Treatment of Nephrolithiasis

Dietary and Pharmacologic Management to Prevent Recurrent Nephrolithiasis in Adults: A clinical Practice Guideline From the American College of Physicians

This ACP guideline not only summarizes their recommendations and the evidence behind them, it also serves as a nice review of the many treatments for recurrent nephrolithiasis. I was particularly interested to learn that in the 6 trials they found, there is a 50% relative risk reduction, and a roughly 24% absolute risk reduction (NNT= about 4) for thiazides in the treatment of calcium containing stones (most kidney stones).

Summary of recommendations from the abstract:

"Recommendation 1: ACP recommends management with increased fluid intake spread throughout the day to achieve at least 2 L of urine per day to prevent recurrent nephrolithiasis. (Grade: weak recommendation, low-quality evidence)
Recommendation 2: ACP recommends pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol to prevent recurrent nephrolithiasis in patients with active disease in which increased fluid intake fails to reduce the formation of stones. (Grade: weak recommendation, moderate-quality evidence)"

Posted by Gank_90

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