How to Reduce Recurrent Nephrolithiasis

Advise patients to drink at least 2 L daily; consider thiazide diuretics, citrate therapy and allopurinol for patients with “active” calcium stone formation.

American College of Physicians (ACP) Key Recommendations

• Increased fluid intake to achieve 2 L of urine output daily (weak recommendation; low-quality evidence).

• Drug therapy with a thiazide diuretic, citrate, or allopurinol for patients with active disease despite increased fluid intake (weak recommendation; moderate-quality evidence).

Reference:

1. 
   Qaseem A et al. Dietary and pharmacologic management to prevent recurrent nephrolithiasis in adults: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2014 Nov 4; 161:659.