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