Renal stones can be anywhere along the renal system – kidneys, ureters and bladder. Commonest cause of renal stones are lack of adequate water intake, areas with high mineral content in drinking water and recurrent urinary tract infections. In acute phase patients often present with intense flank pain, nausea, vomiting and or haematuria.
Medications:
Oxalate stones
- Tab. Aquazide 12.5 (Hydrochlorothiazide 12.5 mg) 1 tablet a day. Increase to 25 mg once a day if tolerated.
- Tab. Urimax 0.4 (Tamsulosin 0.4 mg) 1 tablet at bedtime. Increase to twice a day if tolerated.
- Cap. Uprise-D3 60K (Cholecalciferol 60,000 IU) 1 capsule once a month.
Uric acid stones
- Tab. Zyloric 100(Allopurinol 100 mg) 1 tablet once a day. Gradually increase till 100 mg thrice a day.
- Tab. Urimax 0.4 (Tamsulosin 0.4 mg) 1 tablet at bedtime. Increase to twice a day if tolerated.
Supportive therapy:
- Tab. Ugesic 20 (Piroxicam 20 mg) 1 tablet sublingually a day for 3 days.
- Tab. Cyclopam (Dicyclomine 20 mg, Paracetamol 500 mg) 1 tablet 4 times a day for colicky pain.
Patients may need treatment for urinary tract infection
General advice:
- Advice drinking 2.5 liters of water every day.
- Restrict salt and animal protein intake.
- Avoid soft drinks and Vitamin C supplements.
- Avoid oxalate containing foods like chocolate, tea, coffee, lime, lemon, tomato, spinach, nuts, beer, shellfish, eggs, beets, poppy seeds, beans, carrots, okra, oranges, strawberries, sweet potatoes, soya bean.
- Increase dietary fibre intake, banana and coconut water.
- Ensure adequate dietary calcium and vitamin D intake – milk, yogurt, cheese, legumes, dark green vegetables, nuts, etc.
Investigations:
- Renal function test – to rule out renal impairment.
- Urine routine and microscopy – to identify types of crystals and to rule out infection.
- Serum uric acid, calcium – this can be raised in renal stones.
- USG KUB – to identify renal stones and assess its size, location and signs of back pressure i.e. hydronephrosis.
- Complete blood count – to rule out infection.
- Vitamin D levels – low vitamin D levels lead to higher risk of renal stones.
- Intravenous pyelogram (IVP) – To identify the stone and assess its size, location and signs of back pressure i.e. hydronephrosis.
- Parathyroid hormone level – to rule out high levels as a cause for stone formation.
Referral:
Consider referring patient to urologist in case of urinary track obstruction, renal failure or if any other complications.