How do thiazides help kidney stones?
When used appropriately in renal leak hypercalciuria, thiazides prevent secondary hyperparathyroidism and normalize vitamin D3 synthesis, calcium absorption, and urinary calcium excretion. Stone formation rates drop more than 90% in patients with renal calcium leak who are placed on long-term thiazide therapy.
Why is Hydrochlorothiazide used for kidney stones?
Hydrochlorothiazide can be used to treat calcium-containing kidney stones because it decreases the amount of calcium excreted by the kidneys in the urine and thus decreases the amount of calcium in urine to form stones.
Are thiazide diuretics used for kidney stones?
In response to increasing incidence of kidney calculi, various interventions have been performed to prevent the occurrence of stones, including dietary interventions and medical treatments [4,5,6]. Among them, thiazide diuretics are the commonly used drugs for preventing recurrent kidney calculi [7, 8].
Why are thiazide diuretics used for hypercalciuria?
Thiazides are specifically indicated for patients with renal leak hypercalciuria, in whom they not only reduce the inappropriate renal calcium loss but also lower parathyroid hormone (PTH) levels and normalize other metabolic processes.
How does a thiazide diuretic work?
Thiazide diuretics are drugs that cause both natriuresis (removal of sodium in the urine) and diuresis. Thiazide diuretics work by blocking sodium and chloride (Na/Cl) channels in the distal convoluted tubule of the nephron and inhibit the reabsorption of sodium and water.
What is the mechanism of action of thiazide diuretics?
The MOA of thiazide diuretics is to decrease sodium reabsorption and therefore decreased fluid reabsorption; this directly causes decreased levels of circulating sodium.
Do diuretics help pass kidney stones?
Not only do diuretic foods help flush out kidney stones, but they also help discard kidney stone forming minerals. Some common foods that contain diuretics include celery, parsley, brussel sprouts, cucumbers, watermelon, and asparagus.
How do thiazides increase calcium reabsorption?
Thiazides enhance Ca reabsorption in the distal convoluted tubule, by increasing Na/Ca exchange (which makes thiazides useful in treating the calcium-subtype of kidney stones).
How do diuretics cause kidney stones?
Certain medications have been implicated in kidney stone formation. Patients taking diuretics or water pills increase calcium concentration in their urine. Patients who take calcium containing antacids and calcium supplements also increase their urinary calcium.
Does hydrochlorothiazide prevent kidney stones?
Your doctor may prescribe a thiazide diuretic, which can reduce the amount of calcium released into the urine. These include hydrochlorothiazide, chlorthalidone, or indapamide, all of which help to prevent kidney stones from returning, especially in people who have high levels of calcium in the urine.
Which diuretic causes renal stones?
Urinary calculi can be induced by a number of medications used to treat a variety of conditions. Loop diuretics, carbonic anhydrase inhibitors, and abused laxatives can cause metabolic abnormalities that facilitate the formation of stones.
Which diuretic causes calcium stones?
Hypercalciuria is the most common metabolic risk factor for the development of kidney stones. Numerous studies (including several randomized trials)4-6 have shown the efficacy of thiazide diuretics for both lowering urinary calcium excretion and the subsequent likelihood of future kidney stone episodes.
Thiazide Type Diuretics Reduce Stone Formation
The common thiazide type drugs in use today are hydrochlorothiazide, chlorthalidone, and indapamide. All three have been used in stone prevention t...
Thiazide Is Not Used Alone
Because they can reduce formation of new calcium stones, thiazide type diuretics are co-equal with potassium citrate as a medication physicians can...
How Do Thiazides Affect The Kidneys?
With a brief blush and downward gaze, I choose our own publication as perhaps not unreasonable as a source. Partly I am guilty of favoritism, partl...
How Do Thiazides Lower Urine Calcium?
I have said it is not just by acting on the kidneys, for that is to close down the drain – the bathtub will overflow perhaps but you cannot reduce...
Effect of Thiazide on Bone Mineral Balance
All this raises an obvious question: Do thiazides improve bone health, reduce fractures, increase bone mineral content?A recent review summarizes a...
Is One Drug Better Than another?
I think so. For example, hydrochlorothiazide has been used 2 times a day in the stone trials, whereas indapamide and chlorthalidone are long acting...
How many stone formers have calcium?
Stone composition was known in 1,154 stone formers (49%), of whom 1,091 had calcium stones. Those who received thiazide diuretics were more likely to have a known calcium component of the stones than those who did not receive thiazide diuretics. Table 1. Characteristics of incident symptomatic stone formers. Thiazide.
How many struvite stones are excluded from sensitivity analysis?
There were 9 struvite and 2 cystine stone formers excluded from the sensitivity analysis. The multivariate adjusted risk of DM with thiazide diuretic for any indication (HR 1.16; 95% CI 0.65, 2.03) or for kidney stone prophylaxis (HR 0.84; 95% CI 0.29, 2.40) did not change substantively with these exclusions.
Do stone formers have a higher BMI?
The stone formers who received thiazide diuretics during followup were more likely to be older, white race, have a family history of stone disease, have a higher BMI, have hypertension at baseline or during followup, and have more total stone events (table 1). Stone formers who received thiazide diuretics during followup had a longer overall follow-up than those who did not receive thiazide diuretics (mean 13.9 vs 9.8 years, p <0.001). This was expected since receiving a thiazide diuretic after the first stone event predicates followup time on a future event. Stone composition was known in 1,154 stone formers (49%), of whom 1,091 had calcium stones. Those who received thiazide diuretics were more likely to have a known calcium component of the stones than those who did not receive thiazide diuretics.
Can thiazide be used for kidney stones?
However, thiazide diuretics may be underused for the prevention of recurrent kidney stones in the general population due to patient or physician concerns regarding the side effects of this class of medications. There is a lack of data regarding adverse, long-term side effects of thiazides used for stone prevention.
Is calcium stone former a thiazide diuretic?
Like hypertensive patients, calcium stone formers are at increased risk for DM, independent of thiazide diuretic use.28The association between nephrolithiasis and subsequent DM may be due to a common metabolic defect that contributes to the development of both diseases.28,29Regardless of the underlying mechanism(s) for the association between DM and nephrolithiasis, we did not find any evidence that thiazide diuretic use for stone prophylaxis further increases the risk of diabetes.
Can thiazide cause hyperglycemia?
The mechanism of thiazide diuretic induced glucose intolerance is not understood.25,26It has been hypothesized that hypokalemia is the most likely cause of thiazide induced hyperglycemia, perhaps leading to impaired beta-cell insulin release.27Unfortunately we did not have serum potassium levels in our study to evaluate for a potential link between hypokalemia and DM risk. There is no definitive evidence of a mechanistic chain between thiazide diuretics and hyperglycemia, potassium dependent or independent.26The clinical relevance of possible thiazide induced diabetes has been debated since analysis from ALLHAT did not reveal an increased risk of cardiovascular events among patients with impaired fasting glucose or diabetes mellitus who received thiazides.8Thus, many have concluded that the cardiovascular benefit of better HTN control when thiazide diuretics are used may outweigh any potential cardiovascular harm from a modestly increased risk of DM. However, normotensive stone formers who take thiazide diuretics will probably not benefit from lowering a blood pressure that is already normal. Thus, an increased risk of DM with thiazide diuretic use in stone formers without HTN is of particular concern. However, our results revealed no increased DM risk among stone formers when thiazide diuretics were used solely for kidney stones.
Can thiazide diuretics cause diabetes?
The ALLHAT, which followed more than 30,000 patients with hypertension and randomized them to an angiotensin converting enzyme inhibitor, calcium channel blocker or thiazide diuretic therapy, showed that thiazide diuretics resulted in a modest increased risk of diabetes mellitus. ALLHAT showed an increase in the incidence of new onset diabetes after 4 years in the chlorthalidone group compared with the amlodipine and lisinopril groups (11.6% vs 9.8% and 8.1%).8Indeed, the potential for a disturbance in glucose metabolism has been a concern since the introduction of thiazides as a class of antihypertensive agent,9,10and has been described in nondiabetic, pre-diabetic and diabetic patients, although the mechanism for this association is unknown.9,11–13Since an association between insulin resistance and HTN has been described,14–16hypertensive individuals might be more susceptible to any hyperglycemic potential of this medication class compared to individuals without HTN in whom the medication is used solely to reduce urine calcium excretion. Thus, we assessed the risk of new onset DM among stone formers in relation to thiazide use and hypertension.
What is the best treatment for kidney stones?
Nonsteroidal anti-inflammatory drugs are the first choice for pain relief in patients with kidney stones. Alpha blockers are the first choice for medical expulsive therapy in patients with kidney stones.
What are the measures to prevent recurrence of kidney stones?
Measures to prevent recurrence of kidney stones include lifestyle modifications, citrate supplementation, and medications. 2, 15, 31, 38, 39 Lifestyle modifications are the cornerstone of prevention after a first kidney stone in patients with low risk of recurrence, whereas citrate supplementation and medications are reserved for patients with recurrent stones. 15, 31, 38, 39 Patients at high risk of stone recurrence should receive preventive measures tailored to the results of the metabolic assessment.
Why are kidney stones more common in children?
Kidney stones are becoming more prevalent in children because of increasing rates of diabetes mellitus, obesity, and hypertension in this population. 2 – 4, 9 Increasing age is a risk factor for kidney stones; therefore, adolescents are more likely to form stones than younger children. 2 Children with kidney stones are more likely to have a metabolic, neurologic, or congenital urinary system structural abnormality; to have concomitant urinary infection; and to have recurrent stones. 2, 3, 9, 31
How often should kidney stones be removed?
Many kidney stones are asymptomatic and found on imaging; each year, 10% to 25% become symptomatic or require intervention. 5 Conservative management is an option for adults who are healthy, unfit for surgery, or pregnant, and who have access to health care and can adhere to active surveillance (imaging after six months, then annually). 5, 36 The patient should be referred for stone removal if symptoms, obstruction, or recurrent infection develops, or if the stone grows larger. 5, 36 Stone removal should be considered if the patient prefers removal to conservative management; plans to conceive in the near future; has calyceal diverticular stones, stones larger than 10 mm (possibly larger than 4 mm), or renal pathology; or is unsuited for conservative management. 36
What lab test should be used to determine if a stone is high?
Basic laboratory evaluations include creatinine (for renal function), ionized calcium (for hyperparathyroidism), and uric acid (for hyperuricemia); parathyroid hormone should be measured only if the serum calcium level is high. 15, 31 If a stone was not retrieved for analysis, additional tests should be considered: urine pH (for nephrocalcinosis and other metabolic abnormalities), microscopy of sediment from morning urine (for urine crystals that may suggest stone composition), and a test for cystinuria (especially in children because it is an inherited metabolic disorder). 31
What is the best way to test for oxalate stones?
The patient should be instructed to strain his or her urine to catch the stone, then send the stone in a urine specimen cup or a clean, dry container for analysis; non–calcium oxalate stones require additional metabolic testing. 15, 31 Recurrent stones should also be considered for analysis because their composition may differ from the initial stone. 15, 31 When stone analysis is not available, ultrasonography should be ordered to look for renal abnormalities if it was not performed before the stone was passed. Non–contrast-enhanced CT should be considered if residual stone is suspected; this modality may help identify stone composition. 31
What should be included in a kidney stone evaluation?
Patients with newly diagnosed kidney stones should receive a basic evaluation consisting of a detailed medical history, serum chemistry, and urinalysis/urine culture. Patients at risk of stone recurrence ( Table 3 31 and Table 4 2, 32 – 35) should be referred for additional metabolic testing (e.g., 24-hour urine collection for total volume, pH, and calcium oxalate, uric acid, citrate, sodium, potassium, and creatinine levels) and individualized preventive measures. 15, 31 The medical history should review the stone history (including family history of kidney stones), diet, current medications, and conditions associated with an increased risk of kidney stones. 2, 15, 31 – 34
What can help prevent calcium stones?
Good hydration can help prevent recurrence of calcium stones. In addition, thiazide diuretics such as hydrochlorothiazide can help the kidney absorb more calcium, leaving less of it in the urine where it can form stones. Potassium citrate is another medication that can bind to calcium and help keep calcium oxalate and calcium phosphate in ...
What is the risk of kidney stones?
The lifetime risk of kidney stones among adults in the US is approximately 9% , and it appears that global warming may be increasing that risk. (As the climate warms, human beings are more likely to get dehydrated, which increases the risk of stone formation.) There are four major types of kidney stones: calcium oxalate/calcium phosphate, uric acid, struvite (magnesium ammonium phosphate), and cystine.
What is the cause of struvite stones?
Struvite stones are composed of magnesium ammonium phosphate, and form in alkaline urine. The most common cause of struvite stones is a bacterial infection that raises the urine pH to neutral or alkaline. Acetohydroxamic acid (AHA) can reduce urine pH and ammonia levels and help dissolve stones.
What is the best way to dissolve uric acid stones?
Adjusting the pH of the urine, most commonly with the medication potassium citrate, reduces the risk of uric acid stone formation and can also help dissolve existing stones. Sodium bicarbonate can also be used to alkalinize the urine. Some people with uric acid stones do produce high amounts of uric acid.
Can uric acid stones be too much?
Uric acid stones. Most patients with uric acid stones don’t have too much uric acid. Instead their urine is too acidic. When that happens, normal levels of uric acid dissolve into the urine where it can crystalize into stones.
What foods increase oxalate in urine?
Foods high in oxalates (nuts, spinach, potatoes, tea, and chocolate) can increase the amount of oxalate in the urine. Consume these in moderation. Calcium phosphate stones are less common than calcium oxalate stones.
Is calcium oxalate a kidney stone?
Meanwhile, scientists continue to explore treatments and to keep an eye on viral variants. Calcium stones are the most common type of kidney stones, and can be either calcium oxalate or calcium phosphate. As mentioned, good hydration is important to prevent calcium stones.
How to remove a small stone in the kidney?
To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube (ureteroscope) equipped with a camera through your urethra and bladder to your ureter. Once the stone is located, special tools can snare the stone or break it into pieces that will pass in your urine.
What is the procedure to break a kidney stone?
For certain kidney stones — depending on size and location — your doctor may recommend a procedure called extracorporeal shock wave lithotripsy (ESWL). ESWL uses sound waves to create strong vibrations (shock waves) that break the stones into tiny pieces that can be passed in your urine.
Can you drink more fluids after kidney surgery?
For instance, your doctor may recommend an antibiotic before and for a while after surgery to treat your kidney stones. Cystine stones . Along with suggesting a diet lower in salt and protein, your doctor may recommend that you drink more fluids so that you produce a lot more urine,.
Can calcium supplements cause kidney stones?
Continue eating calcium-rich foods, but use caution with calcium supplements. Calcium in food doesn' t have an effect on your risk of kidney stones. Continue eating calcium-rich foods unless your doctor advises otherwise.
What to take for pain after passing a stone?
To relieve mild pain, your doctor may recommend pain relievers such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
How to pass a stone?
You may be able to pass a small stone by: Drinking water. Drinking as much as 2 to 3 quarts (1.8 to 3.6 liters) a day will keep your urine dilute and may prevent stones from forming. Unless your doctor tells you otherwise, drink enough fluid — ideally mostly water — to produce clear or nearly clear urine.
Does Mayo Clinic help with kidney stones?
Our caring team of Mayo Clinic experts can help you with your kidney stones-related health concerns Start Here
What medications can cause kidney stones?
Here are just some of the medications that can potentially lead to kidney stones, as well as the medical conditions they’re often prescribed for: 1 Acetazolamide – glaucoma, epilepsy 2 Ciprofloxacin – antibiotic 3 Ephedrine – asthma and congestion 4 Furosemide – high blood pressure 5 Guaifenesin and ephedrine – bronchial issues 6 Magnesium Trisilicate – gastroesophageal reflux disease 7 Sulfonamides – antibiotic 8 Topiramate – epilepsy and seizures 9 Trimaterene – high blood pressure 10 Zonisamide – epilepsy
What drugs are used for HIV?
In short, this set of drugs really needs to be monitored. Potassium-sparing diuretics (like triamterene) and protease inhibitors (like indinavir, which are commonly prescribed for individuals with HIV, AIDS, or hepatitis C) are two other medications that can have this type of result.
Can vitamin C cause calcium stones?
Even over-the-counter vitamins can raise your risk of calcium stones. Vitamin C and D are the biggest culprits, so keep this in mind if you take either of these. Then there are the medications that have a tendency to support the formation of uric acid stones.
Can glucocorticoids cause calcium stones?
Other medications that can result in calcium-based stones include glucocorticoids (an anti-inflammatory and immunosuppressive), theophylline (which is typically prescribed for asthma, chronic bronchitis, and emphysema), and even some antacids. Even over-the-counter vitamins can raise your risk of calcium stones.
Can antivirals cause kidney stones?
One such prescription is antivirals, and some studies have connected antiviral use with “stone formation due to the low solubility of drugs at a normal urinary pH.” Not only does this particular set of drugs increase your risk of kidney stones, but acute renal failure—this is when your kidneys aren’t working like they should—can also occur. In short, this set of drugs really needs to be monitored.
Can taking a loop diuretic cause kidney stones?
Additionally, certain medications can raise your risk of certain types of stones. For example, taking loop diuretics can sometimes lead to calcium kidney stones. Loop diuretics are “ a powerful type of diuretic ” that work by reducing, if not completely eliminating, your body’s ability to reabsorb sodium, chloride, and potassium.
Can magnesium cause stones?
While the medications listed above can contribute to the formation of stones, some health experts suggest that there are some prescriptions that directly cause your body to make the stones.
What are the keywords used in thiazide diuretics?
Two researchers independently searched all studies with keywords of thiazide diuretics and kidney calculi published in the PubMed, EMBASE, and Cochrane Library databases. The following search terms were used: “kidney stones”, “kidney calculi”, “renal calculi”, “nephrolith”, “thiazide diuretics”, “sodium chloride cotransporter inhibitors”. The article search was limited by study design of RCTs. The search was performed until December 31, 2018. In addition, the references of the included studies were also retrieved to supplement the relevant research, including gray literatures (e.g., clinical trials). When the opinions of the two researchers differed, a third researcher was consulted. When there were other languages used, we sought help from linguists.
How many cases of renal calculi in thiazide diuretic group?
There were 286 cases of patients with recurrent kidney calculi in the thiazide diuretic groups and 52 cases of new stones, accounting for 18.2% of all patients; conversely, there were 285 cases in the placebo and untreated groups and 119 cases of new stones, accounting for 41.2% of all patients. The pooled RR for the incidence of renal calculi in the thiazide diuretic groups was 0.44 (95% CI 0.33–0.58, P < 0.0001, I2 = 21%; fixed-effects model; Fig. 3 ); the pooled RD was − 0.23 (95% CI − 0.30 to − 0.16, P < 0.0001, I2 = 43%; fixed-effects model; Fig. 4 ).
What are the adverse reactions of thiazide diuretics?
Further, 3.7–20% of the patients in the thiazide diuretic groups withdrew from the trials owing to the development of adverse reactions (e.g., hypokalemia , elevated uric acid levels, and abnormal blood glucose and cholesterol levels). Clinically, the main adverse reactions of thiazide diuretics are as follows: (1) water and electrolyte disturbance, such as hypokalemia and hyponatremia; (2) cardiovascular problems, such as blood volume insufficiency and orthostatic hypotension; (3) gastrointestinal reactions, such as anorexia, nausea, gastric irritation, and constipation; (4) central nervous system problems, such as dizziness, paresthesia, and headache; and (5) abnormalities in related metabolic indicators, such as hyperglycemia and elevated total cholesterol levels [ 25, 26, 27 ]. Makam et al. [ 28] showed that 14.3% of thiazide users and 6.0% of non-users had adverse reactions (serum sodium level of < 135 mmol/L; serum potassium level of < 3.5 mmol/L; and estimated glomerular filtration rate reduction by > 25% compared with that at baseline) ( P < 0.05). In the ALLHAT trial, the incidence of newly diagnosed diabetes was 17.1% in patients with metabolic syndrome after using chlorthalidone for 4 years; that in patients without metabolic syndrome was 7.7% ( P < 0.05) [ 29 ].
Is thiazide a good diuretic?
We reviewed the clinical guidelines and found that the 2016 updated edition of the Canadian Urological Association guidelines considered thiazide diuretics as a highly recommended drug for preventing recurrent kidney calculi (level of evidence: 1–3 and grade A–B recommendation, based on the Oxford levels of evidence and grades of recommendation). However, the grade according to the American College of Physicians guidelines was weak (grade: weak recommendation, moderate-quality evidence).
Does thiazide reduce renal calculi?
The quality of evidence for thiazide diuretics in reducing the incidence of kidney calculi was low; that in reducing the 24-h urinary calcium level among the patients with recurrent renal calculi was moderate (Table 2 ). Further, the quality of evidence for short-acting and long-acting thiazide diuretics in reducing the incidence of kidney calculi was low (Table 3 ).
Why did the Thiazide group not complete the study?
Borghi et al. [ 20] reported that two patients in their thiazide diuretic group did not complete the study because of the development of hypotension and hypokalemia; Ettinger et al. [ 19] reported that 41.5% of the patients in their thiazide diuretic group withdrew from the study owing to intolerance of thiazide diuretics (presence of fatigue, dizziness, and muscle symptoms); Laerum and Larsen [ 17] reported that two patients in their thiazide diuretic group withdrew owing to the development of hypokalemia or gout and three patients withdrew owing to the presence of mild fatigue and indigestion; Ohkawa et al. [ 15] mentioned that six patients in their thiazide diuretic group developed dizziness; two patients, weakness; and one patient, general malaise; and Scholz et al. reported that one patient in their thiazide diuretic group and another patient in their placebo group withdrew owing to the development of side effects. Further, 11 patients in their thiazide diuretic group complained of fatigue, nausea, and hypotension during treatment; however, the symptoms were not severe enough to cause treatment interruption [ 9 ].
How many records were searched for thiazide diuretics?
A total of 103 records were searched according to the search strategy (Additional file 1: Table S1), and 28 of them were related to thiazide diuretics for preventing kidney calculi after screening of the titles and abstracts (Fig. 1 ). Eight of them were reviews; seven investigated non-thiazide diuretics compared with a control condition; two reported failure to reduce the incidence of renal calculi; two were meta-analyses; three were non-RCTs; and six reported reduction of the occurrence of kidney calculi. We finally included eight RCTs conducted on thiazide diuretics [ 9, 10, 15, 16, 17, 18, 19, 20 ].
