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).


  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 4161:659.
Read all articles in Medical General, medical procedures, Nephrology, Paracentesis
Tags: diuretics, HPC updates, kidney stones, nephrolithiasis, thiazides

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