Interventions to prevent recurrent kidney stones
| DIETARY INTERVENTIONS |
| All—Increase fluid intake to produce a urine volume of at least 2.5 L/day |
| Calcium stones and hypercalciuria—Limit sodium intake to 2,300 mg/day; consume at least 1,000 or 1,200 mg/day of dietary calcium; restrict nondairy animal protein to 0.8 to 1 g/kg/day; increase intake of fresh fruits and vegetables |
| Calcium oxalate stones and relatively high urinary oxalate intake—Limit intake of oxalate-rich foods and maintain normal calcium intake |
| Calcium oxalate stones and hypocitraturia—Increase intake of fruits and vegetables and limit nondairy animal protein |
| Uric acid stones or calcium stones with hyperuricosuria—Limit intake of nondairy animal protein to 0.8 to 1 g/kg/day |
| Cystine stones—Limit sodium intake to 2,300 mg/day and protein intake to 0.8–1g/kg/day |
| PHARMACOLOGIC INTERVENTIONS |
| Hypercalciuria and recurrent calcium stones—Thiazide diuretics |
| Recurrent calcium stones and hypocitraturia—Potassium citrate |
| Uric acid and cystine stones—Potassium citrate to alkalize urine to optimal level |
| Recurrent calcium oxalate stones and hyperuricosuria— Allopurinol |
| Uric acid stones—Do not use allopurinol as first-line therapy, but consider it in refractory cases |
| Type 1 hyperoxaluria—Pyridoxine |
| Cystine stones unresponsive to conservative measures— Offer a cystine-binding thiol drug, eg, D-penicillamine or tiopronin. Pharmacotherapy should always be used in conjunction with conservative measures of dietary modification and urinary alkalization |
| Residual or recurrent struvite stones, and surgical interventions are contraindicated or refused—Consider urease inhibitors, acetohydroxamic acid |