Chronic treatment-nephrolithiasis

(CJASN 2016;11:1305 & 2017;12:1699)

• Increase fluid intake (>2 L/d) for goal UOP 2 L/d (J Nephrol 2016;29:211)

• Calcium stones: 24-h urine identifies specific urinary risk factors to treat

Diet: ↓ Na and meat (NEJM 2002;346:77), ↓ oxalate foods & sucrose/fructose

Meds: thiazides (↓ urine Ca), K-citrate if low urine citrate, allopurinol if high urine uric acid

Avoid low dietary Ca as ↑ oxalate absorp (NEJM 2002;346:77), unclear role of Ca suppl.

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• Uric acid: fluid intake, urine alkalinization (K-citrate) to pH 6.5–7, allopurinol
• Magnesium ammonium phosphate (struvite): antibiotics for UTI; urologic intervention; acetohydroxamic acid; urease inhibitor reserved for experienced clinician, poorly tolerated
• Cystine: fluid, urine alkaliniz (K-citrate) to 7–8, d-penicillamine, tiopronin (KI 2006;69:1041)