Measures to prevent recurrence of renal or ureteric stones

Dietary and lifestyle advice

Advice regarding diet and fluid intake::

• adults to drink 2.5 to 3 litres of water per day, and children and young people (depending on their age) 1 to 2 litres
• adding fresh lemon juice to drinking water
• avoiding carbonated drinks
• adults to have a daily salt intake of no more than 6 g, and children and young people (depending on their age) 2 to 6 g
• not restricting daily calcium intake, but maintaining a normal calcium intake of 700 to 1,200 mg for adults, and 350 to 1,000 mg per day for children and young people (depending on their age).
• avoid excess dietary protein, as this acidifies urine and promotes hyperuricosuria, predisposing to stone development (2)

Potassium citrate

• alongside the recommendations on dietary and lifestyle advice
  • potassium citrate should be considered for adults with a recurrence of stones that are predominantly (more than 50%) calcium oxalate
  • potassium citrate should be considered for children and young people with a recurrence of stones that are predominantly (more than 50%) calcium oxalate, and with hypercalciuria or hypocitraturia.

Thiazides

• alongside the recommendations on dietary and lifestyle advice
  • thiazides should be considered for adults with a recurrence of stones that are predominantly (more than 50%) calcium oxalate and hypercalciuria, after restricting their sodium intake to no more than 6 g a day

Notes:

• metabolic testing
  • stone analysis should be considered for adults with ureteric or renal stones
  • measure serum calcium for adults with ureteric or renal stones
  • consider referring children and young people with ureteric or renal stones to a paediatric nephrologist or paediatric urologist with expertise in this area for assessment and metabolic investigations

Reference:

• NICE (December 2018).Renal and ureteric stones: assessment and management (NG118)
• Wilcox CR et al. Kidney stone disease: an update on its management in primary care. BJGP 2020; 70: 205–206.