Are there other therapies such as SGLT2 inhibitors or alpha lipoic acid that you are offering your patients with cystinuria who continue to have active stone disease despite conservative therapy and thiol-based agents?

I am not aware of quality trials for new agents being advocated for the treatment of cystinuria. I do not prescribe them. Generally, the failure to respond to standard therapy reflects a failure of the patient to follow the appropriate diet and titrate the usual medications as regards urine pH and cystine excretion. I like the cystinuria panel offered by Litholink; it offers "cystine capacity," an indicator as to whether the urine is under- or supersaturated with respect to cystine, and the parameters that contribute. This allows me to target treatment areas that need to be improved. I have no financial interest in Litholink.

Stephen B. Erickson, MD