Question

A 34-year-old man presented with bilateral recurrent renal stones:
Treatment options.

Hint:

Both medical therapy and lifestyle modifications are key components in preventing recurrent renal stones.

Answer 1

The treatment of recurrent renal stones involves addressing both the acute episodes of stone formation and the underlying metabolic abnormalities to prevent recurrence.
Step 1: Medical Management:
1. Hydration: Ensuring adequate fluid intake to prevent dehydration and reduce urine concentration.
2. Dietary Modifications: Adjusting dietary intake, such as reducing oxalate-rich foods, limiting sodium and animal protein, and increasing citrate intake.
3. Medications: - Thiazide Diuretics: For hypercalciuria, thiazide diuretics help reduce calcium excretion in the urine.
- Potassium Citrate: For hypocitraturia, potassium citrate increases urinary citrate, preventing stone formation.
- Allopurinol: For hyperuricosuria, allopurinol can reduce uric acid levels in the urine.
- Bicarbonate or Citrate Therapy: For metabolic acidosis associated with distal renal tubular acidosis.
Step 2: Surgical Management:
1. Lithotripsy: Shockwave lithotripsy (SWL) is used to break down stones into smaller pieces, making them easier to pass.
2. Endoscopic Stone Removal: Procedures like ureteroscopy and percutaneous nephrolithotomy (PCNL) are used to remove or fragment larger stones.
3. Open Surgery: Reserved for very large or complicated stones that cannot be treated with less invasive methods.
Step 3: Prevention:
1. Long-Term Medical Therapy: Patients with recurrent stones may require long-term medications, such as thiazides or potassium citrate, to prevent recurrence.
2. Lifestyle Modifications: Encourage regular physical activity, weight management, and avoidance of high-risk dietary habits.