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Medical Management of Stone Disease Gary C. Bellman, M.D. Urology office 818 703 9500

Medical Management of Stone Disease Gary C. Bellman, M.D. Urology office 818 703 9500. Evidence Based Recommendation for the Management of Urolithiasis. Fluids: Goal is for patients to produce 2 litres of fluid per day Water is a good choice as is citrus juices

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Medical Management of Stone Disease Gary C. Bellman, M.D. Urology office 818 703 9500

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  1. Medical Management of Stone DiseaseGary C. Bellman, M.D. Urologyoffice 818 703 9500

  2. Evidence Based Recommendation for the Management of Urolithiasis • Fluids: Goal is for patients to produce • 2 litres of fluid per day • Water is a good choice as is citrus juices • Lemonaide is the best beverage as it is highest in citrate (stone inhibitor)

  3. Calcium • Moderate calcium intake is recommended and actually protective for stone formation • Low calcium intake increases the risks of stones • If supplemental calcium is indicated five calcium citrate (citracal) • Check bone density in stone patients

  4. General dietary recommendations • Minimize red meat • Decrease salt intake • Limit vit C to 750 mg/day • Multivitamins are ok

  5. flank pain, stone or musculoskeletal? often bilateral, little lower Worse with activity, end of the day Can radiate to buttocks or down thigh Unilateral Unaffected by position or activity Radiates anteriorly, testicle

  6. Fluid management and ureteral stones Don’t try to “flush out” the stone… Leads to more pain

  7. Expulsive Therapyuseful in distal ureteral stones • Flomax 0.4 mg/day • Flomax is good for men and women! • Consider Prednisone in select patients • Euvolemia, patients in renal colic are often prerenal • benefit has only been shown in distal stones • Patients who present with a proximal stone is far less likely to pass it spontaneously

  8. Be liberal with calcium intake If supplemental calcium is indicated, i.e post menapausal women use…..

  9. EFFECT OF ANIMAL PROTEIN  urinary uric acid due to purine load  urine pH due to acid load urinary calcium due to reduced pH Animal protein: Red meat, fish, poultry

  10. Avoid High Dietary Oxalate • -- High-Oxalate Foods •   Tea (black)   Cocoa   Spinach   Mustard greens   Pokeweed   Swiss chard   Beets   Rhubarb   Okra   Berries (some)   Chocolate   Nuts   Wheat germ   Soy crackers   Pepper

  11. Inhibitors of Urinary Stone Formation

  12. Calcium Oxalate 60% • -- High-Oxalate Foods •   Tea (black)   Cocoa   Spinach   Mustard greens   Pokeweed   Swiss chard   Beets   Rhubarb   Okra   Berries (some)   Chocolate   Nuts   Wheat germ   Soy crackers   Pepper

  13. Recommendation Consider urocit k 20 meq for low citrate HCTZ or chlorthalidone for hypercalciuria

  14. Consider Uro consult if… • Intractable pain • Proximal /mid ureteral stone • Infection • Renal insufficiency • diabetes

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