- Section 1 Assessment of the patient with renal disease
- Section 2 The Patient with fluid, electrolyte, and renal tubular disorders
- Section 3 The patient with glomerular disease
- Section 4 The patient with interstitial disease
- Section 5 The patient with reduced renal function
- Section 6 The patient with another primary diagnosis
- Section 7 The patient with urinary tract infection
- Section 8 The patient with infections causing renal disease
- Section 9 The patient with urinary stone disease
- Chapter 199 Epidemiology of nephrolithiasis
- Chapter 200 Approach to the patient with kidney stones
- Chapter 201 Calcium stones
- Chapter 202 Uric acid stones
- Chapter 203 Cystine stones
- Chapter 204 Cell biology of nephrocalcinosis/nephrolithiasis
- Chapter 205 Medical management of nephrocalcinosis and nephrolithiasis
- Chapter 206 Imaging and interventional treatment
- Section 10 The Patient with Hypertension
- Section 11 The patient with acute kidney injury (and critical care nephrology)
- Section 12 The patient on dialysis
- Section 13 The transplant patient
- Section 14 Renal disease at different stages of life (infancy, adolescence, pregnancy, old age)
- Section 15 The patient with genetic renal disease
- Section 16 The patient with structural and congenital abnormalities
- Section 17 Drugs and renal disease
- Section 18 Nephrology in the future
(p. 1697) Medical management of nephrocalcinosis and nephrolithiasis
- (p. 1697) Medical management of nephrocalcinosis and nephrolithiasis
, Naim M. Maalouf
, Khashayar Sakhaee
, and Orson W. Moe
Recombinant human parathyroid hormone is a recently approved adjunct therapy for the management of chronic hypoparathyroidism (Mannstadt M, et al. Efficacy and safety of recombinant human parathyroid hormone (1-84) in hypoparathyroidism (REPLACE): a double-blind, placebo-controlled, randomised, phase 3 study. Lancet Diabetes Endocrinol. 2013 Dec;1(4):275-83). By reducing supplemental calcium requirements and urinary calcium excretion, it may prevent the incidence and/or progression of nephrocalcinosis in patients with chronic hypoparathyroidism (Rubin MR et al. Therapy of Hypoparathyroidism With PTH(1-84): A Prospective Six Year Investigation of Efficacy and Safety. J Clin Endocrinol Metab. 2016 Jul;101(7):2742-50).
Nephrolithiasis is increasingly recognized as a chronic systemic disease (Sakhaee K et al. Kidney stone 2012: Pathogenesis, Diagnosis and Management. J Clin Endocrinol Metab, June 2012, 97(6): 1847-1860), associated with an increase in mortality ((Tang Jie, Mettler P. et al. The association of prevalent kidney stone disease with mortality in U.S. adults: the National Health and Nutrition Examination Survey III, 1988-1994. Am J Nephrol 2013; 37(5), 501-506)
The role of the intestinal microbiome in oxalate metabolism and kidney stone formation is increasingly recognized (Mehta M, Goldfarb DS and Nazzal L. The role of the microbiome in kidney stone formation. Int J Surg. 2016, Nov 12 (epub ahead of print).
The updated 2014 European Association of Urology (EAU) guidelines for the management of ureteral calculi recommend medical expulsive therapy for all patients with newly diagnosed ureteral stones < 6 mm, if active removal is not indicated, since the chance of spontaneous passage is high (Turk C., Petrik A, Sarica K. et al. EUA guidelines on diagnosis and conservative management of urolithiasis. European Urology. 69(2016) 468-474). (2007 guidelines used a cut off of <10mm)
NSAIDS are the recommended first line therapy for renal colic based on updated 2014 EAU guidelines (Turk C et al 2016)
In 2014, the American Urologic Association (AUA), published comprehensive guidelines on the medical management of kidney stones with the purpose of providing recommendations on prevention, evaluation and treatment of nephrolithiasis (Pearle M.S., Goldfarb D.S., Assimos D.G. et al. Medical management of kidney stones: AUA guidelines. J Urol. 2014, 192 (2), 316-24).
Both EAU and AUA 2014 guidelines have published general dietary recommendations and lifestyle modifications to prevent kidney stones.
It has been suggested by tThe AUA 2014 guidelines suggest that either thiazides and/or potassium citrate can be considered in patients with recurrent calcareous stones who do not demonstrate metabolic abnormalities on a 24 hour urine collection or whom other metabolic abnormalities have been appropriately addressed and stone formation persists (Pearle MS et al J Urol. 2014, 192 (2), 316-242014)
Febuxostate® has been studied in the hyperuricosuic calcium stone forming population (Goldfarb DS et al. Clin J Am Soc Nephrol 2013; 8(11), 1960-67)
Minor alteration to Table 205.7
11 new references
Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.
If you have purchased a print title that contains an access token, please see the token for information about how to register your code.