Kidney Stones - Treatment

Preventing Recurrence

Dietary Considerations. People with kidney stones appear to be more sensitive to certain foods than people who do not form kidney stones and need to make specific changes in their diet. They should work with their doctors to develop a dietary plan that fits their individual situation. Drinking plenty of fluids is important for preventing recurrence of any kidney stone.

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Indications for Drug Treatments. If dietary measures fail then drug treatments may be helpful. A number of drugs are available to prevent recurrences of calcium oxalate and other stones. Allopurinol, thiazide, potassium citrate, and potassium-magnesium citrate have all been shown to inhibit stone formation. In addition, drug treatments can sometimes also help prevent other complications related to stones, such as osteoporosis.

Correcting Underlying Conditions Known to Cause Kidney Stones. It is also important to treat and correct, if possible, any underlying disorder that may be causing stones to form. Such disorders include distal renal tubular acidosis, hyperthyroidism, sarcoidosis, and certain cancers. To prevent calcium stones that form in hyperparathyroid patients, a surgeon may remove the affected parathyroid gland (located in the neck). In most cases, only one of the glands is enlarged. Removing it ends the patient's problem with kidney stones.

Treatment by Stone Type
Stone Type	Diet and Lifestyle	Medications	Procedures
Calcium Oxalate	Plenty of fluids. (Choose water, lemon juice. Avoid grapefruit, apple, and cranberry juice.) Restrict protein and salt. Increase fiber. Restrict fats (particularly with short bowel syndrome). Balance normal calcium intake with potassium- and phosphate-rich foods. Restrict calcium only in people who have genetic abnormalities that cause high intestinal absorption of calcium. Restrict foods high in oxalates only in patients with rare intestinal conditions that cause hyperoxaluria.	Diuretics, Citrate salts, phosphates, cholestyramine.	Lithotripsy, uteroscopy, percutaneous nephrolithotomy, open surgery.
Uric Acid	Plenty of fluids (Choose water, blackcurrent juice. Avoid cranberry juice.). Increase calcium intake (be sure well balanced with potassium and phosphates). Reduce protein and other foods with high-purine content.	Potassium citrate, sodium bicarbonate, allopurinol.	Lithotripsy, uteroscopy, percutaneous nephrolithotomy, open surgery.
Struvite stones	Plenty of fluids (water, cranberry juice). Reduce proteins.	Antibiotics to eliminate any infection. Acetohydroxamic acid (AHA) may be helpful in combination with antibiotics. In some cases, organic acids administered through urinary tract.	May respond poorly to most lithotripsy procedures and require open surgery. (Newer procedures may be helpful.)
Cystine stones	Very high fluid intake (four quarts a day). Restrict protein.	Alkalizing agents (such as bicarbonate). Sometimes d-penicillamine, tiopronine, or captopril useful for lowering cystine levels.	May respond poorly to most lithotripsy procedures and require open surgery. (Newer procedures may be helpful.)