Pharmacologic Treatment of Kidney Stones: Current Medication and pH Monitoring
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v2i3.2264
Abstract
Nephrolithiasis is a globally prevalent urologic condition associated with significant morbidity and patient discomfort. Current management of kidney stones includes both surgical and pharmacologic interventions. Though surgery may be necessary under certain circumstances, pharmacologic treatment is a more affordable, readily available, and a less invasive option for patients. A comprehensive scoping review was conducted to summarize the available literature on the pharmacologic strategies for managing the predominant stone types, including calcium oxalate, calcium phosphate, uric acid, struvite, and cystine stones. Central to these therapeutic approaches is the regulation of factors such as urine pH, stone crystallization, and patient metabolics that precipitate stone development and growth. This review highlights the pharmacological options available for treating each kidney stone type, emphasizing the importance of patient tailored medical management that should be considered by every physician.
Keywords
nephrolithiasis; calcium oxalate; uric acid; struvite; cystine; medical management; pharmacological management; pH monitoring
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[22] Ettinger B, Tang A, Citron JT, Livermore B, Williams T. Randomized trial of allopurinol in the prevention of calcium oxalate calculi. N Engl J Med. 1986;315:1386-9, http://dx.doi.org/10.1056/NEJM198611273152204
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[27] Xu LHR, Adams-Huet B, Poindexter JR, Maalouf NM, Moe OW, Sakhaee K. Temporal changes in kidney stone composition and in risk factors predisposing to stone formation. J Urol. 2017;197:1465-71, http://dx.doi.org/10.1016/j.juro.2017.01.057
[28] Rodman JS. Intermittent versus continuous alkaline therapy for uric acid stones and ureteral stones of uncertain composition. Urology. 2002;60:378-82, http://dx.doi.org/10.1016/S0090-4295(02)01725-9
[29] Łoniewski I, Wesson DE. Bicarbonate therapy for prevention of chronic kidney disease progression. Kidney Int. 2014;85:529-35, http://dx.doi.org/10.1038/ki.2013.401
[30] Bobulescu IA, Park SK, Xu LHR, Blanco F, Poindexter J, AdamsHuet B, et al. Net acid excretion and urinary organic anions in idiopathic uric acid nephrolithiasis. Clin J Am Soc Nephrol. 2019;14:411-20, http://dx.doi.org/10.2215/CJN.10420818
[31] Torricelli FCM, De S, Li I, Sarkissian C, Monga M. Can obese stone formers follow dietary recommendations? J Endourol. 2014;28:248-51, http://dx.doi.org/10.1089/end.2013.0536
[32] Griffith DP. Struvite stones. Kidney Int. 1978;13:372-82, http://dx.doi.org/10.1038/ki.1978.55
[33] Rodman JS. Struvite stones. Nephron. 1999;81 Suppl 1:50-9, http://dx.doi.org/10.1159/000046299
[34] Flannigan RK, Battison A, De S, Humphreys MR, Bader M, Lellig E, et al. Evaluating factors that dictate struvite stone composition: a multi-institutional clinical experience from the EDGE Research Consortium. Can Urol Assoc J J Assoc Urol Can. 2018;12:131-6, http://dx.doi.org/10.5489/cuaj.4804
[35] Chamberlin JD, Clayman RV. Medical treatment of a staghorn calculus: the ultimate noninvasive therapy. J Endourol Case Rep. 2015;1:21-3, http://dx.doi.org/10.1089/cren.2015.29003.jdc.
[36] Griffith DP, Gleeson MJ, Lee H, Longuet R, Deman E, Earle N. Randomized, Double-Blind Trial of LithostatTM (Acetohydroxamic Acid) in the Palliative Treatment of Infection-Induced Urinary Calculi. Eur Urol. 1991;20:243-7, http://dx.doi.org/10.1159/000471707
[37] Chillarón J, Font-Llitjós M, Fort J, Zorzano A, Goldfarb DS, Nunes V, et al. Pathophysiology and treatment of cystinuria. Nat Rev Nephrol. 2010;6:424-34, http://dx.doi.org/10.1038/nrneph.2010.69
[38] Lipkin ME, Preminger GM. Demystifying the medical management of nephrolithiasis. Rev Urol. 2011;13:34-8.
[39] Pak CYC, Fuller C, Sakhaee K, Zerwekh JE, Adams BV. Management of cystine nephrolithiasis with alphamercaptopropionylglycine. J Urol. 1986;136:1003-8, http://dx.doi.org/10.1016/S0022-5347(17)45188-3
[40] Modersitzki F, Goldfarb DS, Goldstein RL, Sur RL, Penniston KL. Assessment of health-related quality of life in patients with cystinuria on tiopronin therapy. Urolithiasis. 2020;48:313-20, http://dx.doi.org/10.1007/s00240-019-01174-6
[41] Barbey F, Joly D, Rieu P, Méjean A, Daudon M, Jungers P. Medical treatment of cystinuria: critical reappraisal of long-term results. J Urol. 2000;163:1419-23, http://dx.doi.org/10.1016/s0022-5347(05)67633-1
[42] Knoll T, Zöllner A, Wendt-Nordahl G, Michel MS, Alken P. Cystinuria in childhood and adolescence: recommendations for diagnosis, treatment, and follow-up. Pediatr Nephrol. 2005;20:19-24, http://dx.doi.org/10.1007/s00467-004-1663-1
[43] Canvasser NE, Rivera M, Bechis SK, Ingimarsson J, Knoedler J, Stern K, et al. Over-the-counter alkali agents to raise urine pH and citrate excretion: a prospective crossover study in healthy adults. Urology. 2022;168:72-8, http://dx.doi.org/10.1016/j.urology.2022.05.049
[2] Trinchieri A, Coppi F, Montanari E, Del Nero A, Zanetti G, Pisani E. Increase in the prevalence of symptomatic upper urinary tract stones during the last ten years. Eur Urol. 2000;37:23-5, http://dx.doi.org/10.1159/000020094
[3] Pearle MS, Goldfarb DS, Assimos DG, Curhan G, DenuCiocca CJ, Matlaga BR, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014;192:316-24, http://dx.doi.org/10.1016/j.juro.2014.05.006
[4] EAU Guidelines. Edn. presented at the EAU Annual Congress Milan 2023, ISBN 978-94-92671-19-6.
[5] Martini LA, Cuppari L, Cunha MA, Schor N, Heilberg IP. Potassium and sodium intake and excretion in calcium stone forming patients. J Ren Nutr. 1998;8:127-31, http://dx.doi.org/10.1016/S1051-2276(98)90003-6
[6] Knoll T, Schubert AB, Fahlenkamp D, Leusmann DB, Wendt-Nordahl G, Schubert G. Urolithiasis through the ages: data on more than 200,000 urinary stone analyses. J Urol. 2011;185:1304-11, http://dx.doi.org/10.1016/j.juro.2010.11.073
[7] Pak CYC, Sakhaee K, Pearle MS. Detection of absorptive hypercalciuria type I without the oral calcium load test. J Urol. 2011;185:915-9, http://dx.doi.org/10.1016/j.juro.2010.10.067
[8] Eisner BH, Goldfarb DS, Pareek G. Pharmacologic treatment of kidney stone disease. Urol Clin North Am. 2013;40:21-30, http://dx.doi.org/10.1016/j.ucl.2012.09.013
[9] Sorokin I, Pearle MS. Medical therapy for nephrolithiasis: state of the art. Asian J Urol. 2018;5:243-55, http://dx.doi.org/10.1016/j.ajur.2018.08.005
[10] Escribano J, Balaguer A, Pagone F, Feliu A, Roqué I, Figuls M. Pharmacological interventions for preventing complications in idiopathic hypercalciuria. Cochrane Database Syst Rev. 2009;2009:CD004754, http://dx.doi.org/10.1002/14651858.CD004754.pub2
[11] Moe OW, Pearle MS, Sakhaee K. Pharmacotherapy of urolithiasis: evidence from clinical trials. Kidney Int. 2011;79:385-92, http://dx.doi.org/10.1038/ki.2010.389
[12] Alexander RT, McArthur E, Jandoc R, Welk B, Fuster DG, Garg AX, et al. Thiazide diuretic dose and risk of kidney stones in older adults: a retrospective cohort study. Can J Kidney Health Dis. 2018;5, http://dx.doi.org/10.1177/2054358118787480, 205435811878748
[13] Dhayat NA, Bonny O, Roth B, Christe A, Ritter A, Mohebbi N, et al. Hydrochlorothiazide and prevention of kidneystone recurrence. N Engl J Med. 2023;388:781-91, http://dx.doi.org/10.1056/NEJMoa2209275
[14] Parks JH, Coe FL. A urinary calcium-citrate index for the evaluation of nephrolithiasis. Kidney Int. 1986;30:85-90, http://dx.doi.org/10.1038/ki.1986.155
[15] Maalouf NM. Approach to the adult kidney stone former. Clin Rev Bone Miner Metab. 2012;10:38-49, http://dx.doi.org/10.1007/s12018-011-9111-9
[16] Phillips R, Hanchanale VS, Myatt A, Somani B, Nabi G, Biyani CS. Citrate salts for preventing and treating calcium containing kidney stones in adults. Cochrane Database Syst Rev. 2015;2015:CD010057, http://dx.doi.org/10.1002/14651858.CD010057.pub2
[17] Ticinesi A, Nouvenne A, Maalouf NM, Borghi L, Meschi T. Salt and nephrolithiasis. Nephrol Dial Transplant. 2016;31:39-45, http://dx.doi.org/10.1093/ndt/gfu243
[18] Stern KL, Canvasser N, Borofsky M, Gleason VM, Kamphuis G, El Tayeb MM, et al. Alkalinizing agents: a review of prescription, over-the-counter, and medical food supplements. J Endourol. 2020;34:1-6, http://dx.doi.org/10.1089/end.2019.0292
[19] Kurtz MP, Eisner BH. Dietary therapy for patients with hypocitraturic nephrolithiasis. Nat Rev Urol. 2011;8:146-52, http://dx.doi.org/10.1038/nrurol.2011.9
[20] Wiederkehr MR, Moe OW. Uric acid nephrolithiasis: a systemic metabolic disorder. Clin Rev Bone Miner Metab. 2011;9:207-17, http://dx.doi.org/10.1007/s12018-011-9106-6
[21] Favus MJ, Coe FL. Clinical characteristics and pathogenetic mechanisms in hyperuricosuric calcium oxalate renal stone disease. Scand J Urol Nephrol Suppl. 1980;53:171-7
[22] Ettinger B, Tang A, Citron JT, Livermore B, Williams T. Randomized trial of allopurinol in the prevention of calcium oxalate calculi. N Engl J Med. 1986;315:1386-9, http://dx.doi.org/10.1056/NEJM198611273152204
[23] Goldfarb DS, MacDonald PA, Gunawardhana L, Chefo S, McLean L. Randomized controlled trial of febuxostat versus allopurinol or placebo in individuals with higher urinary uric acid excretion and calcium stones. Clin J Am Soc Nephrol. 2013;8:1960-7, http://dx.doi.org/10.2215/CJN.01760213
[24] Hess B. High-calcium intake abolishes hyperoxaluria and reduces urinary crystallization during a 20-fold normal oxalate load in humans. Nephrol Dial Transplant. 1998;13:2241-7, http://dx.doi.org/10.1093/ndt/13.9.2241
[25] Siener R, Netzer L, Hesse A. Determinants of Brushite stone formation: a case-control study. PLoS ONE. 2013;8:e78996, http://dx.doi.org/10.1371/journal.pone.0078996
[26] Doizi S, Poindexter JR, Pearle MS, Blanco F, Moe OW, Sakhaee K, et al. Impact of potassium citrate vs citric acid on urinary stone risk in calcium phosphate stone formers. J Urol. 2018;200:1278-84, http://dx.doi.org/10.1016/j.juro.2018.07.039
[27] Xu LHR, Adams-Huet B, Poindexter JR, Maalouf NM, Moe OW, Sakhaee K. Temporal changes in kidney stone composition and in risk factors predisposing to stone formation. J Urol. 2017;197:1465-71, http://dx.doi.org/10.1016/j.juro.2017.01.057
[28] Rodman JS. Intermittent versus continuous alkaline therapy for uric acid stones and ureteral stones of uncertain composition. Urology. 2002;60:378-82, http://dx.doi.org/10.1016/S0090-4295(02)01725-9
[29] Łoniewski I, Wesson DE. Bicarbonate therapy for prevention of chronic kidney disease progression. Kidney Int. 2014;85:529-35, http://dx.doi.org/10.1038/ki.2013.401
[30] Bobulescu IA, Park SK, Xu LHR, Blanco F, Poindexter J, AdamsHuet B, et al. Net acid excretion and urinary organic anions in idiopathic uric acid nephrolithiasis. Clin J Am Soc Nephrol. 2019;14:411-20, http://dx.doi.org/10.2215/CJN.10420818
[31] Torricelli FCM, De S, Li I, Sarkissian C, Monga M. Can obese stone formers follow dietary recommendations? J Endourol. 2014;28:248-51, http://dx.doi.org/10.1089/end.2013.0536
[32] Griffith DP. Struvite stones. Kidney Int. 1978;13:372-82, http://dx.doi.org/10.1038/ki.1978.55
[33] Rodman JS. Struvite stones. Nephron. 1999;81 Suppl 1:50-9, http://dx.doi.org/10.1159/000046299
[34] Flannigan RK, Battison A, De S, Humphreys MR, Bader M, Lellig E, et al. Evaluating factors that dictate struvite stone composition: a multi-institutional clinical experience from the EDGE Research Consortium. Can Urol Assoc J J Assoc Urol Can. 2018;12:131-6, http://dx.doi.org/10.5489/cuaj.4804
[35] Chamberlin JD, Clayman RV. Medical treatment of a staghorn calculus: the ultimate noninvasive therapy. J Endourol Case Rep. 2015;1:21-3, http://dx.doi.org/10.1089/cren.2015.29003.jdc.
[36] Griffith DP, Gleeson MJ, Lee H, Longuet R, Deman E, Earle N. Randomized, Double-Blind Trial of LithostatTM (Acetohydroxamic Acid) in the Palliative Treatment of Infection-Induced Urinary Calculi. Eur Urol. 1991;20:243-7, http://dx.doi.org/10.1159/000471707
[37] Chillarón J, Font-Llitjós M, Fort J, Zorzano A, Goldfarb DS, Nunes V, et al. Pathophysiology and treatment of cystinuria. Nat Rev Nephrol. 2010;6:424-34, http://dx.doi.org/10.1038/nrneph.2010.69
[38] Lipkin ME, Preminger GM. Demystifying the medical management of nephrolithiasis. Rev Urol. 2011;13:34-8.
[39] Pak CYC, Fuller C, Sakhaee K, Zerwekh JE, Adams BV. Management of cystine nephrolithiasis with alphamercaptopropionylglycine. J Urol. 1986;136:1003-8, http://dx.doi.org/10.1016/S0022-5347(17)45188-3
[40] Modersitzki F, Goldfarb DS, Goldstein RL, Sur RL, Penniston KL. Assessment of health-related quality of life in patients with cystinuria on tiopronin therapy. Urolithiasis. 2020;48:313-20, http://dx.doi.org/10.1007/s00240-019-01174-6
[41] Barbey F, Joly D, Rieu P, Méjean A, Daudon M, Jungers P. Medical treatment of cystinuria: critical reappraisal of long-term results. J Urol. 2000;163:1419-23, http://dx.doi.org/10.1016/s0022-5347(05)67633-1
[42] Knoll T, Zöllner A, Wendt-Nordahl G, Michel MS, Alken P. Cystinuria in childhood and adolescence: recommendations for diagnosis, treatment, and follow-up. Pediatr Nephrol. 2005;20:19-24, http://dx.doi.org/10.1007/s00467-004-1663-1
[43] Canvasser NE, Rivera M, Bechis SK, Ingimarsson J, Knoedler J, Stern K, et al. Over-the-counter alkali agents to raise urine pH and citrate excretion: a prospective crossover study in healthy adults. Urology. 2022;168:72-8, http://dx.doi.org/10.1016/j.urology.2022.05.049
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