Kidney stone medical therapy

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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].

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]
  • The combination works in effective pain relief.[3]
  • NSAIDS should be stopped before undergoing Extracorporeal shockwave lithotripsy to reduce the risk of bleeding.
Non steroidal anti inflammatory drugs (NSAIDS)
  • Parenteral regimen
    • Preferred regimen (1): Ketorolac 60 mg as a single dose or 30 mg IM q6h
    • Alternative regimen (1): Ketorolac 10 to 30 mg (as single dose) IM and then q4-6 h as needed (maximum: 120 mg/day)
    • Alternative regimen (2): Ketorolac 30 mg as a single dose or 30 mg IV q6h (maximum: 120 mg/day)
  • Oral regimen
    • Preferred regimen (1): Ketorolac 20 mg, followed by 10 mg q4-6 h as needed; maximum: 40 mg/day; follows the parenteral dose (contraindicated in patients with renal failure)
    • Alternative regimen (1):Indomethacin 20 mg PO q8h
    • Alternative regimen (2):Indomethacin 40 mg PO q8-12h

Opioids

  • Parenteral regimen
    • Preferred regimen (1): Morphine 5 mg IV q4h as needed.


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.
  3. Cordell WH, Wright SW, Wolfson AB, Timerding BL, Maneatis TJ, Lewis RH, Bynum L, Nelson DR (August 1996). "Comparison of intravenous ketorolac, meperidine, and both (balanced analgesia) for renal colic". Ann Emerg Med. 28 (2): 151–8. PMID 8759578.

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