Management of Kidney Stones in 2020Andrew D. Rule, MD; John C. Lieske, MD; Vernon M. Pais Jr,MD
The management of renal colic crisis is updated through this article. It is intended to be practical and concrete. It is motivated by the frequent recurrence of seizures. In 28 years in the US (State of Minnesota) the incidence has been multiplied by 4.25 in women and 2.06 in men.
At the time of the crisis, the analgesic treatment can be based on opiates but non-steroidal anti-inflammatory drugs are to be preferred. A simple x-ray or an ultrasound should be prescribed as first-line treatment in order to locate the stone.
Assessing the size of the stone is a major prognostic element and conditions the passage through the ureter:
- < 10 mm spontaneous passage possible
- Surgical management if failure of passage 4 to 6 weeks after the onset of the attack
Asymptomatic stones located in the kidney do not require surgery but simple monitoring by imaging (ultrasound ideal every 1 to 2 years).
At the time of the first crisis at least 50% of patients have another asymptomatic stone located in a kidney.
The composition of the stones is essential because it makes it possible to adapt the treatment and to predict recurrences. Calcium oxalate stones are the most common. The less frequent the composition of the calculation, the more the risk of recurrence increases. Urinary pH is closely linked to the composition of stones during renal colic attacks: hydroxyapatite for a pH > 6.3 and uric acid for a pH < 5.5.
Certain risk factors are well identified and make it possible to assess the risk of recurrence (family history among others).
Above all, dietary measures and drug treatments will prevent recurrence.
An accurate and real-time diagnosis associated with a preventive approach can optimize the care and the overall management of this vast problem.
Comments: This article is particularly relevant and realistic on the management of renal colic. We can discuss the waiting period of 4 to 6 weeks for stones whose size is > 10 mm or ≤ 10 mm. NSAIDs are preferred over opioids for pain management. We will remember the importance of collecting the calculus in all cases and at the initial stage in order to guide the treatment.
