Amy E. Krambeck, MD, presented “Medications for Stone Disease” during the 44th Annual Ralph E. Hopkins Urology Seminar on February 6, 2025, in Jackson Hole, Wyoming.
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How to cite: Krambeck, Amy E. “Medications for Stone Disease.” February 6, 2025. Accessed Mar 2025. https://grandroundsinurology.com/medications-for-stone-disease/
Medications for Stone Disease – Summary
Amy E. Krambeck, MD, discusses the metabolic management of kidney stones and provides a comprehensive overview of pharmacologic treatments. In this 23-minute presentation, Dr. Krambeck explains that while guideline recommendations have remained unchanged for over a decade, certain medications remain underutilized despite strong clinical evidence. She highlights current pharmacological options for treating different patient types:
- For struvite stones, acetohydroxamic acid, a urease inhibitor, can significantly reduce stone growth but is poorly tolerated, limiting its use to patients unable to undergo surgery. Similarly, renacidin, used to dissolve struvite stones through nephrostomy tube instillation, is rarely utilized due to risks of hypermagnesemia and sepsis.
- In cystine stones, cheating agents such as tiopronin offer better tolerability than older treatments like d-penicillamine. They reduce recurrence while requiring careful monitoring for nephrotic syndrome.
- Uric acid stones can be prevented by raising urinary pH with potassium citrate, a first-line therapy that outperforms allopurinol except in cases of hyperuricosuria with normal urinary calcium.
- For hypercalciuria, the role of thiazide diuretics in this condition is emphasized, particularly in combination with potassium citrate to prevent citrate depletion.
- For enteric hyperoxaluria, calcium supplementation, particularly calcium citrate, is effective. It counteracts excessive oxalate absorption in patients with bowel disorders.
- Lumisaran (Oxlumo) is a novel RNA-targeting therapy for primary hyperoxaluria type 1. It offers significant reductions in oxalate levels and is a potential alternative to liver-kidney transplantation.
Dr. Krambeck asserts that all patients require strict monitoring, frequent renal function checks, and a low-sodium diet. Personalized treatment based on each patient’s needs is paramount.
About The 44th Annual Ralph E. Hopkins Urology Seminar:
The Ralph E. Hopkins Urology Seminar is a multi-day meeting focused on training urologists in the latest in assessing, diagnosing, and treating urologic conditions in the clinical setting. Updates are provided on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, sexual function, emerging surgical techniques, and general urology. The 44th iteration of the meeting took place from February 5th to February 8th, 2025, in Jackson Hole, Wyoming.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Amy E. Krambeck, MD, is a professor of urology at Northwestern University Feinberg School of Medicine in Chicago, Illinois. Dr. Krambeck earned her medical degree from the University of Missouri School of Medicine in Columbia. She completed her urology residency at the Mayo Clinic in Rochester, Minnesota, where she received extensive training and refined her surgical expertise. Following her residency, Dr. Krambeck pursued an endourology fellowship at the Methodist Institute for Kidney Stone Research in Indianapolis, Indiana.
Dr. Krameck specializes in the surgical and medical management of stone disease and benign prostatic hyperplasia (BPH), and she has alleviated the symptoms of many patients. Her research focuses on the pathogenesis of stone disease and novel treatments for urolithiasis during pregnancy.
Dr. Krambeck began her career as an endourologist at the Mayo Clinic's Department of Urology, where she demonstrated exceptional surgical skills and a strong commitment to patient care. In 2016, Dr. Krambeck joined Indiana University, where she led the benign urologic diseases division until 2020. Her leadership and expertise significantly advanced the division, offering patients innovative treatments for various urologic conditions.
Dr. Krambeck's dedication to her patients, extensive knowledge, and research contributions have established her as a leading figure in urology. She continues to influence the future of urologic care through her clinical excellence and academic endeavors.
