2013; Xu 2013). Examples of thiazide diuretics are hydrochlorothiazide (Microzide), chlorthalidone (Thalitone, Hygroton), and indapamide (Lozol).
The usefulness of thiazide diuretics is limited by a number of negative side effects including low blood pressure; elevated blood glucose, uric acid, cholesterol, and triglyceride levels; and magnesium, citrate, and potassium loss (Heseltine 1988; Rohlfing 1986; Xu 2013). It has been suggested that thiazides may work better if used in combination with potassium citrate therapy and a low-salt diet (Sakhaee, Maalouf 2012).
Cystinuria treatment. Medications that split cystine into two molecules are used to prevent cystine stones in people with cystinuria. Such medications include d-penicillamine (Cuprimine) and alpha-mercaptopropionylglycine. Penicillamine can have severe side effects that include bone marrow suppression, blood disorders, kidney disease, and kidney failure (NLM 2012; Sakhaee, Maalouf 2012). Captopril (Capoten) has also been used for cystine stones, and has a more favorable side effect profile (Sloand 1987; Aliotta 2015).