Nephrolithiasis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Adjuvant alpha‐blocker therapy following shock wave lithotripsy

A systematic review of randomised controlled trials (RCTs) found that adjuvant alpha‐blockers (most commonly tamsulosin) following shock wave lithotripsy, in addition to usual care, may result in improved stone fragment clearance, less need for auxiliary treatments, fewer major adverse events, and a reduced stone-clearance time, compared with usual care alone. The included RCTs were of low methodological rigor with poor reporting quality of small sample size and without stratification for important prognostic variables such as stone size and location, resulting in low certainty of evidence.[82]

Burst wave lithotripsy

Burst wave lithotripsy (BWL), the transcutaneous application of focused, cyclic ultrasound pulses, has been investigated for the management of stones ≤12 mm.[119] In the first in-human study of this technique, a 90% reduction of stone volume into ≤2 mm within 10 minutes of BWL exposure was observed, with minimal tissue injury.[119]

Dexamethasone plus ketorolac

Combination therapy with dexamethasone (a corticosteroid) with ketorolac has been shown to provide more effective pain relief for renal colic than ketorolac alone.[120]

Lumasiran

Lumasiran, a double-stranded small interfering ribonucleic acid (siRNA), may be of benefit in patients with kidney stones due to primary hyperoxaluria type 1.[121] It targets glycolate oxidase, thus reducing hepatic oxalate production.[121] Lumasiran is approved in Europe and the US for the treatment of primary hyperoxaluria type 1 across all age groups.

Nedosiran

Nedosiran, a double-stranded siRNA, may be of benefit in patients with primary hyperoxaluria type 1. It works by reducing urinary oxalate levels by inhibiting expression of hepatic lactate dehydrogenase, a liver enzyme in the oxalate synthesis pathway. Nedosiran is approved in the US for the treatment of primary hyperoxaluria type 1 (and relatively preserved kidney function) in children aged 9 years and older and adults. However, it is not approved in Europe as yet.

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