What is your approach to managing patients with recurrent nephrolithiasis who consistently fail to adhere to recommended dietary changes including animal protein and sodium restriction and remain at elevated stone risk due to hypercalciuria despite thiazide diuretic use?

I typically repeat the prior recommendations and discuss potential barriers to better compliance with the patient in follow-up to try to encourage better compliance. I do point out that they might compensate for some dietary indiscretions in salt and protein by drinking extra fluid, since "dilution ...

This question is why I selected stone prevention as a clinical interest. Adherence is critical and perhaps more complex for me than all of the numerical issues with stone pathogenesis. When diet fails as described above, I have failed, and I do what I can to improve. No one answer because diet and l...