What should be included in patient education about nephrolithiasis?

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

A patient who tends to develop stones should be counseled to seek immediate medical attention if he or she experiences flank or abdominal pain or notes visible blood in the urine.

Although discovering the underlying cause of a patient’s stones and starting preventive therapy is not the primary responsibility of the physician treating a patient with acute renal colic (such measures are best addressed once the immediate problem has been addressed), this physician should, at the very least, educate the patient and family members about the availability of preventive testing and treatment. When properly performed and evaluated, preventive treatment plans can improve the situation in most patients with stones.

Note that failure to offer stone-prevention advice could actually be a source of medicolegal liability. Numerous patients have claimed they have not been told about stone-prevention options.

One anecdotal example from the practice of one of the editors is that of a 65-year-old man with a 5-year history of more than 60 stones. Although he underwent two open surgeries for stone removal, his stones were not evaluated for chemical composition. Eventually, the stones were analyzed and found to be pure uric acid. Although his uric acid excretion rate was normal, he had highly acidic urine, which led to the uric acid calculi formation. After starting oral therapy of allopurinol and potassium citrate, he remained free of stones for 10 years.

Even patients who develop single stones may be strongly motivated to follow a program for maximum kidney stone prophylaxis. Discussing the pros and cons of a comprehensive stone-prevention program with all patients who have documented kidney stone disease—not with just those who are obviously at high risk—may be prudent.

For patient education information, see the Kidneys and Urinary System Center, as well as Kidney Stones, Blood in the Urine, and Intravenous Pyelogram. In addition, numerous Internet sites offer kidney stone information, including the National Institutes of Health (NIH) and the Urology Care Foundation.


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