Internal Medicine: Open Access
Open Access

Treatment of Kidney Stones using Empiric Therapy

Samy McFarlane^{* *}Correspondence: Samy McFarlane, Department of Medicine, Osaka University, New York, USA, Email:

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Description

According to limited statistics, most patients with kidney stones are not given much, if any, preventative counselling. Many patients have been urged to "drink a lot of water," but no dietary counselling or pharmacologic treatment has been supplied. It is fairly uncommon to encounter patients who have not been informed that dairy (calcium) restriction is no longer necessary, despite the fact that this was once a common element of the preventative prescription. Only 8% of patients classified as "high risk" for recurrence had their urine collected for 24 hours. Only a small percentage of patients with renal colic seen in emergency departments are examined by an urologist, and even fewer see a nephrologist.

Some practitioners may be intimidated by urine chemistry and renal physiology, which may lead to the neglect of preventative interventions for stone patients. The belief that analyzing a 24- hour urine collection necessitates arcane expertise appears to be widespread. There was a time when determining the cause of increased urine calcium excretion needed a more comprehensive and time-consuming assessment. Such examinations are not recommended by the American Urological Association (AUA) or the European Association of Urology (EAU) recommendations.

Non-lithologists are unaware of the link between stones and lower bone mineral density, hypertension, vascular illness, metabolic syndrome, myocardial infarction, and chronic kidney disease. Despite the fact that kidney stones do not have the severity (i.e., death rates) of heart disease or cancer, the related co-morbidities provide adequate grounds to consider them indicators of suggestions to address nutrition, weight reduction, and exercise. Despite many of us highlighted these connections at medicine and nephrology grand rounds, many people are unaware of them.

Lifestyle

Because obesity and weight growth are linked to kidney stones, controlling weight is important not just for stone prevention but also to slow the progression of co-morbidities. This evaluation does not include the best methods for weight loss. Patients may experience an awakening after learning that stones are the first symptom of their generally bad lifestyles.

Fluid therapy

The huge advantage of increasing fluid consumption to increase urine volume is undeniable. In one randomized experiment, kidney stone recurrences were observed in 12 of 99 individuals who were counselled to increase fluid intake and 27 of 100 patients who were not (p=0.008). The average time between recurrences in the first group was 39 months and 25 months in the second. Each 500 mL increase in water consumption was linked with a considerably lower incidence of kidney stone recurrence in a meta-analysis of 15 trials judged relevant.

The science that explains how urine dilution reduces supersaturation and so prevents stone formation may be easily understood by lay stone formers and has a simple, intuitive appeal. The treatment is quite low-cost. It's also entirely safe (if prescribed correctly) and has only one side effect: polyuria. Urinary frequency increases are especially significant in men with prostatic hypertrophy and men and women who have incontinence. It may also be difficult to attain for people who work in jobs that limit their access to fluids and restroom facilities, such as drivers. Another negative consequence of increased fluid consumption that hasn't been examined in stone formers is sleep disruption, which might contribute to an increase in cardiovascular morbidity. According to one rough estimate, proper volume intake might avoid 80 percent of stone recurrences.

Conclusion

The use of careful phenotyping to identify individuals with kidney stones has a long and illustrious history in discovering the chemical foundation for stone development. Advances in our genetic understanding of kidney stones will provide amazing insights into the pathogenesis of this frequent ailment. In the environment of a university and research-based kidney stone clinic, both urine chemical examination and patient genotyping are particularly valuable at this time. In many parts of the globe, these procedures are neither available nor strictly essential in a therapeutic context. In the world's numerous stone formers, a careful use of an empiric prescription based on stone composition would have a significant impact on reducing stone recurrence.