Patients with renal stones should be counseled about the disease process, the need for hydration, and, in some cases, dietary modification. The evaluation should include a thorough history, including the number of previous episodes of renal stones. Serum studies are usually performed, including a parathyroid hormone level. A more extensive evaluation is performed for patients with recurrent episodes and generally includes a 24-hour urine collection. Stone analysis can help identify the cause and help guide treatment and management. Patients with uric acid stones can be treated by alkalinizing the urine with potassium citrate or allopurinol.1 Patients with calcium stones can be treated with thiazide diuretics for hypercalciuria. Patients with cystine stones can be treated with captopril, penicillamine, or tiopronin. Management of struvite stones is more difficult, but antibiotics and acetohydroxamic acid can be used.
1. Pietrow P, Karellas M. Medical management of common urinary calculi. Am Fam Physician 2006;74:86-94.
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