Kidney Stones - Treatment

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Organic Acids. Medical treatments to dissolve stones may be useful with in patients who do not respond to other medications, or in combination with surgeries. Acidic urine dissolves struvite stones, so the doctor may wash the urinary tract with a solution of organic acids (e.g., Renacidin). Candidates for irrigation must have sterile urine and healthy kidney function. In surgical patients, irrigation is performed 4 or 5 days after the operation. The urinary tract is washed with saline for 1 to 2 days and, if there are no problems, the organic acid solution is given for another 1 or 2 days until all stones are dissolved. The patient's urine should be tested on a regular basis to be sure that bacteria does not return.

Aluminum Hydroxide Gel. An aluminum hydroxide gel anti-acid may reduce phosphate levels but it carries a long-term risk of aluminum toxicity. Prolonged depletion of phosphorus can also increase the risk for calcium oxalate stones. Experts recommend limiting phosphorus through a low-protein diet.

Medications for Cystine Stones

The first-line treatment for cystine stones is increasing the alkalization of urine so the stone can dissolve. If alkalization fails, drugs such as d-penicillamine, alpha-mercaptopropionylglycine (tiopronine), or captopril may be used to lower cystine concentration. Fluid intake for cystine stones must be even more voluminous than for regular stones. The patient should uniformly drink at least four quarts of water over a 24-hour period.

Review Date: 05/22/2006
Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital