In a systematic review of 31 studies (mostly randomized trials), increased fluid intake; a diet with normal to high calcium, low protein, and low sodium; thiazide diuretics; alkali therapy; and allopurinol were associated with lower recurrence of calcium oxalate or calcium phosphate stones in adults, although strength of evidence was low. Selective, stone-based pharmacotherapy didn’t clearly differ from empiric therapy. Acetohydroxamic acid was associated with reduced growth of infection-related stones but to more adverse events. Data were sparse for children, imaging strategies, and harms overall.
Clinical takeaway: For adults with recurrent calcium-based stones, prioritize counseling on high fluid intake, sodium and protein reduction with adequate dietary calcium, and consider thiazides, alkali therapy, or allopurinol based on stone type and risk profile.
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