Kidney Stones (Nephrolithiasis): Metaphylaxis in Struvite or Other Infectious Stones

Therapeutic Target

Prevention of stone recurrence (recurrence of urinary stones).

Therapy recommendations

Reduction of risk factors

  • Behavioral risk factors
    • Dehydration
  • Disease-related risk factors
    • Anorexia nervosa (anorexia nervosa)
    • Urinary dysfunction
    • Urinary tract infections with urease-forming bacteria* (urine pH > 7.0; favors crystallization of magnesium ammonium phosphate (10-15%) as well as carbonate apatite).
  • Medication
    • Chronic antibiotic therapy
    • Laxative abuse (misuse of laxatives)

* Obligate urease-forming bacteria: Proteus spp, Morganella morganii, Corynebacterium urealyticum, Ureaplasma urealyticum and Providencia rettgeri;also some of the E. coli and Pseudomonas aeruginosa can produce urease.Optional urease-forming bacteria: Klebsiella spp, Staphylococcus spp, Serratia marcescens, Enterobacter gergoviae and Providencia stuartii.

Nutritional therapy

  • Fluid intake 2.5-3 l/day.

Agents or measures of metaphylaxis.

  • Complete removal of the infectious stone mass from the hollow system (if present).
  • Treatment of the urinary tract infection with a tested antibiotic (resistogram!).
  • L-methionine or ammonium chloride for urine acidification (setting an acid urine pH between 5.8-6.2).

Operative therapy

  • When removing the stones, flush the kidney with hemacidrin (solution that dissolves struvite stones).