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Faculty experts at Indiana University School of Medicine Department of Urology are researching new ways to treat stone disease, including metabolic management of kidney stones and treating patients without the use of narcotics.
By not prescribing narcotics after procedures, faculty experts are researching ways to decrease opioid use in Indiana. In 2011, the Centers for Disease Control and Prevention declared an opioid epidemic in the United States. From 2016-17, opioid overdoses increased 70 percent in the Midwest.
Faculty researchers, led by Amy Krambeck, MD, enrolled patients in a study in which some of the patients were given narcotics commonly used after procedures while others were not prescribed any narcotics. Researchers found the patients who were not given narcotics recovered faster and were less likely to visit the emergency room or refill prescriptions for other pain medications when they ran out. Furthermore, those patients that had never received a narcotic prior to surgery were less likely to experience significant pain episodes requiring the use of narcotics than those that had been previously exposed. This study highlights the importance of preventing narcotic exposure to patients that have never received narcotics or are not already receiving narcotics on a regular basis.
Metabolic Management of Stone Disease
Researchers are studying ways to prevent new kidney stones from forming through metabolic management, or making changes to a patient’s diet. Faculty researchers found stone recurrence is common in high-risk patients, but general dietary recommendations can help to prevent stone recurrence. If a patient is taking thiazide diuretics, the medication requires a low-sodium diet. Sometimes a patient may need to take potassium citrate and calcium supplements. Potassium citrate is a medication that can help reduce the chances of stone recurrence, but is often expensive and can cause reflux or indigestion in patients. Researchers at Indiana University studied dietary alternatives to potassium citrate in order to help patients increase fluid intake, alkalinize urine and raise urinary citrate levels. They found diet that low calorie orange juice had the highest levels of citrate and free alkali compared to any other beverage available. When volunteers were given low calorie orange juice they noticed a rise in urine volume, a rise in urine pH, and a rise in urine citrate which are all protective against stone formation. Furthermore, other beverages such as lemon additives to water (i.e. crystal light or similar products) also provide similar benefits but to a lesser degree. Researchers are now enrolling patients in a trial comparing these diet alternatives to potassium citrate therapy. Stone-forming patients with low urinary citrate or low urinary pH are eligible for the study.
Treating Kidney Stones in Pregnant Women
Researchers are studying better ways to remove kidney stones in pregnant women. Previously, pregnant women who developed kidney stones would be given narcotics and a ureteral stent to help with the pain until the stone could be treated after delivery. However, narcotics and multiple anesthetics for stenting and stent exchange could be dangerous for the baby. Faculty researchers are using new techniques to perform ureteroscopy procedures to remove the kidney stones from women while pregnant in a minimally invasive way. This allows for quicker recovery to limit the baby’s exposure to narcotics and anesthetics.
Other Active Research Projects
This study, funded by the National Institutes of Health, aims to find the cause of Randall’s plaques. Randall’s plaques occur when calcium deposited in the interstitial tissue of the renal papilla. Researchers want to find the link to these plaques and calcium-based kidney stones.
The purpose of this study is to test whether removing small, asymptomatic stones from the same or opposite kidney will prevent future symptomatic stone episodes. Patients with recurrent or multiple stones that are visible on a computerized tomography (CT) scan or kidney, ureter and bladder X-ray may be eligible to participate.
The goal of this study is to determine the best duration of antibiotics prior to percutaneous nephrolithotomy (PCNL) in patients at a higher risk for infectious complications. Previous studies have demonstrated that longer durations of antibiotics may not necessarily be beneficial to patients and may actually increase complication rates. This study compares a one-week course versus a two-day course of antibiotics prior to surgery. Patients undergoing PCNL with an indwelling stent or nephrostomy tube or infected urine culture are eligible for this study.
The purpose of this study is to measure how well two different state of the art devices work to break up and remove kidney stones. Patients undergoing PCNL with stones greater than 2 cm in size are eligible for this study.
Researchers are trying to determine an effective antibiotic schedule following definitive surgical therapy of kidney stones caused by bacterial infection (struvite stones). They are comparing a short course of antibiotics, two weeks, to a suppressive low dose treatment for three months. Patients who undergo PCNL with a suspected struvite stone are candidates for this study.
The goal of this study is to learn more about the effect of an investigational drug (meaning the drug has not been approved by the United States Food and Drug Administration or any other health authority) used to treat hyperoxaluria, which occurs when there are large amounts of oxalate in the urine. If a patient has a documented history of high oxalate in urine and has a disorder associated with malabsorptions (such as Crohn’s disease or short bowel syndrome) they may be eligible to participate.