Tuesday, 21 March 2017

Recurrent kidney stones: IMA guidelines

Recurrent kidney stones: IMA guidelines
About half of people who develop a kidney stone will find it recurring at least once at some stage. New Delhi, March 20, 2017: Lifetime prevalence of kidney stones is approximately 13% in men and 7% in women. Without treatment, approximately 35% to 50% of those with kidney stones will experience recurrence within 5 years from the first stone. Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and National President Indian Medical Association (IMA) in a joint statement said, “A stone may cause no problems but often it causes pain. Most kidney stones are small and pass out with the urine. Some stones become stuck in a kidney or in the tube draining urine from the kidney (the ureter). They can then cause persistent symptoms or problems. There are various treatment options to remove a stuck stone. About half of people who have a kidney stone develop another one at a later time in their life. Drinking plenty of water each day may prevent this from happening again (a recurrence).”
“Some stones become stuck in a kidney or in one of the tubes draining urine from a kidney (the ureter) and cause persistent symptoms or problems. In these cases, the pain usually becomes severe and you may need to be admitted to hospital. Sometimes a large stone can completely block the passage of urine down one of the tubes draining urine from the kidney (the ureter). This may lead to infection or damage to the kidney. This is usually avoided, as X-rays or scans will detect a blockage and large stones can be removed.”, adds Dr K K Aggarwal.
Following are some guidelines: • Increase fluid intake to achieve at least 2 L of urine per day. “Increased fluid intake spread throughout the day can decrease stone recurrence by at least half with virtually no side effects. However, people who already drink the recommended amount of liquids, or when increased fluid intake is contraindicated, should not increase their fluid intake. • Available evidence shows no difference between intake of tap water or intake of a specific brand of mineral water in preventing kidney stones. • If drinking increased amounts of water is ineffective in preventing kidney stones, one may try pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol. These three types of drugs effectively reduced recurrence of composite calcium stones in patients who had a history of two or more stones. Combination therapy is no more effective than monotherapy. All these drugs were associated with adverse events. For thiazides, these were orthostasis, gastrointestinal upset, erectile dysfunction, fatigue, and muscle symptoms. Citrates are associated with gastrointestinal symptoms and allopurinol with rash, acute gout, and leukopenia. • Patients should reduce intake of colas and other soft drinks acidified with phosphoric acid, as lower consumption is linked to lower risk for stone recurrence. • Fruit-flavored soft drinks can be taken as they are often acidified with citric acid. • Patients should reduce consumption of dietary oxalate, typically found in chocolate, beets, nuts, rhubarb, spinach, strawberries, tea, and wheat bran. • Patients should eat less dietary animal protein and purines. • Patients should maintain normal dietary calcium.

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