Kidney stones

To the Editor: Thanks for the excellent review articles on nephrolithiasis in your October 2009 issue.^1,2

Dr. Hall¹ cites studies in which patients given the alpha blocker tamsulosin (Flomax) or the calcium channel blocker nifedipine (Procardia) had improved rates of kidney stone passage compared with placebo. As a primary care physician, I am often confronted with the challenge of managing a patient who is waiting for a kidney stone to pass while taking tamsulosin. Is Dr. Hall aware of any clinical studies, or at least theoretical reasons, which would support adding nifedipine in such cases?

Secondly, Dr. Hall cites studies that demonstrated that a higher intake of dietary calcium is actually associated with fewer calcium stone events in both men and women. An unanswered question is whether patients taking calcium supplements for osteoporosis or osteopenia can safely continue to do so after a calcium stone event, or indeed, whether calcium supplementation might actually be helpful in preventing a recurrent calcum stone.

If there is an absence of randomized studies to answer these questions, Dr. Hall’s recommendations based on his expert experience would be most welcome.

To the Editor: Thanks for the excellent review articles on nephrolithiasis in your October 2009 issue.^1,2

Dr. Hall¹ cites studies in which patients given the alpha blocker tamsulosin (Flomax) or the calcium channel blocker nifedipine (Procardia) had improved rates of kidney stone passage compared with placebo. As a primary care physician, I am often confronted with the challenge of managing a patient who is waiting for a kidney stone to pass while taking tamsulosin. Is Dr. Hall aware of any clinical studies, or at least theoretical reasons, which would support adding nifedipine in such cases?

Secondly, Dr. Hall cites studies that demonstrated that a higher intake of dietary calcium is actually associated with fewer calcium stone events in both men and women. An unanswered question is whether patients taking calcium supplements for osteoporosis or osteopenia can safely continue to do so after a calcium stone event, or indeed, whether calcium supplementation might actually be helpful in preventing a recurrent calcum stone.

If there is an absence of randomized studies to answer these questions, Dr. Hall’s recommendations based on his expert experience would be most welcome.

To the Editor: Thanks for the excellent review articles on nephrolithiasis in your October 2009 issue.^1,2

Dr. Hall¹ cites studies in which patients given the alpha blocker tamsulosin (Flomax) or the calcium channel blocker nifedipine (Procardia) had improved rates of kidney stone passage compared with placebo. As a primary care physician, I am often confronted with the challenge of managing a patient who is waiting for a kidney stone to pass while taking tamsulosin. Is Dr. Hall aware of any clinical studies, or at least theoretical reasons, which would support adding nifedipine in such cases?

Secondly, Dr. Hall cites studies that demonstrated that a higher intake of dietary calcium is actually associated with fewer calcium stone events in both men and women. An unanswered question is whether patients taking calcium supplements for osteoporosis or osteopenia can safely continue to do so after a calcium stone event, or indeed, whether calcium supplementation might actually be helpful in preventing a recurrent calcum stone.

If there is an absence of randomized studies to answer these questions, Dr. Hall’s recommendations based on his expert experience would be most welcome.