By vgreene, 29 December, 2015 ↑fluids to achieve daily urine output of ≥2 L/day per ACP1 and AHRQ;2 whereas AUA3 and EUA4 recommend ≥2.5 L/day
By vgreene, 29 December, 2015 Tx w/ thiazide, citrate, or allopurinol. ✓ single 24-hr urine @ 6 mo;8 if no tx response, repeat stone analysis, per AUA9
By vgreene, 29 December, 2015 ACP7 concluded multicomponent diet studies showed mixed results and inadequate evidence on tailoring drug/diet by stone type and blood/urine chemistries
By vgreene, 29 December, 2015 Diet: If relatively high urine oxalate, limit oxalate-rich foods and maintain NL Ca++ intake, per AUA9
By vgreene, 29 December, 2015 If hyperuricosuria w/ NL UCa++: Allopurinol3 per AUA; limit nondairy animal protein, per AUA9
By vgreene, 29 December, 2015 If low/relatively low U citrate: K+ citrate,20 increase fruits + veggies, limit nondairy animal protein, per AUA9
By vgreene, 29 December, 2015 If relatively high UCa++: thiazide,19 limit dietary Na+ ≤2,300 mg/day, consume dietary Ca++ 1,000-1,200 mg/day, per AUA21
By vgreene, 29 December, 2015 If stones persist w/ NL metabolic studies (or issues already addressed): Thiazide19 and/or K+ citrate;20 K+ citrate preferred over thiazide; per AUA
By vgreene, 29 December, 2015 AUA, EAU suggest stone analysis + urine metabolic studies to guide drug15,16 + diet17, 18 tx
By vgreene, 29 December, 2015 Thiazide (higher dose),10 citrate, or allopurinol, per ACP.11 AHRQ12 prefers thiazides or citrates over allopurinol. Combo tx (thiazide + citrate) not supported by AHRQ,13 ACP14