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Diseases » Kidney stones » Treatments
 

Treatments for Kidney stones

Contents
  1. Kidney stones: Introduction
  2. Treatment list for Kidney stones
  3. Alternative Treatments
  4. Latest treatments for Kidney stones
  5. News about treatments
  6. Discussion of treatments for Kidney stones
  7. Buy Products Related to Treatments for Kidney stones
  8. Kidney stones: Introduction

Treatments for Kidney stones

The list of treatments mentioned in various sources for Kidney stones includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

Kidney stones: Is the Diagnosis Correct?

The first step in getting correct treatment is to get a correct diagnosis. Differential diagnosis list for Kidney stones may include:

Hidden causes of Kidney stones may be incorrectly diagnosed:

Kidney stones: Marketplace Products, Discounts & Offers

Products, offers and promotion categories available for Kidney stones:

Curable Types of Kidney stones

Possibly curable types of Kidney stones may include:

  • Renal failure due to eclampsia
  • Renal failure due to malignant hypertension
  • Renal failure associated with transplant rejection
  • more curable types...»

Kidney stones: Research Doctors & Specialists

Research all specialists including ratings, affiliations, and sanctions.

Drugs and Medications used to treat Kidney stones:

Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment or change in treatment plans.

Some of the different medications used in the treatment of Kidney stones include:

  • Citric Acid, Magnesium Carbonate and Glucono-delta-lactone
  • Renacidin

Unlabeled Drugs and Medications to treat Kidney stones:

Unlabelled alternative drug treatments for Kidney stones include:

  • Amiloride
  • Apo-Amilzide
  • Midamor
  • Moduret
  • Moduretic
  • Novamilor
  • Nu-Amilzide
  • Riva-Amilzide
  • Methylene Blue - Chronic urolithiasis
  • Urolene Blue - Chronic urolithiasis

Latest treatments for Kidney stones:

The following are some of the latest treatments for Kidney stones:

Hospital statistics for Kidney stones:

These medical statistics relate to hospitals, hospitalization and Kidney stones:

  • 0.45% (56,987) of hospital episodes were for urolithiasis in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 90% of hospital consultations for urolithiasis required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 71% of hospital episodes for urolithiasis were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 29% of hospital episodes for urolithiasis were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • more hospital information...»

Hospitals & Medical Clinics: Kidney stones

Research quality ratings and patient incidents/safety measures for hospitals and medical facilities in specialties related to Kidney stones:

Hospital & Clinic quality ratings » »

Choosing the Best Treatment Hospital: More general information, not necessarily in relation to Kidney stones, on hospital and medical facility performance and surgical care quality:

Medical news summaries about treatments for Kidney stones:

The following medical news items are relevant to treatment of Kidney stones:

Discussion of treatments for Kidney stones:

Kidney Stones in Adults: NIDDK (Excerpt)

Fortunately, surgery is not usually necessary. Most kidney stones can pass through the urinary system with plenty of water (2 to 3 quarts a day) to help move the stone along. Often, you can stay home during this process, drinking fluids and taking pain medication as needed. The doctor usually asks you to save the passed stone(s) for testing. (You can catch it in a cup or tea strainer used only for this purpose.) (Source: excerpt from Kidney Stones in Adults: NIDDK)

Kidney Stones in Adults: NIDDK (Excerpt)

Surgical Treatment

Surgery should be reserved as an option for cases where other approaches have failed or shouldn't be tried. Surgery may be needed to remove a kidney stone if it
  • Does not pass after a reasonable period of time and causes constant pain
  • Is too large to pass on its own or is caught in a difficult place
  • Blocks the flow of urine
  • Causes ongoing urinary tract infection
  • Damages kidney tissue or causes constant bleeding
  • Has grown larger (as seen on followup x-ray studies).

Until recently, surgery to remove a stone was very painful and required a lengthy recovery time (4 to 6 weeks). Today, treatment for these stones is greatly improved, and many options do not require major surgery. Extracorporeal Shockwave Lithotripsy

Extracorporeal shockwave lithotripsy (ESWL) is the most frequently used procedure for the treatment of kidney stones. In ESWL, shock waves that are created outside of the body travel through the skin and body tissues until they hit the dense stones. The stones break down into sand-like particles and are easily passed through the urinary tract in the urine.

Extracorporeal shockwave lithotripsy.

There are several types of ESWL devices. In one device, the patient reclines in a water bath while the shock waves are transmitted. Other devices have a soft cushion on which the patient lies. Most devices use either x-rays or ultrasound to help the surgeon pinpoint the stone during treatment. For most types of ESWL procedures, anesthesia is needed.

In some cases, ESWL may be done on an outpatient basis. Recovery time is short, and most people can resume normal activities in a few days.

Complications may occur with ESWL. Most patients have blood in their urine for a few days after treatment. Bruising and minor discomfort of the back or abdomen from the shock waves are also common. To reduce the risk of complications, doctors usually tell patients to avoid taking aspirin and other drugs that affect blood clotting for several weeks before treatment.

Another complication may occur if the shattered stone particles cause discomfort as they pass through the urinary tract. In some cases, the doctor will insert a small tube called a stent through the bladder into the ureter to help the fragments pass. Sometimes the stone is not completely shattered with one treatment, and additional treatments may be needed. Percutaneous Nephrolithotomy

Sometimes a procedure called percutaneous nephrolithotomy is recommended to remove a stone. This treatment is often used when the stone is quite large or in a location that does not allow effective use of ESWL.

Percutaneous nephrolithotomy.

In this procedure, the surgeon makes a tiny incision in the back and creates a tunnel directly into the kidney. Using an instrument called a nephroscope, the surgeon locates and removes the stone. For large stones, some type of energy probe (ultrasonic or electrohydraulic) may be needed to break the stone into small pieces. Generally, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the healing process.

One advantage of percutaneous nephrolithotomy over ESWL is that the surgeon removes the stone fragments instead of relying on their natural passage from the kidney.  


Ureteroscopic Stone Removal

Ureteroscopic stone removal.

Although some kidney stones in the ureters can be treated with ESWL, ureteroscopy may be needed for mid- and lower-ureter stones. No incision is made in this procedure. Instead, the surgeon passes a small fiberoptic instrument called a ureteroscope through the urethra and bladder into the ureter. The surgeon then locates the stone and either removes it with a cage-like device or shatters it with a special instrument that produces a form of shock wave. A small tube or stent may be left in the ureter for a few days to help the lining of the ureter heal. Before fiber optics made ureteroscopy possible, physicians used a similar "blind basket" extraction method. But this outdated technique should not be used because it may damage the ureters. (Source: excerpt from Kidney Stones in Adults: NIDDK)

What Are Kidney Stones: NIDDK (Excerpt)

If you have a stone that will not pass by itself, your doctor may need to take steps to get rid of it. In the past, the only way to remove a problem stone was through surgery.

Now, doctors have new ways to remove problem stones. The following pages describe a few of these methods.

Shock Waves

Your doctor can use a machine to send shock waves directly to the kidney stone. The shock waves break a large stone into small stones that will pass through your urinary system with your urine. The method does not require cutting open the body.

Two types of shock wave machines exist. With one machine, you sit in a tub of water. With the other type of machine, you lie on a table.

The full name for this method is extracorporeal (EKS-trah-kor-POR-ee-ul) shock wave lithotripsy (LITH-oh-TRIP-see). Doctors often call it ESWL for short. Lithotripsy is a Greek word that means stone crushing.

Tunnel Surgery

In this method, the doctor makes a small cut into the patient's back and makes a narrow tunnel through the skin to the stone inside the kidney. With a special instrument that goes through the tunnel, the doctor can find the stone and remove it. The technical name for this method is percutaneous (PER-kyoo-TAY-nee-us) nephrolithotomy (NEF-row-lith-AH-tuh-mee).

Ureteroscope

A ureteroscope (yoo-REE-ter-uh-scope) looks like a long wire. The doctor inserts it into the patient's urethra, passes it up through the bladder, and directs it to the ureter where the stone is located. The ureteroscope has a camera that allows the doctor to see the stone. A cage is used to catch the stone and pull it out.

Ask your doctor which method is right for you. (Source: excerpt from What Are Kidney Stones: NIDDK)

Kidney Stones: NWHIC (Excerpt)

Fortunately, most stones can be treated without surgery. Most kidney stones can pass through the urinary system with plenty of water (2 to 3 quarts a day) to help move the stone along. In most cases, a person can stay home during this process, taking pain medicine as needed. The doctor usually asks the patient to save the passed stone(s) for testing. (Source: excerpt from Kidney Stones: NWHIC)

Kidney Stones: NWHIC (Excerpt)

Some type of surgery may be needed to remove a kidney stone if the stone:

  • does not pass after a reasonable period of time and causes constant pain,

  • is too large to pass on its own,

  • blocks the urine flow,

  • causes ongoing urinary tract infection,

  • damages the kidney tissue or causes constant bleeding, or

  • has grown larger (as seen on follow up x-ray studies).

Until recently, surgery to remove a stone was very painful and required a lengthy recovery time (4 to 6 weeks). Today, treatment for these stones is greatly improved. Many options exist that do not require major surgery, like lithotripsy, or sending shock waves to break up the stones. (Source: excerpt from Kidney Stones: NWHIC)

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Book Excerpts: Treatment of Kidney stones

Treatments of Kidney stones: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the treatments of Kidney stones.

Dysuria: Treatment
(In a Page: Signs and Symptoms)

  • Cystitis/prostatitis: Appropriate antibiotics
    –Begin with empiric therapy and adjust to sensitivities
    –Noninfectious cystitis: Remove offending medications
    or allergens if possible
  • Pyelonephritis: Outpatient antibiotic treatment in patients who tolerate liquids and have no significant co-morbidities; otherwise, admit for IV hydration and antibiotics
  • Urolithiasis: Hydration, pain control while attempting to pass stones; urology referral if stones will not pass
  • Atrophic vaginitis: Consider estrogen creams or systemic replacement if other symptoms
  • BPH: Symptomatic relief with α-blockers, 5α-reductase-inhibitors, or saw palmetto extract
  • Sexually transmitted diseases
    –Treat specific etiology and screen for coexistent STDs (e.g., HIV, hepatitis B)

    • » READ BOOK EXCERPT ONLINE »

    Source: In a Page: Signs and Symptoms, 2004

    Hematuria: Treatment
    (In a Page: Signs and Symptoms)

    • Older patients with transient hematuria should always be evaluated due to increased risk of urinary tract cancers; refer to urologist for further evaluation and treatment
    • UTI: Start appropriate antibiotics and follow up with urinalysis to see if hematuria resolves
    • Glomerular sources (RBC casts, protein excretion >500 mg/dL, dysmorphic RBCs): Follow BUN/creatinine, blood pressure, creatinine clearance, and 24-hour urine protein, and refer for biopsy if worsening
    • Nonglomerular source (no RBC casts or dysmorphic RBCs in the urine): Urologic consult if imaging indicates a lesion (renal, bladder, or urethral)
    • Stones: Increase hydration, analgesics, urology referral for large or persistent stones
    • Myoglobinuria/hemoglobinuria: Treat underlying cause
    • Beeturia: Evaluate for iron deficiency or achlorhydria due to pernicious anemia, as treating these disorders may eliminate beeturia; eating foods high in oxalate (spinach, oysters) with beets can also cause beeturia

    » READ BOOK EXCERPT ONLINE »

    Source: In a Page: Signs and Symptoms, 2004

    Dysuria: Treatment
    (In A Page: Pediatric Signs and Symptoms)

    • UTI: Empiric antibiotics (e.g., co-trimoxazole) pending culture; adjust antibiotics based on bacterial sensitivities
      • STD
        –Simple cervicitis: Treat with IM ceftriaxone and PO azithromycin, metronidazole if Trichomonas present
        –For an ill patient with signs of PID, consider hospital admission, give IV cefoxitin and PO doxycycline
    • Candidal vaginitis: Topical antifungal agents or oral fluconazole
    • Hypercalciuria/kidney stones
      –Increase fluid intake, decrease sodium intake (increases urinary calcium excretion), do not restrict calcium intake
      –Treat with thiazide diuretics (decrease urinary calcium excretion) if patient is persistently symptomatic and/or has urinary calculi
    • Avoid instrumentation/local irritants (e.g., bubble baths)

    >

    » READ BOOK EXCERPT ONLINE »

    Source: In A Page: Pediatric Signs and Symptoms, 2007

    Hematuria: Treatment
    (In A Page: Pediatric Signs and Symptoms)

    • UTI: Empiric antibiotic (e.g., co-trimoxazole)
    • Manage hypertension
      –ACE inhibitors or calcium channel blockers
      –Consider diuretics if edematous
      • Suspected acute glomerulonephritis
        –Low C3, evidence of recent strep or other infection
        –Monitor urine output, weight, BP closely
        –Daily outpatient visits until stable
        –Inpatient admission if oliguria/edema is severe
        –Once acute phase is over, monitor every 1–2 weeks and recheck C3 in 6–8 weeks
    • Nephrolithiasis: Increase fluid intake
      –Sodium-restrict (do not calcium-restrict)
      –Consult urology for severe pain or obstruction
    • Consult nephrology if hematuria persists or is associated with proteinuria, hypertension, persistently decreased C3, or abnormal creatinine

    » READ BOOK EXCERPT ONLINE »

    Source: In A Page: Pediatric Signs and Symptoms, 2007

    Bladder distention: Emergency interventions
    (Handbook of Signs & Symptoms (Third Edition))

    If the patient has severe distention, insert an indwelling urinary catheter to help relieve discomfort and prevent bladder rupture. If more than 700 ml is emptied from the bladder, compressed blood vessels dilate and may make the patient feel faint. Typically, the indwelling urinary catheter is clamped for 30 to 60 minutes to permit vessel compensation.

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Signs & Symptoms (Third Edition), 2006

    Acute renal failure: Treatment (Tx)
    (Professional Guide to Diseases (Eighth Edition))

    Strict fluid management, supportive care (electrolyte replacement; high-calorie, low-

    protein diet), hemodialysis or peritoneal dialysis

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Diseases (Eighth Edition), 2005

    Calcium imbalance: Treatment
    (Professional Guide to Diseases (Eighth Edition))

    Treatment varies and requires correction of the acute imbalance, followed by maintenance therapy and correction of the underlying cause. Mild hypocalcemia may require nothing more than an adjustment in diet to allow adequate intake of calcium, vitamin D, and protein, possibly with oral calcium supplements. Acute hypocalcemia is an emergency that needs immediate correction by I.V. administration of calcium gluconate or calcium chloride. Chronic hypocalcemia also requires vitamin D supplements to facilitate GI absorption of calcium. To correct mild deficiency states, the amounts of vitamin D in most multivitamin preparations are adequate. For severe deficiency, vitamin D is used in four forms: ergocalciferol (vitamin D 2), cholecalciferol (vitamin D3), calcitriol, and dihydrotachysterol, a synthetic form of vitamin D2.

    Treatment of hypercalcemia primarily eliminates excess serum calcium through hydration with normal saline solution, which promotes calcium excretion in the urine. Loop diuretics, such as ethacrynic acid and furosemide, also promote calcium excretion. (Thiazide diuretics are contraindicated in hypercalcemia because they inhibit calcium excretion.) Corticosteroids, such as prednisone and hydrocortisone, are helpful in treating sarcoidosis, hypervitaminosis D, and certain tumors. Plicamycin can also lower serum calcium levels and is especially effective against hypercalcemia secondary to certain tumors. Calcitonin may also be helpful in certain instances. Sodium phosphate solution administered orally or by retention enema promotes calcium deposition in bone and inhibits its absorption from the GI tract.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Diseases (Eighth Edition), 2005

    Polycystic kidney disease: Treatment
    (Professional Guide to Diseases (Eighth Edition))

    Polycystic kidney disease can’t be cured. The primary goal of treatment is preserving renal parenchyma and preventing infectious complications. Management of secondary hypertension will also help prevent rapid deterioration in function. Progressive renal failure requires treatment similar to that for other types of renal disease, including dialysis or, rarely, kidney transplantation.

    When adult polycystic kidney disease is discovered in the asymptomatic stage, careful monitoring is required, including urine cultures and creatinine clearance tests every 6 months. Prompt and vigorous antibiotic treatment is needed when a urine culture reveals infection — even when the patient is asymptomatic. As renal impairment progresses, selected patients may undergo dialysis, transplantation, or both. Cystic abscess or retroperitoneal bleeding may require surgical drainage; intractable pain (a rare symptom) may also require surgery. However, because this disease affects both kidneys, nephrectomy usually isn’t recommended because it increases the risk of infection in the remaining kidney.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Diseases (Eighth Edition), 2005

    Chronic renal failure: Treatment
    (Professional Guide to Diseases (Eighth Edition))

    Treatment focuses on controlling the symptoms, minimizing complications, and slowing the progression of the disease. Associated diseases that cause or result from chronic renal failure must be controlled such as hypertension. Conservative treatment aims to correct specific symptoms. A low-protein diet reduces the production of end products of protein metabolism that the kidneys can’t excrete. (A patient receiving continuous peritoneal dialysis should have a high-protein diet.) A high-calorie diet prevents ketoacidosis and the negative nitrogen balance that results in catabolism and tissue atrophy, and restricts sodium and potassium.

    Maintaining fluid balance requires careful monitoring of vital signs, weight changes, and urine volume (if present). If some renal function remains, administration of loop diuretics such as furosemide, and fluid restriction can reduce fluid retention. Cardiac glycosides may be used to mobilize edema fluids; antihypertensives, to control blood pressure and associated edema. Antiemetics taken before meals may relieve nausea and vomiting; cimetidine or ranitidine may decrease gastric irritation. Methylcellulose or docusate can help prevent constipation.

    Treatment may also include regular stool analysis (guaiac test) to detect occult blood and, as needed, cleaning enemas to remove blood from the GI tract. Anemia necessitates iron and folate supplements; severe anemia requires infusion of fresh frozen packed cells or washed packed cells. However, transfusions relieve anemia only temporarily. Epoetin alpha (erythropoietin) increases RBC production.

    Drug therapy often relieves associated symptoms: an antipruritic, such as trimeprazine or diphenhydramine, for itching and aluminum hydroxide gel to lower serum phosphate levels. The patient may also benefit from supplementary vitamins (particularly B vitamins and vitamin D) and essential amino acids.

    Careful monitoring of serum potassium levels is necessary to detect hyperkalemia. Emergency treatment for severe hyperkalemia includes dialysis therapy and administration of 50% hypertonic glucose I.V., regular insulin, calcium gluconate I.V., sodium bicarbonate I.V., and cation exchange resins such as sodium polystyrene sulfonate.

    Alert Cardiac tamponade resulting from pericardial effusion may require emergency pericardial tap or surgery.

    Blood gas measurements may indicate acidosis; intensive dialysis and thoracentesis can relieve pulmonary edema and pleural effusions.

    Hemodialysis or peritoneal dialysis (particularly continuous ambulatory peritoneal dialysis and continuous cyclic peritoneal dialysis) can help control most manifestations of end-stage renal disease; altering dialyzing bath fluids can correct fluid and electrolyte disturbances. (See Comparing peritoneal dialysis and hemodialysis, page 806. Also see Continuous ambulatory peritoneal dialysis, page 807.) But anemia, peripheral neuropathy, cardiopulmonary and GI complications, sexual dysfunction, and skeletal defects may persist. Maintenance dialysis itself may produce complications, such as protein wasting, refractory ascites, and dialysis dementia. Kidney transplantation may eventually be the treatment of choice for some patients with end-stage renal disease.

    PEDIATRIC TIP Children require more dialysis in relation to their body weight than adults because their metabolic rates and, therefore, food intake, are higher.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Diseases (Eighth Edition), 2005

    Renal calculi: Treatment
    (Professional Guide to Diseases (Eighth Edition))

    Because 90% of renal calculi are smaller than 5 mm in diameter, treatment usually consists of measures to promote their natural passage. Along with vigorous hydration, such treatment includes antimicrobial therapy (varying with the cultured organism) for infection, analgesics such as meperidine for pain, and diuretics to prevent urinary stasis and further calculus formation (thiazides decrease calcium excretion into the urine). Prophylaxis to prevent calculus formation includes a low-calcium diet for absorptive hypercalciuria, parathyroidectomy for hyperparathyroidism, allopurinol for uric acid calculi, and daily administration of ascorbic acid by mouth to acidify the urine.

    Calculi too large for natural passage may require surgical removal. When a calculus is in the ureter, a cystoscope may be inserted through the urethra and the calculus manipulated with catheters or retrieval instruments. Extraction of calculi from other areas (kidney calyx, renal pelvis) may necessitate a flank or lower abdominal approach. Percutaneous ultrasonic lithotripsy and extracorporeal shock wave lithotripsy shatter the calculus into fragments for removal by suction or natural passage.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Diseases (Eighth Edition), 2005

    Lower urinary tract infection: Treatment
    (Professional Guide to Diseases (Eighth Edition))

    Appropriate antimicrobials are the treatment of choice for most initial lower UTIs. A course of antibiotic therapy lasting from 7 to 10 days is standard, but recent studies suggest that a single dose of an antibiotic or an antibiotic regimen of 3 to 5 days length may be sufficient to render the urine sterile. After 3 days of antibiotic therapy, urine culture should show no organisms. If the urine isn’t sterile, bacterial resistance has probably occurred, making the use of a different antimicrobial necessary. Single-dose antibiotic therapy with amoxicillin or co-trimoxazole may be effective in females with acute noncomplicated UTI. A urine culture taken 1 to 2 weeks later indicates whether or not the infection has been eradicated.

    Recurrent infections due to infected renal calculi, chronic prostatitis, or structural abnormality may necessitate surgery; prostatitis also requires long-term antibiotic therapy. In patients without these predisposing conditions, long-term, low-dosage antibiotic therapy is the treatment of choice.

    PEDIATRIC TIP Fluoroquinolones aren’t used for children because of possible adverse effects on developing cartilage.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Diseases (Eighth Edition), 2005

    Introduction: Renal and Urologic Disorders: Treatment methods
    (Professional Guide to Diseases (Eighth Edition))

    Treatment of intractable renal or urinary system dysfunction may require urinary diversion, dialysis, or kidney transplantation. Urinary diversion is the surgical creation of an outlet for excreting urine. The types of urinary diversion include ileal conduit, cutaneous ureterostomy, ureterosigmoidostomy, and creation of a rectal bladder.

    In dialysis, a semipermeable membrane, osmosis, and diffusion imitate normal renal function by eliminating excess body fluids, maintaining or restoring plasma electrolyte and acid-base balance, and removing waste products and dialyzable poisons from the blood. Dialysis is most often used for patients with acute or chronic renal failure. The two most common types of dialysis are peritoneal dialysis and hemodialysis.

    In peritoneal dialysis, a dialysate solution is infused into the peritoneal cavity. Substances then diffuse through the peritoneal membrane. Waste products remain in the dialysate solution and are removed.

    Hemodialysis separates solutes by differential diffusion through a cellophane membrane placed between the blood and the dialysate solution, in an external receptacle. Because the blood must actually pass out of the body into a dialysis machine, hemodialysis requires an access route to the blood supply by an arteriovenous fistula or cannula or by a bovine or synthetic graft. When caring for a patient with such an access route, monitor the patency of the access route, prevent infection, and promote safety and adequate function. After dialysis, watch for such complications as headache, vomiting, agitation, and twitching.

    Patients with end-stage renal disease may benefit from kidney transplantation, despite its limitations: a shortage of donor kidneys, the chance of transplant rejection, and the need for lifelong medications and follow-up care. After kidney transplantation, maintain fluid and electrolyte balance, prevent infection, monitor for rejection, and promote psychological well-being.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Diseases (Eighth Edition), 2005

    Bladder distention: Emergency interventions
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    If the patient has severe distention, insert an indwelling urinary catheter to help relieve discomfort and prevent bladder rupture. If more than 700 ml is emptied from the bladder, compressed blood vessels dilate, which may make the patient feel faint. Typically, the indwelling urinary catheter is clamped for 30 to 60 minutes to permit vessel compensation.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

    Hematuria: Patient counseling
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Teach the patient how to collect serial urine specimens using the three-glass technique. This technique helps determine whether hematuria marks the beginning, end, or entire course of urination.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

    Calcium imbalance: Treatment
    (Handbook of Diseases)

    An acute imbalance requires immediate correction, followed by maintenance therapy and correction of the underlying cause.

    Hypocalcemia

    A mild calcium deficit may require nothing more than an adjustment in diet to allow adequate intake of calcium, vitamin D, and protein, possibly with oral calcium supplements. Acute hypocalcemia is an emergency that needs immediate correction by I.V. administration of calcium gluconate or calcium chloride.

    Chronic hypocalcemia also requires vitamin D supplements to facilitate GI absorption of calcium. Although the amount of vitamin D in most multivitamin preparations is adequate to correct a mild deficiency, different forms of vitamin D are used for severe deficiency, including ergocalciferol (vitamin D2), cholecalciferol (vitamin D3), calcitriol, and dihydrotachysterol, a synthetic form of vitamin D2.

    Hypercalcemia

    Treatment of hypercalcemia primarily eliminates excess serum calcium through hydration with normal saline solution, which promotes calcium excretion in urine. Loop diuretics, such as ethacrynic acid and furosemide, also promote calcium excretion. (Because thiazide diuretics inhibit calcium excretion, they’re contraindicated in hypercalcemic patients.)

    Corticosteroids, such as prednisone and hydrocortisone, are helpful in treating sarcoidosis, hypervitaminosis D, and certain tumors. Plicamycin can lower the serum calcium level and is especially effective against hypercalcemia secondary to certain tumors. Calcitonin may also be helpful in certain instances.

    Sodium phosphate solution administered by mouth or by retention enema promotes calcium deposits in bone and inhibits its absorption from the GI tract.

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Diseases, 2003

    Polycystic kidney disease: Treatment
    (Handbook of Diseases)

    Polycystic kidney disease can’t be cured. The primary goal of treatment is to preserve renal parenchyma and prevent infectious complications. Management of secondary hypertension will also help prevent rapid deterioration in function. Progressive renal failure requires treatment similar to that for other types of renal disease, including dialysis or, rarely, a kidney transplant.

    Asymptomatic stage

    When adult polycystic kidney disease is discovered in the asymptomatic stage, careful monitoring is required, including urine cultures and creatinine clearance tests every 6 months. When a urine culture detects infection, prompt and vigorous antibiotic treatment is needed (even when the patient is asymptomatic).

    Progressive renal impairment

    As renal impairment progresses, selected patients may undergo dialysis, transplantation, or both. Cystic abscess or retroperitoneal bleeding may require surgical drainage; intractable pain (a rare symptom) may also require surgery. Anemia is treated with iron and other supplements, erythropoietin, or blood transfusions. However, because this disease affects both kidneys, nephrectomy usually isn’t recommended because it increases the risk of infection in the remaining kidney.

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Diseases, 2003

    Renal failure, acute: Treatment
    (Handbook of Diseases)

    The goals of treatment include identifying and treating reversible causes, such as nephrotoxic drug therapy, obstructive uropathy, and volume depletion. Supportive measures include a diet high in calories and low in protein, sodium, and potassium, with supplemental vitamins and restricted fluids. Meticulous electrolyte monitoring is essential to detect hyperkalemia.

    If hyperkalemia occurs, acute therapy may include dialysis, hypertonic glucose and insulin infusions, and calcium — all administered I.V. — and oral or rectal administration of potassium exchange resin to remove potassium from the body.

    If measures fail to control uremic symptoms, hemodialysis or peritoneal dialysis may be necessary.

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Diseases, 2003

    Renal failure, chronic: Treatment
    (Handbook of Diseases)

    Conservative treatment aims to correct specific symptoms, minimize complications, and slow progression of the disease. Underlying conditions that cause chronic renal failure must be controlled.

    Diet

    A low-protein diet reduces the production of end products of protein metabolism that the kidneys can’t excrete. (A patient receiving continuous peritoneal dialysis should receive a high-protein diet.)

    A high-calorie diet prevents ketoacidosis and the negative nitrogen balance that results in catabolism and tissue atrophy. Such a diet also restricts sodium and potassium.

    Fluid status

    Maintaining fluid balance requires careful monitoring of vital signs, weight changes, and urine volume (if present). Loop diuretics, such as furosemide (if some renal function remains), and fluid restriction can reduce fluid retention. A cardiac glycoside may be used to mobilize edema fluids; an antihypertensive, especially an angiotensin-converting enzyme inhibitor, to control blood pressure and associated edema.

    Treatment of GI and blood problems

    An antiemetic taken before meals may relieve nausea and vomiting; cimetidine, omeprazole, or ranitidine may decrease gastric irritation. Methylcellulose or docusate can help prevent constipation.

    Treatment may also include regular stool analysis (guaiac test) to detect occult blood and, as needed, cleansing enemas to remove blood from the GI tract.

    Anemia necessitates iron and folate supplements; severe anemia requires infusion of fresh frozen packed cells or washed packed cells. However, transfusions relieve anemia only temporarily. Synthetic erythropoietin (epoetin alfa) may be given to stimulate the division and differentiation of cells within the bone marrow to produce RBCs. An-drogen therapy (testosterone or nandrolone) may increase RBC production.

    Drug therapy, surgery, and dialysis

    Drug therapy can help relieve associated symptoms: an antipruritic, such as trimeprazine or diphenhydramine, to relieve itching and aluminum hydroxide gel to lower serum phosphate levels.

    CLINICAL TIP: Be alert for aluminum toxicity, an adverse reaction to aluminum hydroxide.

    The patient may also benefit from supplementary vitamins (particularly B vitamins and vitamin D) and essential amino acids.

    Careful monitoring of serum potassium levels is necessary to detect hyperkalemia. Emergency treatment for severe hyperkalemia includes dialysis therapy and administration of 50% hypertonic glucose I.V., regular insulin, calcium gluconate I.V., sodium bicarbonate I.V., and cation exchange resins such as sodium polystyrene sulfonate. Cardiac tamponade resulting from pericardial effusion may require emergency pericardial tap or surgery.

    Blood gas measurements may indicate acidosis; intensive dialysis and thoracentesis can relieve pulmonary edema and pleural effusions.

    Hemodialysis or peritoneal dialysis (particularly continuous ambulatory peritoneal dialysis and continuous cyclic peritoneal dialysis) can help control most manifestations of end-stage renal disease. (See Continuous ambulatory peritoneal dialysis, page 718.) Altering dialyzing bath fluids can correct fluid and electrolyte disturbances. However, anemia, peripheral neuropathy, cardiopulmonary and GI complications, sexual dysfunction, and skeletal defects may persist.

    Maintenance dialysis may produce complications, such as protein wasting, refractory ascites, and dialysis dementia. A kidney transplant may eventually be the treatment of choice for some patients with end-stage renal disease.

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Diseases, 2003

    Renal calculi: Treatment
    (Handbook of Diseases)

    Because 90% of renal calculi are smaller than 5 mm in diameter, treatment usually consists of measures to promote natural passage. Along with vigorous hydration, such treatment includes antimicrobial therapy (varying with the cultured organism) for infection; an analgesic, such as meperidine, for pain; and a diuretic to prevent urinary stasis and further calculus formation. (Thiazides decrease calcium excretion into the urine.)

    Prophylaxis to prevent calculus formation includes a low-calcium diet for absorptive hypercalciuria, parathyroidectomy for hyperparathyroidism, and allopurinol and urinary alkalinization for uric acid calculi.

    Medications may be given to decrease calculi formation or aid in the breakdown and excretion of the material causing the calculi. These include medications such as diuretics, phosphate solutions, allopurinol (for uric acid calculi), antibiotics (for struvite calculi), and medications that alkalinize the urine, such as sodium bicarbonate or sodium citrate.

    Calculi too large for natural passage may require surgical removal. When a calculus is in the ureter, a cystoscope may be inserted through the urethra and the calculus manipulated with catheters or retrieval instruments. A small-diameter telescope, the ureteroscope, may be inserted through the ureter to remove calculi from the ureter and kidney. Extraction of calculi from other areas (such as the kidney calyx or renal pelvis) rarely necessitates a flank or lower abdominal approach.

    Percutaneous ultrasonic lithotripsy and extracorporeal shock-wave lithotripsy shatter the calculus into fragments for removal by suction or natural passage. To prevent recurrence of calculi, the patient will also need teaching before discharge. (See Preventing recurrence of renal calculi.)

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Diseases, 2003

    Urinary tract infection, lower: Treatment
    (Handbook of Diseases)

    Appropriate antimicrobials are the treatment of choice for most initial lower UTIs. A 7- to 10-day course of antibiotic therapy is standard, but recent studies suggest that a single dose of an antibiotic or a 3- to 5-day antibiotic regimen may be sufficient to render the urine sterile. After 3 days of antibiotic therapy, urine culture should show no organisms.

    If the urine isn’t sterile, bacterial resistance has probably occurred, making the use of a different antimicrobial necessary. Single-dose antibiotic therapy with amoxicillin or co-trimoxazole may be effective in women with acute, noncomplicated UTI. A urine culture taken 1 to 2 weeks later indicates whether the infection has been eradicated.

    Recurrent infections due to infected renal calculi, chronic prostatitis, or structural abnormality may necessitate surgery; prostatitis also requires long-term antibiotic therapy. In patients without these predisposing conditions, long-term, low-dosage antibiotic therapy is the treatment of choice.

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Diseases, 2003

    Bladder distention: Nursing considerations
    (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

    Monitor the patient’s vital signs and the extent of bladder distention. Obtain bladder urinary volume with a bladder scanner. Encourage the patient to change positions to alleviate discomfort. Administer medications for pain relief.

    Prepare the patient for diagnostic tests, such as endoscopy and radiologic studies, to determine the cause of bladder distention. Withhold fluids and food if surgery is indicated.

    Patient teaching

    If the patient doesn’t require immediate urinary catheterization, provide privacy and suggest that a normal voiding position be assumed. Teach Valsalva’s maneuver, or gently perform Credé’s maneuver. Use the power of suggestion to stimulate voiding. For example, run water in the sink, pour warm water over his perineum, place his hands in warm water, or play tapes of aquatic sounds.

    » READ BOOK EXCERPT ONLINE »

    Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

    Bladder distention: Emergency Actions
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    If the patient has severe distention, insert an indwelling urinary catheter to help relieve discomfort and prevent bladder rupture. If more than 700 ml is emptied from the bladder, compressed blood vessels dilate and may make the patient feel faint. Typically, the indwelling urinary catheter is clamped for 30 to 60 minutes to permit vessel compensation.

    » READ BOOK EXCERPT ONLINE »

    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Dysuria: Patient counseling
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Encourage the patient to increase his fluid intake to 3.2 qt (3 L))/day, unless contraindicated. Explain the importance of frequent urination. Show the female patient how to perform proper perineal care and tell her to avoid tub baths, especially bubble baths, and vaginal deodorants. Explain the importance of taking the full course of prescribed antibiotics, even if symptoms subside.

    » READ BOOK EXCERPT ONLINE »

    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Hematuria: Patient counseling
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Teach the patient how to collect serial urine specimens using the three-glass technique. This technique helps determine whether hematuria marks the beginning, end, or entire course of urination. Encourage the patient to drink plenty of fluids, unless contraindicated.

    » READ BOOK EXCERPT ONLINE »

    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Bladder distention: Nursing considerations
    (Nursing: Interpreting Signs and Symptoms)

    ▪ Insert a urinary catheter to relieve distention. If a catheter is already in place, irrigate or replace it to improve function.

    ▪ Monitor the patient's vital signs, intake and output, and the extent of bladder distention.

    ▪ Encourage the patient to change positions to alleviate discomfort.

    ▪ Administer an analgesic, as appropriate.

    ▪ Prepare the patient for diagnostic tests (such as cystoscopy and radiologic studies) to determine the cause of bladder distention.

    ▪ Prepare the patient for surgery if interventions fail to relieve bladder distention and obstruction prevents catheterization.

    ▪ Provide privacy for voiding and encourage a normal voiding position.

    Patient teaching

    ▪ Explain the underlying cause and treatment plan.

    ▪ Teach the patient to use Valsalva's maneuver or Credé's method to empty the bladder.

    ▪ Explain how to stimulate voiding or perform self-catheterization as appropriate.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Dysuria: Nursing considerations
    (Nursing: Interpreting Signs and Symptoms)

    ▪ Monitor the patient's vital signs and intake and output.

    ▪ Administer prescribed drugs.

    ▪ Prepare the patient for such tests as urinalysis and cystoscopy.

    Patient teaching

    ▪ Explain the importance of increased fluid intake.

    ▪ Emphasize the importance of frequent urination.

    ▪ Teach the patient to perform perineal care.

    ▪ Discourage the use of bubble baths and vaginal deodorants.

    ▪ Discuss the importance of taking prescribed drugs as instructed.

    ▪ Explain to the patient his diagnosis and the treatment plan.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Hematuria: Nursing considerations
    (Nursing: Interpreting Signs and Symptoms)

    ▪ Check vital signs frequently.

    ▪ Monitor intake and output, including the amount and pattern of hematuria.

    ▪ If the patient has an indwelling urinary catheter in place, ensure its patency and irrigate it if necessary to remove clots and tissue that may impede urine drainage.

    ▪ Administer prescribed analgesics, and enforce bed rest as indicated.

    ▪ Prepare the patient for diagnostic tests, such as blood and urine studies, cystoscopy, and renal X-rays or biopsy.

    ▪ Monitor hemoglobin level and hematocrit; administer blood products as ordered.

    Patient teaching

    ▪ Show the patient how to collect urine specimens.

    ▪ Emphasize the need to increase fluid intake.

    ▪ Explain the underlying cause of hematuria and its treatment.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Urinary Tract Infections: Management of Urinary Tract Infection
    (Pediatric Infectious Disease)

    In children who are not toxic and can maintain hydration, oral antibiotics can be started. Traditional oral antibiotics for the treatment of urinary tract infection in children include amoxicillin, trimethoprim-sulfamethoxazole, and oral cephalosporins. The increasing resistance of E. coli to amoxicillin has reduced empiric therapy with this antibiotic. The newer-generation oral cephalosporins, such as cefixime, cefdinir, and ceftibuten, have excellent gram-negative enteric bacteria coverage and can be useful in the treatment of resistant E. coli urinary tract infections. Nitrofurantoin has been used for the treatment of cystitis, although its failure to achieve good bloodstream concentrations has led to the recommendation that it should not be used to treat febrile infants or children with upper urinary tract involvement. The total duration of therapy for a urinary tract infection is variable, although patients typically receive 7 to 14 days of therapy.

    » READ BOOK EXCERPT ONLINE »

    Source: Pediatric Infectious Disease, 2004



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