Medical Management of Kidney Stones: AUA Guideline (2022)

ScienceDirect

Corporate sign inSign in / register

ViewPDF

  • Access throughyour institution

The Journal of Urology

Volume 192, Issue 2,

August 2014

, Pages 316-324

Purpose

The purpose of this guideline is to provide a clinical framework for thediagnosis, prevention and follow-up of adult patients with kidney stones based on the best available published literature.

Materials and Methods

The primary source of evidence for this guideline was the systematic review conducted by the Agency for Healthcare Research and Quality on recurrent nephrolithiasis in adults. To augment and broaden the body of evidence in the AHRQ report, the AUA conducted supplementary searches for articles published from 2007 through 2012 that were systematically reviewed using a methodology developed a priori. In total, these sources yielded 46 studies that were used to form evidence-based guideline statements. In the absence of sufficient evidence, additional statements were developed as Clinical Principles and Expert Opinions.

Results

Guideline statements were created to inform clinicians regarding the use of a screening evaluation for first-time and recurrent stone formers, the appropriate initiation of a metabolic evaluation in select patients and recommendations for the initiation and follow-up of medication and/or dietary measures in specific patients.

Conclusions

A variety of medications and dietary measures have been evaluated with greater or less rigor for their efficacy in reducing recurrence rates instone formers. The guideline statements offered in this document provide asimple, evidence-based approach to identify high-risk or interested stone-forming patients for whom medical and dietary therapy based on metabolic testing and close follow-up is likely to be effective in reducing stone recurrence.

Introduction

Kidney stone disease is a common malady, affecting nearly 1 in 11 individuals in the United States at some point in their lives.1 Stones are also likely to recur, with at least 50%of individuals experiencing another stone within 10 years of the first occurrence. For those who have experienced a stone or undergone surgical intervention for a stone, there is strong motivation to avoid a repeat episode. This guideline is aimed at practitioners from a variety of disciplines who are confronted with patients afflicted with stone disease, and it is based on a systematic review of the literature with respect to the evaluation, treatment and follow-up of first-time and recurrent stone formers. Patient preferences and goals must be taken into account by the practitioner when considering these guidelines, as the cost, inconvenience and side effects of drugs and dietary measures to prevent stone disease must be weighed against the benefit of preventing a recurrent stone.

(Video) Guideline-Based Approach to Metabolic Stone Management for the General Urologist

Section snippets

Methodology

The AHRQ systematic review titled Recurrent Nephrolithiasis in Adults: Comparative Effectiveness of Preventative Medical Strategies was utilized as the primary source of evidence for guideline development. Additionally, the AUA conducted supplementary searches of PubMed® and EMBASE® for relevant articles published between January 2007 and November 2012, which were systematically reviewed using a methodology developed a priori. The AUA conducted an extensive peer review process. The initial

Background

Kidney stone disease is a common condition. According to the most recent National Health and Nutrition Examination Survey, the overall prevalence of self-reported kidney stones from 2007–2010 was 8.8%, with a higher prevalence among men (10.6%) than women (7.1%).1 This prevalence represents a 70% increase over the last reported prevalence (5.2%) derived from an NHANES sample (1988–1994), and the increased prevalence was observed across all age groups and in both sexes. Although historically

Evaluation

1. A clinician should perform a screening evaluation consisting of a detailed medical and dietary history, serum chemistries and urinalysis on a patient newly diagnosed with kidney or ureteral stones. (Clinical Principle)

A detailed history should elicit from the patient any medical conditions, dietary habits or medications that predispose to stone disease. Nutritional factors associated with stone disease, depending on stone type and risk factors, include calcium intake below or significantly

Future Research

For a disease with relatively high incidence and prevalence, research in the prevention of kidney stone disease is surprisingly sparse, perhaps because of the sporadic occurrence and transient symptoms associated with kidney stones as well as a perception that the pharmaceutical industry is not likely to find substantial profit in stone prevention. The recent AHRQ-sponsored review of medical management identified only 28 RCTs performed through 2012.49

The interest in kidney stones has grown in

References (50)

  • H.A. Fink et al.Diet, fluid, or supplements for secondary prevention ofnephrolithiasis: a systematic review and meta-analysis of randomized trials

    Eur Urol

    (2009)

  • G.M. Preminger et al.Eventual attenuation of hypocalciuric response to hydrochlorothiazide in absorptive hypercalciuria

    J Urol

    (1987)

  • P.K. Pietrow et al.Durability of the medical management of cystinuria

    J Urol

    (2003)

  • M.R. Robinson et al.Impact of long-term potassium citrate therapy on urinary profiles and recurrent stone formation

    JUrol

    (2009)

  • C.Y. Pak et al.Prevention of stone formation and bone loss in absorptive hypercalciuria by combined dietary and pharmacological interventions

    J Urol

    (2003)

  • C.Y. Pak et al.Managementof cystine nephrolithiasis with alpha-mercaptopropionylglycine

    J Urol

    (1986)

  • J.S. RodmanIntermittent versus continuous alkaline therapy for uric acid stones and ureteral stones of uncertain compostion

    Urology

    (2002)

  • B. Ettinger et al.Chlorthalidone reduces calcium oxalate calculous recurrence but magnesium hydroxide does not

    JUrol

    (1988)

  • G.M. Preminger et al.Alkali action on the urinary crystallization of calcium salts: contrasting responses to sodium citrate and potassium citrate

    J Urol

    (1988)

  • P. Barcelo et al.Randomized double-blind study of potassium citrate in idiopathic hypocitraturic calcium nephrolithiasis

    JUrol

    (1993)

  • B. Ettinger et al.Potassium-magnesium citrate is an effective prophylaxis against recurrent calcium oxalate nephrolithiasis

    J Urol

    (1997)

  • F. Barbey et al.Medical treatment of cystinuria: critical reappraisal of long term results

    J Urol

    (2000)

  • I.A. Bobulescu et al.Renal transport of uric acid: evolving concepts and uncertainties

    (Video) AUA Guidelines for Management of Ureteral Stones

    Adv Chronic Kidney Dis

    (2012)

  • M.A. Seltzer et al.Dietary manipulation with lemonade to treat hypocitraturic calcium nephrolithiasis

    J Urol

    (1996)

  • E.M. WorcesterStones from bowel disease

    Endocrinol Metab Clin North Am

    (2002)

  • D.E. Kang et al.Long-term lemonade based dietary manipulation in patients with hypocitraturic nephrolithiasis

    J Urol

    (2007)

  • J.H. Parks et al.Correspondence between stone composition and urine supersaturationin nephrolithiasis

    Kidney Int

    (1997)

  • E.N. Taylor et al.Diabetes mellitus and the risk of nephrolithiasis

    Kidney Int

    (2005)

  • L. Borghi et al.Essential arterial hypertension and stone disease

    Kidney Int

    (1999)

  • C.D. Scales et al.Changing gender prevalence of stone disease

    JUrol

    (2007)

  • M.S. Pearle et al.Urologic Diseases in America Project: urolithiasis

    J Urol

    (2005)

  • C.D. Scales et al.Prevalence of kidney stones in the United States

    Eur Urol

    (2012)

  • E.N. Taylor et al.

    Obesity, weight gain, and the risk of kidney stones

    JAMA

    (2005)

  • M.S. Pearle et al.

    Meta-analysis of randomized trials for medical prevention of calcium oxalate nephrolithiasis

    JEndourol

    (1999)

  • C.Y. Pak et al.

    Predictive value of kidney stone composition in the detection of metabolic abnormalities

    Am JMed

    (2004)

  • Cited by (441)

    • Comparison of Empiric Preventative Pharmacologic Therapies on Stone Recurrence Among Patients with Kidney Stone Disease

      2022, Urology

      To compare the frequency of stone-related events among patients receiving thiazides, alkali citrate, and allopurinol without prior 24 h urine testing. It is unknown whether 1 preventative pharmacological therapy (PPT) medicationclass is more beneficial for reducing kidney stone recurrence when prescribed empirically.

      Using medical claims data from working-age adults with kidney stone disease diagnoses (2008-2018), we identified those prescribed thiazides, alkali citrate, or allopurinol. We excluded those who received 24 h urine testing prior to initiating PPT and those with less than 3 years of follow-up. We fit multivariable regression models to estimate the association between the occurrence of a stone-related event (emergency department visit, hospitalization, or surgery for stones) and PPT medication class.

      Our cohort consisted of 1834 (60%), 654 (21%), and 558 (18%) patients empirically prescribed thiazides, alkali citrate, or allopurinol, respectively. After controlling for patient factors including medication adherence and concomitant conditions that increase recurrence risk, the adjusted rate of any stone event was lowestfor the thiazide group (14.8%) compared toalkali citrate(20.4%) orallopurinol (20.4%)(each P < .001).Thiazides, compared to allopurinol, were associated with 32% lower odds of a subsequent stone event by 3 years (OR 0.68, 95% CI 0.53-0.88). No such association was observed when comparing alkali citrate to allopurinol (OR 1.00, 95% CI 0.75-1.34).

      Empiric PPT with thiazides is associated with significantly lower odds of subsequent stone-related events. When 24 h urine testing is unavailable, thiazides may be preferred over alkali citrate or allopurinol for empiric PPT.

    • Associations of Obesity and Neighborhood Factors With Urinary Stone Parameters

      2022, American Journal of Preventive Medicine

      (Video) Treatment of the Ureteral Stone: What Do the AUA Guidelines Say?

      Obesity is associated with kidney stone disease, but it is unknown whether this association differs by SES. This study assessed the extent to which obesity and neighborhood characteristics jointly contribute to urinary risk factors for kidney stone disease.

      This was a retrospective analysis of adult patients with kidney stone disease evaluated with 24-hour urine collection (2001–2020). Neighborhood-level socioeconomic data were obtained for a principal component analysis, which identified 3 linearly independent factors. Associations between these factors and 24-hour urine measurements were assessed using linear regression as well as groupings of 24-hour urine results using multivariable logistic regression. Finally, multiplicative interactions were assessed testing effect modification by obesity, and analyses stratified by obesity were performed. Analyses were performed in 2021.

      In total, 1,264 patients met the study criteria. Factors retained on principal component analysis represented SES, family structure, and housing characteristics. On linear regression, there was a significant inverse correlation between SES and 24-hour urine sodium (p=0.0002). On multivariable logistic regression, obesity was associated with increased odds of multiple stone risk factors (OR=1.61; 95% CI=1.15, 2.26) and multiple dietary factors (OR=1.33; 95% CI=1.06, 1.67). No significant and consistent multiplicative interactions were observed between obesity and quartiles of neighborhood SES, family structure, or housing characteristics.

      Obesity was associated with the presence of multiple stone risk factors and multiple dietary factors; however, the strength and magnitude of these associations did not vary significantly by neighborhood SES, family structure, and housing characteristics.

    • A Randomized Trial Evaluating the Use of a Smart Water Bottle to Increase Fluid Intake in Stone Formers

      2022, Journal of Renal Nutrition

      The aim of this study is to evaluate if the use of a smart water bottle improves urine volume in stone forming patients.

      Adults with nephrolithiasis and low urine volume (<1.5L) documented on a 24-hour urinalysis (24hr U) were randomized to receive either standard dietary recommendations to increase fluid intake (DR arm), or DR and a smart water bottle (HidrateSpark®; Hydrate Inc., Minneapolis, MN) that recorded fluid intake, synced to the user’s smartphone, and provided reminders to drink (SBarm). Participants completed baseline surveys assessing barriers to hydration. They then repeated a 24hr U and survey at 6 and 12weeks, respectively.

      Eighty-five subjects (44 DR, 41 SB) were enrolled. The main baseline factor limiting fluid intake was not remembering to drink (60%). Follow-up 24hr Us were available for 51 patients. The mean increase in volume was greater in the SB arm (1.37L, 95% confidence interval −0.51 to 3.25) than the DR arm (0.79L, 95% confidence interval −1.15 to 2.73) (P=.04). A smaller percentage of subjects in the SB arm reported not remembering to drink as the main factor limiting fluid intake in the follow-up questionnaire compared to baseline (45.4% vs. 68.4%, P<.05). This was not true for the DR arm (40.0% vs. 51.2%, P=.13).

      Difficulty remembering to drink is a barrier to achieving sufficient fluid intake in stone formers. The use of a smart bottle was associated with greater increases in 24hr U volumes and less difficulty remembering to drink.

    • Comparison of Selective vs Empiric Pharmacologic Preventive Therapy of Kidney Stone Recurrence With High-Risk Features

      2022, Urology

      To compare the frequency of stone-related events among subgroups of high-risk patients with and without 24-hour urine testing before preventive pharmacological therapy (PPT) prescription.While recent studies show, on average, no benefit to a selective approach to PPT for urinary stone disease (USD), there could be heterogeneity in treatment effect across patient subgroups.

      Using medical claims data from working-age adults and their dependents with USD (2008-2019), we identified those with a prescription fill for a PPT agent (thiazide diuretic, alkali therapy, or allopurinol). We then stratified patients into subgroups based on the presence of a concomitant condition or other factors that raised their stone recurrence risk. Finally, we fit multivariable regression models to measure the association between stone-related events (emergency department visit, hospitalization, and surgery) and 24-hour urine testing before PPT prescription by high-risk subgroup.

      Overall, 8369 adults with USD had a concomitant condition that raised their recurrence risk. Thirty-three percent (n=2722) of these patients were prescribed PPT after 24-hour urine testing (median follow-up, 590 days), and 67% (n=5647) received PPT empirically (median follow-up, 533 days). Compared to patients treated empirically, those with a history of recurrent USD had a significantly lower hazard of a subsequent stone-related event if they received selective PPT (hazard ratio, 0.83; 95% confidence interval, 0.71-0.96). No significant associations were noted for selective PPT in the other high-risk subgroups.

      Patients with a history of recurrent USD benefit from PPT when guided by findings from 24-hour urine testing.

    • Medical Treatment and Prevention of Urinary Stone Disease

      2022, Urologic Clinics of North America

    • Plant-Based Milk Alternatives and Risk Factors for Kidney Stones and Chronic Kidney Disease

      2022, Journal of Renal Nutrition

      Patients with kidney stones are counseled to eat a diet low in animal protein, sodium, and oxalate and rich in fruits and vegetables, with a modest amount of calcium, usually from dairy products. Restriction of sodium, potassium, and oxalate may also be recommended in patients with chronic kidney disease. Recently, plant-based diets have gained popularity owing to health, environmental, and animal welfare considerations. Our objective was to compare concentrations of ingredients important for kidney stones and chronic kidney disease in popular brands of milk alternatives.

      Sodium, calcium, and potassium contents were obtained from nutrition labels. The oxalate content was measured by ion chromatography coupled with mass spectrometry.

      The calcium content is highest in macadamia followed by soy, almond, rice, and dairy milk; it is lowest in cashew, hazelnut, and coconut milk. Almond milk has the highest oxalate concentration, followed by cashew, hazelnut, and soy. Coconut and flax milk have undetectable oxalate levels; coconut milk also has comparatively low sodium, calcium, and potassium, while flax milk has the most sodium. Overall, oat milk has the most similar parameters to dairy milk (moderate calcium, potassium and sodium with low oxalate). Rice, macadamia, and soy milk also have similar parameters to dairy milk.

      As consumption of plant-based dairy substitutes increases, it is important for healthcare providers and patients with renal conditions to be aware of their nutritional composition. Oat, macadamia, rice, and soy milk compare favorably in terms of kidney stone risk factors with dairy milk, whereas almond and cashew milk have more potential stone risk factors. Coconut milk may be a favorable dairy substitute for patients with chronic kidney disease based on low potassium, sodium, and oxalate. Further study is warranted to determine the effect of plant-based milk alternatives on urine chemistry.

      (Video) Management of Renal/Ureteric Stones - UK NICE Guidelines (2020) for Medical Professionals

    View all citing articles on Scopus

    Recommended articles (6)

    • Research article

      Endothelial safety of radiological contrast media: Why being concerned

      Vascular Pharmacology, Volume 58, Issues 1–2, 2013, pp. 48-53

      Iodinated radiocontrast media have been the most widely used pharmaceuticals for intravascular administration in diagnostic and interventional angiographic procedures. Although they are regarded as relatively safe drugs and vascular biocompatibility of contrast media has been progressively improved, severe adverse reactions may occur, among which acute nephropathy is one of the most clinically significant complications after intravascular administration of contrast media and a powerful predictor of poor early and long-term outcomes. Since radiocontrast media are given through the arterial or the venous circulation in vascular procedures, morphological and functional changes of the microvascular and macrovascular endothelial cells substantially contribute to the pathogenesis of organ-specific and systemic adverse reactions of contrast media. Endothelial toxicity of contrast media seems to be the result of both direct proapoptotic effects and morphological derangements, as well as endothelial dysfunction and induction of inflammation, oxidative stress, thrombosis, and altered vasomotor balance, with predominant vasoconstrictive response in atherosclerotic coronary arteries and kidney microcirculation. Further understanding of pathogenetic mechanisms underlying contrast media-induced adverse reactions in cellular targets, including endothelial cells, will hopefully lead to the development of novel preventive strategies appropriately curbing the pathogenesis of contrast media vasotoxicity.

    • Research article

      Varicocele: Early Surgery versus Observation

      The Journal of Urology, Volume 192, Issue 3, 2014, pp. 645-647

    • Research article

      Central Venous Access for Hemodialysis

      Handbook of Dialysis Therapy, 2017, pp. 40-49.e1

    • Research article

      Vitamin D Intake and the Risk of Incident Kidney Stones

      The Journal of Urology, Volume 197, Issue 2, 2017, pp. 405-410

      Kidney stones are a common and painful condition. Longitudinal prospective studies on the association between the intake of vitamin D and the risk of incident kidney stones are lacking.

      We performed a prospective analysis of 193,551 participants in the Health Professionals Follow-up Study and Nurses’ Health Study I and II. Participants were divided into categories of total (less than 100, 100 to 199, 200 to 399, 400 to 599, 600 to 999, 1,000 IU per day or greater) and supplemental (none, less than 400, 400 to 599, 600 to 999, 1,000 IU per day or greater) vitamin D intake. During a followup of 3,316,846 person-years there were 6,576 incident kidney stone events. Cox proportional hazards regression models were adjusted for age, body mass index, comorbidities, use of medications and intake of other nutrients.

      After multivariate adjustment there was no statistically significant association between vitamin D intake and risk of stones in the HPFS (HR for 1,000 or greater vs less than 100 IU per day 1.08, 95% CI 0.80, 1.47, p for trend = 0.92) and the NHS I (HR 0.99, 95% CI 0.73, 1.35, p for trend = 0.70), whereas there was a suggestion of a higher risk in the NHS II (HR 1.18, 95% CI 0.94, 1.48, p for trend = 0.02). Similar results were found for supplemental vitamin D intake.

      Vitamin D intake in typical amounts was not statistically associated with risk of kidney stone formation, although higher risk with higher doses than those studied here cannot be excluded.

    • Research article

      What Is the Future of Kidney Stone Management?

      European Urology, Volume 66, Issue 6, 2014, pp. 1052-1053

    • Research article

      Managing Urolithiasis

      Annals of Emergency Medicine, Volume 67, Issue 4, 2016, pp. 449-454

    View full text

    Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

    (Video) "UPDATE ON MEDICAL MANAGEMENT OF KIDNEY STONES"

    FAQs

    What is the management of kidney stones? ›

    Your doctor may prescribe allopurinol (Zyloprim, Aloprim) to reduce uric acid levels in your blood and urine and a medicine to keep your urine alkaline. In some cases, allopurinol and an alkalizing agent may dissolve the uric acid stones. Struvite stones.

    What is conservative management for kidney stones? ›

    Conservative management includes pain control (usually with acetaminophen and a non-steroidal anti-inflammatory drug like ibuprofen), hydration (6 to 8 glasses of water a day), and medical expulsive therapy using an alpha blocker (e.g., tamsulosin).

    What size kidney stone requires Pcnl? ›

    Percutaneous nephrolithotomy is typically recommended when: Large kidney stones block more than one branch of the collecting system of the kidney. These are known as staghorn kidney stones. Kidney stones are larger than 0.8 inch (2 centimeters) in diameter.

    Which USG for renal calculi? ›

    The findings of this study showed that ultrasonography had 80% sensitivity and 100% specificity in identifying renal calculi in children. In other words, ultrasonography is an excellent diagnostic test for renal calculi, and only one case of false positive has been reported.

    What are the 5 types of kidney stones? ›

    Types of Kidney Stones
    • Calcium Oxalate Stones. The most common type of kidney stone is a calcium oxalate stone. ...
    • Calcium Phosphate Stones. Calcium phosphate kidney stones are caused by abnormalities in the way the urinary system functions. ...
    • Struvite Stones. ...
    • Uric Acid Stones. ...
    • Cystine Stones.

    How do they remove 20 mm kidney stones? ›

    Flexible ureteroscopy (fURS) has become a more effective and safer treatment for whole upper urinary tract stones. Percutaneous nephrolithotomy (PNL) is currently the first-line recommended treatment for large kidney stones ≥ 20 mm and it has an excellent stone-free rate for large kidney stones.

    How do you remove a 13mm kidney stone naturally? ›

    People who have kidney stones should consume lots of water to flush out these stones through urine. Generally, it is advised to drink 7-8 glasses of water a day. The concoction of lemon juice and olive oil might sound a little weird but it is a very effective home remedy to get kidney stones out of your system.

    What size kidney stone requires surgery? ›

    Thus, doctors are of the opinion that the kidney stones of 6mm or more require surgery. A quick fact: Stones of size 4mm or less have an 80 percent chance of passing on their own. The probability of a stone passing through urine decreases with the increase in the size of the stone.

    Is 7 mm kidney stone big? ›

    Kidney stones 6 - 7mm are not too big, but also not small, can take medicine or use lithotripsy methods. The choice of treatment method depends on the type of stone, the impact of the stone on the kidney, the hospital's equipment, and the experience and qualifications of the treating doctor.

    How do you treat a 15mm kidney stone? ›

    The most commonly used approaches include shock wave lithotripsy (SWL), ureteroscopy (URS), percutaneous nephrolithotripsy, laparoscopic ureterolithotomy, and open ureterolithotomy.

    What is the maximum size of kidney stone? ›

    Most kidney stones are about the size of a chickpea, but they can also be as small as a grain of sand and as large as a golf ball. Small stones can pass through your urinary tract but you might need surgery for the larger ones.

    Will a KUB show kidney stones? ›

    Basic information regarding the size, shape, and position of the kidneys, ureters, and bladder may be obtained with a KUB X-ray. The presence of calcifications ( kidney stones ) in the kidneys or ureters may be noted. There may be other reasons for your doctor to recommend a KUB X-ray.

    Is there a blood test for kidney stones? ›

    Commonly used blood tests for kidney stone diagnosis are the basic metabolic panel (BMP) or the comprehensive metabolic panel (CMP) and the uric acid test.

    What is the best position to pass a kidney stone? ›

    When you have a kidney stone, the priority is to pass it as soon as possible to eliminate the pain. Research indicates that the best position to lay with kidney stones is on the side with the pain. In other words, if the stone is in your left ureter, lie on your left side; if it's in the right ureter, lie on the right.

    How can I remove kidney stones without surgery? ›

    Extracorporeal shock wave lithotripsy is a technique for treating stones in the kidney and ureter that does not require surgery. Instead, high energy shock waves are passed through the body and used to break stones into pieces as small as grains of sand.

    What are the main causes of kidney stones? ›

    Kidney stones (also called renal calculi, nephrolithiasis or urolithiasis) are hard deposits made of minerals and salts that form inside your kidneys. Diet, excess body weight, some medical conditions, and certain supplements and medications are among the many causes of kidney stones.

    Are there 2 types of kidney stones? ›

    A kidney stone is a hard object that is made from chemicals in the urine. There are four types of kidney stones: calcium oxalate, uric acid, struvite, and cystine. A kidney stone may be treated with shockwave lithotripsy, uteroscopy, percutaneous nephrolithomy or nephrolithotripsy.

    Can a 11mm kidney stone dissolve? ›

    The smaller the kidney stone, the more likely it will pass on its own. If it is smaller than 5 mm (1/5 inch), there is a 90% chance it will pass without further intervention. If the stone is between 5 mm and 10 mm, the odds are 50%. If a stone is too large to pass on its own, several treatment options are available.

    Is a 10 mm kidney stone big? ›

    Large kidney stones are stones that measure approximately 5 mm or larger. Based on their size, they may have trouble moving through the urinary tract out of the body. In fact, they are prone to become lodged causing severe pain and other symptoms.

    Can you pass a 13mm kidney stone? ›

    Kidney stones that are less than 5 millimeters (mm) in size will commonly pass with medical management. Stones that are greater than 10 mm will usually require surgery.

    Is a 6 mm kidney stone big? ›

    Size: Stones measuring 4mm or less have a high probability of passing without the need for professional intervention. Kidney stones that are 6mm or larger in diameter will most likely need treatment and/or removal.

    How is a 6mm kidney stone removed? ›

    A urologist can remove the kidney stone or break it into small pieces with the following treatments: Shock wave lithotripsy. The doctor can use shock wave lithotripsy link to blast the kidney stone into small pieces. The smaller pieces of the kidney stone then pass through your urinary tract.

    How do you treat an 8mm kidney stone? ›

    The best treatment for stones of 8mm size is Shock Wave Lithotripsy. Shock wave lithotripsy involves the use of thousands of shockwaves in order to break the large stone into smaller stone pieces. Once this is achieved, you are allowed to go home and the doctor asks you to drink plenty of fluids.

    Can a 10mm kidney stone dissolve? ›

    Stones that are greater than 10 mm will commonly require surgical treatment. Stones between 5 and 10 may pass on their own. You should drink plenty of water, keep your urine clear, follow a low salt diet and I advocate the DASH diet for patients with kidney stones.

    Which injection is used for kidney stone pain? ›

    If the stone is causing severe pain, the urologist may choose to prescribe a narcotic. Providers may also inject patients with Ketorolac (Toradol), a more powerful anti-inflammatory medication.

    Can you pass a 8mm kidney stone? ›

    Some are small enough to pass on their own when you urinate. Dr. Lee noted a 3 mm stone has about 80 percent chance of passing on its own. At about 5 mm, the odds are about 50 percent, but if a stone reaches 8 mm, the odds drop to 20 percent.

    What is the treatment for 11 mm size stone in kidney? ›

    Most evidence suggests that stones less than 10 mm in diameter have a reasonable chance of passing through the urinary tract spontaneously. You may be offered medical expulsive therapy (MET) using an alpha blocker medication, such as tamsulosin.

    When is surgery necessary for kidney stones? ›

    You might have a procedure or surgery to take out kidney stones if: The stone is very large and can't pass on its own. You're in a lot of pain. The stone is blocking the flow of urine out of your kidney.

    Can you pass a 9 mm kidney stone? ›

    (See 'Preventing future kidney stones' below.) If the stone does not pass — Stones larger than 9 or 10 millimeters rarely pass on their own and generally require a procedure to break up or remove the stone. Some smaller stones also do not pass.

    What size stone needs lithotripsy? ›

    Most kidney stones that develop are small enough to pass without intervention. However, in about 20 percent of cases, the stone is greater than 2 centimeters (about one inch) and may require treatment.

    Is 7mm kidney stone need surgery? ›

    Kidney stone treatment depends on the size and type of stone as well as whether infection is present. Stones 4 mm and smaller in about 90 percent of cases; those 5–7 mm do so in 50 percent of cases; and those larger than 7 mm rarely pass without a surgical procedure.

    Can 7mm stone pass through ureter? ›

    Measuring the Kidney Stone Size

    Between 4 mm and 6 mm, only 60 percent will pass without medical intervention, and on average take 45 days to exit your body naturally. Anything bigger than 6 mm will almost always need medical care to help remove the stone.

    Is 15 mm big for a kidney stone? ›

    Medium sized stones in the kidney (5-20mm diameter) generally require treatment even if they are not causing any symptoms. This is because these calculi are unlikely to pass spontaneously and very likely to cause problems at some point in the future.

    How do you get rid of 18 mm kidney stone? ›

    Removal of kidney stones: URS - YouTube

    How do you get rid of 8mm kidney stones naturally? ›

    1. Staying hydrated is key. Drinking plenty of fluids is a vital part of passing kidney stones and preventing new stones from forming. ...
    2. Water. When passing a stone, upping your water intake can help speed up the process. ...
    3. Lemon juice. ...
    4. Basil juice. ...
    5. Apple cider vinegar. ...
    6. Celery juice. ...
    7. Pomegranate juice. ...
    8. Kidney bean broth.

    Can a 6.5 mm kidney stone be passed? ›

    Stones that are 4–6 mm are more likely to require some sort of treatment, but around 60 percent pass naturally. This takes an average of 45 days. Stones larger than 6 mm usually need medical treatment to be removed. Only around 20 percent pass naturally.

    Which type of kidney stone is the hardest? ›

    Cystine stones are very hard stones. Many doctors call them the hardest kidney stones a human can make. This makes them more difficult to break and completely remove. Cystine stones grow in the urine when there is too much cystine in the urine (or cystinuria).

    Is a CT scan or ultrasound better for kidney stones? ›

    To diagnose painful kidney stones in hospital emergency rooms, CT scans are no better than less-often-used ultrasound exams, according to a clinical study conducted at 15 medical centers. Unlike ultrasound, CT exposes patients to significant amounts of radiation.

    How accurate is ultrasound for kidney stones? ›

    Overall, the researchers calculated that kidney stones would be correctly detected in 54 percent of ultrasounds done in the emergency room, in 57 percent of the ultrasounds done by a radiologist and in 88 percent of the CT scans.

    Is CT or MRI better for kidney stones? ›

    A healthcare provider orders a CT scan to make sure a kidney stone is actually causing your pain. Imaging studies, like CT scans, are the most precise way to diagnose kidney stones.

    Is there medication to dissolve kidney stones? ›

    Your doctor may prescribe potassium citrate to help prevent kidney stones from growing larger or returning. Potassium citrate can also be used to help dissolve and prevent uric acid kidney stones.

    Do you need a CT scan for kidney stones? ›

    To diagnose kidney stones, doctors usually order a CT scan. But repeated scans can cause a buildup of radiation. "This radiation exposure is not something that you get and it washes out of your system," says urologist Dinesh Singh, MD.

    What are the warning signs of kidney stones? ›

    Follow These Top Warning Signs Indicating You May Have Kidney Stones
    • Back or belly pain. ...
    • Pain when urinating. ...
    • Cloudy, pinkish or foul-smelling urine. ...
    • Sudden urge to urinate. ...
    • Decreased urine flow. ...
    • Nausea. ...
    • Fever and chills. ...
    • Kidney stones require prompt medical care.

    What is the fastest way to relieve kidney stone pain? ›

    Over-the-counter pain medications, like ibuprofen (Advil, Motrin IB), acetaminophen (Tylenol), or naproxen (Aleve), can help you endure the discomfort until the stones pass. Your doctor also may prescribe an alpha blocker, which relaxes the muscles in your ureter and helps pass stones quicker and with less pain.

    What foods cause kidney stones? ›

    Avoid stone-forming foods: Beets, chocolate, spinach, rhubarb, tea, and most nuts are rich in oxalate, which can contribute to kidney stones. If you suffer from stones, your doctor may advise you to avoid these foods or to consume them in smaller amounts.

    What is an alpha blocker for kidney stones? ›

    The alpha blocker tamsulosin (Flomax) can be used to improve clearance of stones larger than 5 mm, shorten expulsion times, and reduce hospitalization. (Strength of Recommendation: B, based on meta-analyses of moderate-quality randomized controlled trials.)

    How can I remove kidney stones without surgery? ›

    Extracorporeal shock wave lithotripsy is a technique for treating stones in the kidney and ureter that does not require surgery. Instead, high energy shock waves are passed through the body and used to break stones into pieces as small as grains of sand.

    What are the 5 most common symptoms of kidney stones? ›

    What are the symptoms of kidney stones?
    • Feeling pain in your lower back or side of your body. ...
    • Having nausea and/or vomiting with the pain.
    • Seeing blood in your urine.
    • Feeling pain when urinating.
    • Being unable to urinate.
    • Feeling the need to urinate more often.
    • Fever or chills.
    3 May 2021

    How do you relieve kidney stone pain fast? ›

    Over-the-counter pain medications, like ibuprofen (Advil, Motrin IB), acetaminophen (Tylenol), or naproxen (Aleve), can help you endure the discomfort until the stones pass. Your doctor also may prescribe an alpha blocker, which relaxes the muscles in your ureter and helps pass stones quicker and with less pain.

    What should eat in kidney stone? ›

    Diet and Calcium Stones
    • Drink plenty of fluids, particularly water.
    • Eat less salt. ...
    • Have only 2 or 3 servings a day of foods with a lot of calcium, such as milk, cheese, yogurt, oysters, and tofu.
    • Eat lemons or oranges, or drink fresh lemonade. ...
    • Limit how much protein you eat. ...
    • Eat a low-fat diet.
    10 Aug 2020

    How do you remove a 13mm kidney stone naturally? ›

    People who have kidney stones should consume lots of water to flush out these stones through urine. Generally, it is advised to drink 7-8 glasses of water a day. The concoction of lemon juice and olive oil might sound a little weird but it is a very effective home remedy to get kidney stones out of your system.

    How is a 12mm kidney stone removed? ›

    Treatment: Shock Wave Therapy

    The most common medical procedure for treating kidney stones is known as extracorporeal shock wave lithotripsy (ESWL). This therapy uses high-energy shock waves to break a kidney stone into little pieces. The small pieces can then move through the urinary tract more easily.

    Can kidney stone be removed by medicine? ›

    Dissolving uric acid stones

    Uric acid stones are the only type of kidney stones that can sometimes be dissolved with the help of medication. Alkaline citrate salts or sodium bicarbonate are considered for this purpose, and sometimes allopurinol.

    What medications cause kidney stones? ›

    Drugs that induce calculi via this process include magnesium trisilicate; ciprofloxacin; sulfa medications; triamterene; indinavir; and ephedrine, alone or in combination with guaifenesin.

    What is the main cause of kidney stones? ›

    Possible causes include drinking too little water, exercise (too much or too little), obesity, weight loss surgery, or eating food with too much salt or sugar. Infections and family history might be important in some people. Eating too much fructose correlates with increasing risk of developing a kidney stone.

    What removes kidney stones naturally? ›

    Apple cider vinegar contains acetic acid which helps dissolve kidney stones. In addition to flushing out the kidneys, apple cider vinegar can also decrease any pain caused by the stones. In addition, water and lemon juice can help flush the stones and prevent future kidney stones.

    What is the best position to pass a kidney stone? ›

    When you have a kidney stone, the priority is to pass it as soon as possible to eliminate the pain. Research indicates that the best position to lay with kidney stones is on the side with the pain. In other words, if the stone is in your left ureter, lie on your left side; if it's in the right ureter, lie on the right.

    Which injection is used for kidney stone pain? ›

    If the stone is causing severe pain, the urologist may choose to prescribe a narcotic. Providers may also inject patients with Ketorolac (Toradol), a more powerful anti-inflammatory medication.

    What should be avoided in kidney stone? ›

    To prevent uric acid stones, cut down on high-purine foods such as red meat, organ meats, beer/alcoholic beverages, meat-based gravies, sardines, anchovies and shellfish. Follow a healthy diet plan that has mostly vegetables and fruits, whole grains, and low-fat dairy products.

    Is banana good for kidney stone? ›

    Potassium present in bananas helps in balancing the calcium and oxalate content thereby reducing the chances of kidney stones. Potassium also helps in keeping the urine acidity in check. Thus, eating one banana every day can bring about a major relief in your condition of kidney stones.

    What drinks to avoid with kidney stones? ›

    Tart drinks like lemonade, limeade, and fruit juices are naturally high in citrate that helps keep kidney stones at bay. But hold back on foods and drinks flavored with sugar or, especially, high-fructose corn syrup. They can lead to stones.

    Videos

    1. Renal stones treatment - NICE Guidelines
    (TomHan)
    2. Metabolic Evaluation in Stone Disease; EAU Guidelines; 24 hours urine collection; Dietary Management
    (Master the Medicine)
    3. Medical Management of Renal Calculi Dr Sandeep Dr Dharmendra Jangid
    (SMS Urology LIve Stream)
    4. Medical Management of Stone Disease - EMPIRE Urology Lecture Series
    (EMPIRE Urology)
    5. Advances in the Management and Treatment of Urolithiasis Webinar (2020)
    (AUAUniversity)
    6. 5.6.2020 Urology COViD Didactics - Kidney Stone Prevention 2020: Evaluation and Diet
    (Urology Residents)

    Top Articles

    You might also like

    Latest Posts

    Article information

    Author: Nathanial Hackett

    Last Updated: 12/10/2022

    Views: 6218

    Rating: 4.1 / 5 (72 voted)

    Reviews: 87% of readers found this page helpful

    Author information

    Name: Nathanial Hackett

    Birthday: 1997-10-09

    Address: Apt. 935 264 Abshire Canyon, South Nerissachester, NM 01800

    Phone: +9752624861224

    Job: Forward Technology Assistant

    Hobby: Listening to music, Shopping, Vacation, Baton twirling, Flower arranging, Blacksmithing, Do it yourself

    Introduction: My name is Nathanial Hackett, I am a lovely, curious, smiling, lively, thoughtful, courageous, lively person who loves writing and wants to share my knowledge and understanding with you.