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| Medical management of urolithiasis: Great efforts and limited progress |
Victoria Jahrreissa,Christian Seitza,*( ),Fahad Quhalb
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aDepartment of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
bDepartment of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia |
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Abstract Objective: To provide a comprehensive review on the existing literature on medical management of urolithiasis. Methods: A thorough literature review was performed using Medline, PubMed/PMC, Embase, and the Cochrane Database of Systematic Reviews up to December 2022 to identify publications on the medical management of urolithiasis. Studies that assessed dietary and pharmacologic management of urolithiasis were reviewed; studies on medical expulsive therapy were not included in this review. Results: Medical management of urolithiasis ranges from the prophylactic management of kidney stone disease to dissolution therapies. While most treatment concepts have been long established, large randomized controlled trials are scarce. Dietary modification and increased fluid intake remain cornerstones in the conservative management of urolithiasis. A major limitation for medical management of urolithiasis is poor patient compliance. Conclusion: Medical management of urolithiasis is more important in patients with recurrent urolithiasis and patients with metabolic abnormalities putting them at higher risk of developing stones. Although medical management can be effective in limiting stone recurrence, medical interventions often fail due to poor compliance.
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Received: 14 February 2023
Available online: 20 April 2024
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Corresponding Authors:
* E-mail address: christian.seitz@meduniwien.ac.at (C. Seitz).
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| Medication | Dose | Indication | Side effect | | Hydrochlorothiazide [23,27] | ? 25-50 mg per day | ? Calcium stones | ? Gastrointestinal upset | | ? Fatigue | | ? Hypocitraturia | | Potassium citrate [50] | ? 10-20 g per day | ? Calcium stones | ? Epigastric pain | | ? Uric acid stones | ? Heartburn | | ? Cystine stones | ? Nausea | | Allopurinol [37] | ? 100-300 mg per day | ? Calcium stones with hyperuricosuria
? Uric acid with hyperuricosuria
? Uric acid stones refractory to hydration and urine alkalization | ? Skin rash
? Muscle pain
? Nausea
? Diarrhea
? Hypersensitivity reaction | | ? 100 mg per day in isolated hyperuricosuria | | Febuxostat [39] | ? 80 mg per day | ? Calcium stones with hyperuricosuria | ? Muscle pain | | ? Uric acid with hyperuricosuria | ? Constipation | | ? Uric acid stones refractory to hydration and urine alkalization | ? Liver-function test abnormalities | | Calcium supplements [42] | ? Not available | ? Enteric hyperoxaluria | ? Not available | | Tiopronin [48] | ? Adults: dose starts at 600-900 mg per day, divided three times a day
? Children of >20 kg: dose starts at 15 mg/kg per day | ? Cystine stones refractory to hydration and urine alkalization | ? Nausea | | ? Vomiting | | ? Diarrhea | | ? Mouth ulcers | | ? Rash | | ? Proteinuria | | d-Penicillamine [48] | ? 500-1500 mg per day, divided two to three times a day | ? Cystine stones refractory to hydration and urine alkalization | ? Pancytopenia | | ? Proteinuria | | ? Nausea | | ? Impaired taste | | ? Rash | | Captopril [55] | ? 50-150 mg per day | ? Cystine stones refractory to hydration and urine alkalization in patients intolerant to cystine-binding agents | ? Rash | | ? Hypotension | | Pyridoxine [44] | ? 5-10 mg/kg per day | ? Primary hyperoxaluria type 1 | ? Diarrhea | | Lumasiran [45] | ? Loading dose: 3 mg/kg once monthly for 3 months
? Maintenance dose: 3 mg/kg once every 3 months | ? Primary hyperoxaluria type 1 | ? Injection-site reaction | | ? Headache | | ? Rhinitis | | ? Upper respiratory infection |
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Commonly used medications in the treatment or prevention of urolithiasis.
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