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Kidney Stones - Treatment Overview

Your first diagnosis of kidney stones often occurs when you see your doctor or go to an emergency room because you are in great pain. Your doctor may suggest that you wait for the stone to pass and take pain medicine or have a procedure to remove the stone.

Most small stones [less than 5mm] move out of the body (pass) without the need for any treatment other than taking pain medicine and drinking enough fluids.

• The smaller a stone is, the more likely it is to pass on its own. About 9 out of every 10 stones smaller than 5mm and about 5 out of every 10 stones 5mm to 10mm pass on their own. Only 1 or 2 out of every 10 kidney stones need more than home treatment.¹
• The average time a stone takes to pass ranges between 1 and 3 weeks, and two-thirds of stones that pass on their own pass within 4 weeks of when the symptoms appeared.²

Not all kidney stones are diagnosed because of immediate symptoms. Your stone may not be causing you pain, and your doctor may find it during a routine exam or an exam for another condition or disease. In this case, you have the same treatment options as noted below.

Treatment for your first stone

If your doctor thinks the stone can pass on its own, and you feel you can deal with the pain, he or she may suggest home treatment, including:

• Using pain medicine. Nonprescription medicine, such as nonsteroidal anti-inflammatories (NSAIDs), may relieve your pain. Your doctor can prescribe stronger pain medicine if needed.
• Drinking enough fluids. You'll need to keep drinking water and other fluids when you are passing a kidney stone. If you don't get enough fluids, you could getdehydrated. Drink enough fluids to keep your urine clear, about 8 to 10 glasses a day. If you have kidney, heart, or liver disease and are on fluid restrictions, talk with your doctor before increasing your fluid intake.

Your doctor may prescribe medicine to help your body pass the stone. Alpha-blockers have been shown to help kidney stones pass more quickly with very few side effects.⁵ Ask your doctor if these medicines can help you.

If your pain is too severe, if the stones are blocking the urinary tract , or if you also have an infection, your doctor will probably suggest medical or surgical treatment. Your options are:

• Extracorporeal shock wave lithotripsy (ESWL). ESWL uses shock waves that pass easily through the body but are strong enough to break up a kidney stone. This is the most commonly used medical treatment for kidney stones. See a picture of ESWL .
• Ureteroscopy. The surgeon passes a very thin telescope tube (ureteroscope) up the urinary tract to the stone's location, where he or she uses instruments to remove the stone or break it up for easier removal. Occasionally, you may need a small hollow tube (ureteral stent) placed in the ureter for a short time to keep it open and drain urine and any stone pieces. Ureteroscopy is often used for stones that have moved from the kidney to the ureter. See a picture of ureteroscopy .
• Percutaneous nephrolithotomy or nephrolithotripsy. The surgeon puts a narrow telescope into the kidney through a cut in your back. He or she then removes the stone (lithotomy) or breaks it up and removes it (lithotripsy). This procedure may be used if ESWL does not work or if you have a very large stone. See a picture ofnephrolithotomy .
• Open surgery. The surgeon makes a cut in the side or the belly to reach the kidneys and remove the stone. This treatment is rarely used.

Should I use extracorporeal shock wave lithotripsy (ESWL) for my kidney stones?

Kidney Stones - Medications

Medicine you can buy without a prescription, such as nonsteroidal anti-inflammatories (NSAIDs), may relieve your pain. Your doctor can give you stronger pain medicine if needed. NSAIDs include aspirinand ibuprofen (such as Motrin and Advil).

Your doctor may prescribe medicine to help your body pass the stone. Alpha-blockers have been shown to help kidney stones pass more quickly with very few side effects. Ask your doctor if these medicines can help you.

If you get more kidney stones despite drinking more fluids and making changes to your diet, your doctor may give you medicine to help dissolve your stones or to prevent new ones from forming. You may also receive prescription medicine if you have a disease that increases your risk of forming kidney stones. Which medicine you take depends on the type of stones you have.

Medication Choices

Medicine to prevent calcium stones

About 80% of kidney stones are calcium stones.¹ Calcium stones cannot be dissolved by changing your diet or taking medicines. These medicines may keep calcium stones from getting bigger or may prevent new calcium stones from forming:

• Thiazides (such as hydrochlorothiazide, chlorthalidone) and potassium citrate(Urocit-K) are commonly used to prevent calcium stones.
• Orthophosphate (Neutra-Phos) is sometimes used. It has more side effects than thiazides or potassium citrate.

Medicine to prevent uric acid stones

About 5% to 10% of kidney stones are made of uric acid, a waste product that normally exits the body in the urine.¹ Uric acid stones can sometimes be dissolved with medicine.

• Potassium citrate (Urocit-K) and sodium bicarbonate (baking soda) prevent the urine from becoming too acidic, which helps prevent uric acid stones.
• Allopurinol (Lopurin, Zyloprim) makes it more difficult for your body to make uric acid.

Medicine to prevent cystine stones

Less than 1% of kidney stones are made of a chemical called cystine.¹ Cystine stones are more likely to occur in families with a disease that results in too much cystine in the urine (cystinuria).

• Potassium citrate (Urocit-K) prevents the urine from becoming too acidic, which helps prevent cystine kidney stones from forming.
• Penicillamine (Cuprimine, Depen), tiopronin, and captopril (Capoten) all help keep cystine dissolved in the urine, which makes cystine-type kidney stones less likely to form.

Medicine to prevent struvite stones

About 10% to 15% of kidney stones are struvite stones.¹ They can also be called infection stones if they occur with kidney or urinary tract infections (UTIs). These types of kidney stones sometimes are also called staghorn calculi if they grow large enough.

• Urease inhibitors (Lithostat) are rarely used because of their side effects and poor results.

What To Think About

If you have uric acid stones or cystine stones and are taking medicine to prevent more stones from forming, you will most likely have to continue taking that medicine for the rest of your life.

Some struvite stones (staghorn calculi) form because of frequent kidney infections. If you have a struvite stone, you will most likely need antibiotics to cure the infection and help prevent new stones from forming, and you will most likely need surgery to remove the stone.