Clinical Review

Kidney Stones: Current Diagnosis and Management

Clinician Reviews. 2012 February;22(2):31-37

References

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Stents are also associated with infections, but coated stents are available to reduce infection. As with any catheter material inserted into the urinary tract, ureteral stents are a prime location for development of a persistent bacterial biofilm, thus leading to infection. Recent advances in stent manufacturing have included coating stents with various biomaterials to decrease the development of this bacterial biofilm. In a preliminary study in 10 patients using a diamond-like, carbon-coated ureteral stent, Laube et al⁴⁵ demonstrated a reduction in formation of this biofilm, hence lowering the probability of stent-induced infection.

Chronic Stone Management

As previously mentioned, one of the seminal characteristics of stone disease is its ability to recur. After incidental detection of kidney stones through routine diagnostic procedures, the risk for recurrence in patients who do not receive chronic medical management is 30% to 40% within five years.^17,28 In treated patients, by comparison, this risk falls by approximately 50%.^17,26

Patients with a history of stone recurrence must be evaluated for metabolic defects that precipitate stones, since their risk for chronic kidney disease is increased.³⁴ All patients with a history of stone disease should be instructed to increase their fluid intake to maintain a daily urinary output of at least 2.5 L, unless contraindications exist.³⁴

In patients with calcium-based stones who do not benefit from conservative treatment (ie, a low-sodium diet and other dietary modifications), thiazide diuretics may help reduce urinary calcium.^1,46

Struvite stones can be prevented through use of long-term antibiotics to reduce the risk for urinary tract infection and by maintaining urinary pH levels below 6.0.^17,27,34

For patients with uric acid stones, allopurinol may be prescribed to lower uric acid levels; moreover, the solubility of uric acid is greatly increased at higher pH, so it is beneficial to treat these patients with citrate to maintain their urinary pH above 6.0.^47,34

Ensuring a high urine output (≥ 4 L/d34) and alkalinizing urine can help prevent recurrence of cystine stones.^17,33 Treatment with potassium citrate has been shown to maintain a urinary pH of 6.5 to 7.0.³⁴

CONCLUSION

The ever-increasing significance of nephrolithiasis has mandated an organized and systematic management approach. Indeed, the diagnosis and initial therapy for kidney stones have undergone considerable evolution in recent years. The basic tenets of nephrolithiasis management include early diagnosis and pertinent treatment as well as adequate prophylaxis to prevent subsequent stone recurrence.