Nephrolithiasis: prevention and therapy

Abstract

Recent guidelines have identified two steps in the prevention of recurrent urinary stones. The first includes general measures that may be recommended in all patients, irrespective of stone composition. These recommendations are substantially nutritional and include a diet with balanced intake of nutrients and abundant fluid ingestion, low in salt and normal in caloric intake, rich in vegetables and including dairy products. The second step includes specific measures based on the clinical activity of the kidney stone disease and the presence of acquired or hereditary conditions favouring recurrent stone formation. In this setting clinicians may prescribe drugs according to the composition of the stones and the urinary or metabolic abnormalities associated with the stones; surgical treatment may be coupled with medical therapy when there is malformation of the urinary tract or infected stones. Therefore, the role of clinicians in the treatment of stone formers is complex and requires the ability to characterize patients from a clinical, metabolic and nutritional point of view in order to provide the most personalized treatment possible.