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Medical management of nephrocalcinosis and nephrolithiasis 

Medical management of nephrocalcinosis and nephrolithiasis
Medical management of nephrocalcinosis and nephrolithiasis

Bridget Sinnott

, 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

Updated on 28 June 2018. The previous version of this content can be found here.
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date: 28 January 2020

Conditions associated with nephrocalcinosis and nephrolithiasis are described. Some (cystinuria, urate) have specific therapies, and there are some general measure, particular for calcium-containing stones (urine volume, dietary salt, urinary citrate, thiazide diuretics). In the absence of a primary aetiology, urinary biochemical predisposing factors can be manipulated. Properly directed medical therapy is highly effective in preventing recurrence.

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