Kidney stone medical therapy: Difference between revisions

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==Medical Therapy==
==Medical Therapy==
===Nephroliithiasis===
===Nephroliithiasis===
'''Non pharmacological measures'''
 
====== Straining ======
==== '''Non pharmacological measures''' ====
 
===== Straining =====
** Stone ≤5 mm can pass spontaneously.
** Stone ≤5 mm can pass spontaneously.
** Passage of stone also depends on the site of stone.<ref name="pmid10458343">{{cite journal |vauthors=Miller OF, Kane CJ |title=Time to stone passage for observed ureteral calculi: a guide for patient education |journal=J. Urol. |volume=162 |issue=3 Pt 1 |pages=688–90; discussion 690–1 |date=September 1999 |pmid=10458343 |doi= |url=}}</ref>
** Passage of stone also depends on the site of stone.<ref name="pmid10458343">{{cite journal |vauthors=Miller OF, Kane CJ |title=Time to stone passage for observed ureteral calculi: a guide for patient education |journal=J. Urol. |volume=162 |issue=3 Pt 1 |pages=688–90; discussion 690–1 |date=September 1999 |pmid=10458343 |doi= |url=}}</ref>
'''Pharmacological measures'''
 
* 2.1 '''Specific Organ system involv'''
==== '''Pharmacological measures''' ====
*** Parenteral regimen
* Both NSAIDS and opiods are seen efficacious for the pain relief related to nephrolithiasis.<ref name="pmid15178585">{{cite journal |vauthors=Holdgate A, Pollock T |title=Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic |journal=BMJ |volume=328 |issue=7453 |pages=1401 |date=June 2004 |pmid=15178585 |pmc=421776 |doi=10.1136/bmj.38119.581991.55 |url=}}</ref>
**** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
 
**** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
====== Non steroidal anti inflammatory drugs (NSAIDS) ======
**** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
** Parenteral regimen
*** Oral regimen
*** Preferred regimen (1)2 g IV q24h for 14 (14–21) days
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days  
*** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
**** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days  
*** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
** Oral regimen
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days   
*** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days  
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days  
*** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days  
**** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days   
** 2.1.2 '''Pediatric'''
*** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days  
*** Parenteral regimen
* 2.1.2 '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
** Parenteral regimen
**** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
*** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
**** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
*** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
*** Oral regimen
*** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
** Oral regimen
**** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
*** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
**** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
*** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
**** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
*** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
**** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
*** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
**** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
*** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
*** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
 
* 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
* 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
*: '''Note (1):'''  
*: '''Note (1):'''  

Revision as of 19:41, 15 June 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR   The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Medical Therapy

Nephroliithiasis

Non pharmacological measures

Straining
    • Stone ≤5 mm can pass spontaneously.
    • Passage of stone also depends on the site of stone.[1]

Pharmacological measures

  • Both NSAIDS and opiods are seen efficacious for the pain relief related to nephrolithiasis.[2]
Non steroidal anti inflammatory drugs (NSAIDS)
    • Parenteral regimen
      • Preferred regimen (1)2 g IV q24h for 14 (14–21) days
      • Alternative regimen (1): drug name 2 g IV q8h for 14 (14–21) days
      • Alternative regimen (2): drug name 18–24 MU/day IV q4h for 14 (14–21) days
    • Oral regimen
      • Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
      • Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
      • Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
      • Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
  • 2.1.2 Pediatric
    • Parenteral regimen
      • Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
      • Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
      • Alternative regimen (2):  drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '(Contraindications/specific instructions)'
    • Oral regimen
      • Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
      • Preferred regimen (2): drug name (for children aged ≥ 8 years) 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
      • Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
      • Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
      • Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
      • Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)
  • 2.2 'Other Organ system involved 2'
    Note (1):
    Note (2):
    Note (3):
    • 2.2.1 Adult
      • Parenteral regimen
        • Preferred regimen (1): drug name 2 g IV q24h for 14 (14–21) days
        • Alternative regimen (1): drug name 2 g IV q8h for 14 (14–21) days
        • Alternative regimen (2): drug name 18–24 MU/day IV q4h for 14 (14–21) days
      • Oral regimen
        • Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
        • Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
        • Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
        • Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
        • Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
        • Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
    • 2.2.2 Pediatric
      • Parenteral regimen
        • Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
        • Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
        • Alternative regimen (2):  drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
      • Oral regimen
        • Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
        • Preferred regimen (2): drug name 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
        • Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
        • Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
        • Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
        • Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)

References

  1. Miller OF, Kane CJ (September 1999). "Time to stone passage for observed ureteral calculi: a guide for patient education". J. Urol. 162 (3 Pt 1): 688–90, discussion 690–1. PMID 10458343.
  2. Holdgate A, Pollock T (June 2004). "Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic". BMJ. 328 (7453): 1401. doi:10.1136/bmj.38119.581991.55. PMC 421776. PMID 15178585.

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