Management of Nephrolithiasis | |
Factor Category | Guidance |
Comprehensive care | Encourage clinical care management from team of specialists: urologist, nephrologist, endocrinologist, and dietitian |
Treat hypercalciuria | Low salt diet, protein restriction (adults only) and consider a thiazide diuretic. In adults with hypercalciuria and osteoporosis, bisphosphonate therapy may be considered |
Treat hyperuricosuria | Dietary purine restriction, increased fluid intake and urine alkalinization, improve transfusion regimen if evidence of increased ineffective erythropoiesis, and consider allopurinol |
Treat hypocitraturia | potassium citrate |
Hydration | Maintain urine output greater than 2 - 2.5 L/day |
Chelation therapy | Reducing chelation dose or switching chelation therapy is unclear. May not be possible for many patients to change chelation due to concerns over iron overload and tolerance |