Kidney Stones - Treatment

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Allopurinol. Allopurinol (Lupurin, Zyloprim) is very effective at reducing high blood levels of uric acid, and it may be helpful for patients with uric acid stones. Allopurinol will not prevent calcium stones from forming. There is also a slight risk for the formation of xanthine stones with this drug. Side effects include diarrhea, headache, and fever. About 2% of patients have an allergic reaction to allopurinol that causes a rash. In rare cases, the rash can become severe and widespread enough to be life threatening.

Allopurinol reduces uric acid levels rapidly, so it may trigger an attack of gout in vulnerable people. To prevent this problem, patients taking allopurinol should also take a nonsteroidal anti-inflammatory drug (NSAID) for 2 or 3 months. Aspirin should not be taken, because it increases uric acid levels. Patients should discuss the appropriate NSAID choice with their doctor.

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In 2009, the U.S. Food and Drug Administration approved febuxostat (Uloric) to treat gout. It is the first new treatment for gout in 40 years. Febuxostat lowers uric acid levels by inhibiting the same enzyme as allopurinol, and it can be taken by patients who are allergic to allopurinol. This new drug is very effective, but expensive.

Medications for Struvite Stones

Before patients can receive any medical treatment for struvite stones, they must have surgery to completely remove the stones.

Antibiotics for Eliminating Infection. People with struvite stones should receive ongoing treatment with antibiotics to keep the urine free of the bacteria that cause urinary tract infections. Careful follow-up and urine testing are extremely important. A high urine pH indicates low acidity and an increased risk for infection.

Acetohydroxamic Acid (AHA). Acetohydroxamic acid (AHA or Lithostat) is beneficial when used with long-term antibiotics. AHA blocks enzymes that bacteria release, and it has been effective in preventing stones even when bacteria are present. Side effects, however, can be severe. The drug reduces iron levels in the body, so anemia is a common problem. Patients may need to take iron supplements. Other side effects include nausea, vomiting, depression, anxiety, rash, persistent headache, and, rarely, small blood clots in the legs. This drug is recommended only for patients with healthy kidneys whose condition is due to specific struvite-causing organisms. Patients taking this medicine should avoid alcohol. Pregnant women should not take acetohydroxamic acid.