What is your approach to managing patients with recurrent nephrolithiasis who have 24 hour urine chemistry results that demonstrate low risk for stone formation but continue to experience stone events?

My first question is what constitutes a "kidney stone event"? If it is a stone passage, l know of no treatment that will "glue" pre-existing stones in place. Uric acid and cystine stones can be dissolved, however.

If the event is the formation of new stones or the growth of preexisting stones with normal urine chemistries and undersaturation calculation, I suspect the “Whitaker” effect; that people behave differently when they know they are being observed. Or in this situation, they follow their diet and take their medication during the 24-hour urine collection. Re-enforcing the idea that consistent adherence to their treatment program is necessary for preventing stone formation and growth is the best you can do.

Stephen B. Erickson