How do you approach managing patients with recurrent nephrolithiasis who have low supersaturation profiles due to polyuria and stable stone disease on imaging but do have persistent urinary abnormalities such as hyperoxaluria, hypercalciuria, and hypocitraturia?  

If the stone disease is metabolically stable (no change in stone size or increase in number by serial CT imaging), I do not treat urinary chemical abnormalities. Presumably these patients have high levels of urinary inhibitors of crystallization. I encouraged them to continue their successful stone ...

This is a truly wonderful question. The only way to get low supersaturations AND hypercalciuria or high pH or high oxalate or low citrate is with high urine volume in relation to solute excretion rate. This means that as a clinician I delve into the years before stones began looking for obvious peri...