What is the role of medications in the etiology of nephrolithiasis?

Updated: Jun 21, 2018
  • Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

A number of medications or their metabolites can precipitate in urine causing stone formation. These include the following [8, 9, 10] :

  • Indinavir
  • Atazanavir
  • Guaifenesin
  • Triamterene
  • Silicate (overuse of antacids containing magnesium silicate)
  • Sulfa drugs, including sulfasalazine, sulfadiazine, acetylsulfamethoxazole, acetylsulfasoxazole, and acetylsulfaguanidine
  • Ceftriaxone (rarely) [11]

A population-based case-control study from the United Kingdom found that use of any of the following five oral antibiotic classes 3–12 months before the index date was associated with nephrolithiasis:

  • Sulfas - Adjusted odds ratio (OR) 2.33 (95% confidence interval [CI] 2.19-2.48)
  • Cephalosporins – OR 1.88 (95% CI 1.75-2.01)
  • Fluoroquinolones – OR  1.67 (95% CI 1.54-1.81)
  • Nitrofurantoin/methenamine – OR  1.70 (95% CI 1.55-1.88)
  • Broad-spectrum penicillins – OR 1.27 (9% CI 1.18-1.36)

Associations were greatest for exposure at younger ages (P< 0.001) and exposure 3–6 months before the index date (P< 0.001). With all but broad-spectrum penicillins, the risk remained statistically significant 3–5 years from exposure. [12]


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