Would you start stone preventative medications such as potassium citrate and thiazide diuretics for patients with recurrent calcium based nephrolithiasis and abnormal 24 hour urine chemistries if they no longer have calculi on most recent imaging testing?

If they have had stones previously they remain at risk of recurrent stones. Would want to know when was the last stone episode. Was there previous treatment? It would be based on the results of the 24 hr urine and how significant is the hypercalciuria, oxaluria, low the citrate and pH are. Most importantly what are the supersaturations for calcium oxalate, calcium phosphate and uric acid. If the supersaturation is consistently above 6 for Ca-oxalate above 2.5 for ca- phosphate or above 1 for ura...

I agree with points made by both Drs. @Dr. First Last and @Dr. First Last, but I would add the following nuanced answer. I agree that stone disease is generally a lifelong disease, but it can be treated by several different methods. I usually focus only on dietary changes (including adding calcium to the diet with pills if necessary) if recurrences are relatively rare (every few years or more). I would only add daily tablets like thiazides or potassium citrate, if their stone recurrences are onc...

Typically, nephrolithiasis is a recurrent disease process. Treatment is therefore generally lifelong.

However, if you have imaging evidence that there has been no recurrence of new stones or growth of existing stones within the last year, this meets my definition of “metabolic inactivity”, and I would not add any additional stone prevention treatment to whatever the patient is already doing.

Stephen B. Erickson, MD