Thursday, November 6, 2014

Recurrent Kidney Stones: IMA Guidelines

Recurrent Kidney Stones: IMA Guidelines

Lifetime prevalence of kidney stones is approximately 13% in men and 7% in women. Without treatment, approximately 35% to 50% of those with kidney stones will experience recurrence within 5 years from the first stone.

Here are some guidelines

1. Increasing fluid intake to achieve at least 2 L of urine per day. "Increased fluid intake spread throughout the day can decrease stone recurrence by at least half with virtually no side effects. However, people who already drink the recommended amount of liquids, or when increased fluid intake is contraindicated, should not increase their fluid intake.

2. Available evidence shows no difference between intake of tap water or intake of a specific brand of mineral water in preventing kidney stones.

3. If drinking increased amounts of water is ineffective in preventing kidney stones, one may try pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol.  These three types of drugs effectively reduced recurrence of composite calcium stones in patients who had a history of two or more stones. Combination therapy is no more effective than monotherapy.  All these drugs were associated with adverse events. For thiazides, these were orthostasis, gastrointestinal upset, erectile dysfunction, fatigue, and muscle symptoms. Citrates are associated with gastrointestinal symptoms and allopurinol with rash, acute gout, and leukopenia.

4. Patients should reduce intake of colas and other soft drinks acidified with phosphoric acid, as lower consumption is linked to lower risk for stone recurrence.

5. Fruit-flavored soft drinks can be taken as they are often acidified with citric acid.

6. Patients should reduce consumption of dietary oxalate, typically found in chocolate, beets, nuts, rhubarb, spinach, strawberries, tea, and wheat bran.

7. Patients should eat less dietary animal protein and purines.

8. Patients should maintain normal dietary calcium.

[ Contributor: Padma Shri, Dr B C Roy National Awardee and National Science Communication Awardee Dr K K Aggarwal, Honorary Secretary General IMA]

[Reference: November 4 issue of the Annals of Internal Medicine]

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