What is the role of chemoprophylaxis in the treatment of nephrolithiasis?

Updated: Jan 13, 2020
  • Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Prophylactic therapy might include limitation of dietary components, addition of stone-formation inhibitors or intestinal calcium binders, and, most importantly, augmentation of fluid intake. (See Dietary Measures and Prevention of Nephrolithiasis.) Besides advising patients to avoid excessive salt and protein intake and to increase fluid intake, base medical therapy for long-term chemoprophylaxis of urinary calculi on the results of a 24-hour urinalysis for chemical constituents.

In patients with high urine calcium levels and recurrent calcium stones, thiazide diuretics are recommended. In patients with recurrent calcium stones and low or relatively low urinary citrate, potassium citrate should be offered. If a patient suffers from recurrent calcium stones but metabolic abnormalities are absent or controlled with treatment, thiazides, potassium citrate, or both should be offered. [95]

Chemoprophylaxis of uric acid and cystine calculi consists primarily of long-term alkalinization of urine with potassium citrate. If hyperuricosuria or hyperuricemia is documented in patients with pure uric acid stones (present in only a relative minority), allopurinol (300 mg qd) is recommended because it reduces uric acid excretion. Allopurinol should also be offered to patients with recurrent calcium oxalate stones who have hyperuricosuria and normal urinary calcium levels. [95]

Pharmaceuticals that can bind free cystine in the urine (eg, D-penicillamine, 2-alpha-mercaptopropionyl-glycine) help reduce stone formation in cystinuria. Therapy should also include long-term urinary alkalinization and aggressive fluid intake.

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