Annals of Internal Medicine
Summaries for Patients Prevention of Repeated Episodes of Kidney Stones in Adults: A Clinical Practice Guideline From the American College of Physicians
The full report is titled “Dietary and Pharmacologic Management to Prevent Recurrent Nephrolithiasis in Adults: A Clinical Practice Guideline From the American College of Physicians.” It is in the 4 November 2014 issue of Annals of Internal Medicine (volume 161, pages 659-667). The authors are A. Qaseem, P. Dallas, M.A. Forciea, M. Starkey, and T.D. Denberg, for the Clinical Guidelines Committee of the American College of Physicians.
Who developed these recommendations? The American College of Physicians (ACP) developed these recommendations. Members of the ACP are internists (specialists in the care of adults). What is the problem and what is known about it so far? Kidney stones are caused by the accumulation of certain solid materials in the kidney. Although kidney stones can sometimes occur without causing any symptoms, many patients experience severe pain and other problems when the stone is passed in the urine. The problems may include bleeding and damage to the kidney. People who have had a kidney stone are at risk for having another, so effective measures to prevent recurrent kidney stones would be useful. Although dietary or drug therapies are often recommended, whether these therapies can prevent repeated episodes of kidney stones is not clear. In addition, doctors often perform tests to figure out what material the stones are made of to try to better direct therapy and prevent future stones. Whether this is useful is also not clear. How did the ACP develop these recommendations? The ACP reviewed research on the benefits and harms of drug and dietary treatments to prevent recurrent episodes of kidney stones. They also assessed what evidence is available about the value of determining what a kidney stone is made of to direct treatment against repeated episodes. What did the authors find? Not enough evidence is available to know whether determining what a kidney stone is made of would be helpful in preventing additional episodes. Some evidence shows that drinking more liquids may help prevent additional episodes of kidney stones without causing harmful side effects. In addition, there is some evidence that reducing the amount of cola that one drinks may be helpful. Studies of dietary changes varied, and a consistent benefit was not found. Certain drugs (a thiazide diuretic, citrate, and allopurinol) that may help decrease the production of certain materials that commonly cause kidney stones or increase their elimination in urine may also help prevent kidney stones that are made of calcium deposits. Using drugs to prevent kidney stones may cause some side effects.
Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine. Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
What does the ACP recommend that patients and doctors do? Drinking at least 2 L of fluid during the day should be encouraged to prevent additional episodes of kidney stones. If this proves ineffective, doctors should consider prescribing a thiazide diuretic, citrate, or allopurinol. It is not clear whether doing tests to determine what a patient’s kidney stones are made of is helpful in preventing future episodes. What are the cautions related to these recommendations? The quality of available research varies, and studies comparing 1 treatment with another are limited.
Ann Intern Med. 2014;161:I-24. doi:10.7326/P14-9038
I-24 © 2014 American College of Physicians
Downloaded From: http://annals.org/ on 10/31/2016
Summaries for Patients Prevention of Repeated Episodes of Kidney Stones in Adults: A Clinical Practice Guideline From the American College of Physicians
The full report is titled “Dietary and Pharmacologic Management to Prevent Recurrent Nephrolithiasis in Adults: A Clinical Practice Guideline From the American College of Physicians.” It is in the 4 November 2014 issue of Annals of Internal Medicine (volume 161, pages 659-667). The authors are A. Qaseem, P. Dallas, M.A. Forciea, M. Starkey, and T.D. Denberg, for the Clinical Guidelines Committee of the American College of Physicians.
Who developed these recommendations? The American College of Physicians (ACP) developed these recommendations. Members of the ACP are internists (specialists in the care of adults). What is the problem and what is known about it so far? Kidney stones are caused by the accumulation of certain solid materials in the kidney. Although kidney stones can sometimes occur without causing any symptoms, many patients experience severe pain and other problems when the stone is passed in the urine. The problems may include bleeding and damage to the kidney. People who have had a kidney stone are at risk for having another, so effective measures to prevent recurrent kidney stones would be useful. Although dietary or drug therapies are often recommended, whether these therapies can prevent repeated episodes of kidney stones is not clear. In addition, doctors often perform tests to figure out what material the stones are made of to try to better direct therapy and prevent future stones. Whether this is useful is also not clear. How did the ACP develop these recommendations? The ACP reviewed research on the benefits and harms of drug and dietary treatments to prevent recurrent episodes of kidney stones. They also assessed what evidence is available about the value of determining what a kidney stone is made of to direct treatment against repeated episodes. What did the authors find? Not enough evidence is available to know whether determining what a kidney stone is made of would be helpful in preventing additional episodes. Some evidence shows that drinking more liquids may help prevent additional episodes of kidney stones without causing harmful side effects. In addition, there is some evidence that reducing the amount of cola that one drinks may be helpful. Studies of dietary changes varied, and a consistent benefit was not found. Certain drugs (a thiazide diuretic, citrate, and allopurinol) that may help decrease the production of certain materials that commonly cause kidney stones or increase their elimination in urine may also help prevent kidney stones that are made of calcium deposits. Using drugs to prevent kidney stones may cause some side effects.
Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine. Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
What does the ACP recommend that patients and doctors do? Drinking at least 2 L of fluid during the day should be encouraged to prevent additional episodes of kidney stones. If this proves ineffective, doctors should consider prescribing a thiazide diuretic, citrate, or allopurinol. It is not clear whether doing tests to determine what a patient’s kidney stones are made of is helpful in preventing future episodes. What are the cautions related to these recommendations? The quality of available research varies, and studies comparing 1 treatment with another are limited.
Ann Intern Med. 2014;161:I-24. doi:10.7326/P14-9038
I-24 © 2014 American College of Physicians
Downloaded From: http://annals.org/ on 10/31/2016
