Table 4.

TREATMENT RECOMMENDATIONS FOR PREVENTION OF IDIOPATHIC CALCIUM STONES IN ADULTS

Treatment	Mechanism of action	Doses	Selection criteria	Potential complications
Fluids	Lowers supersturation by dilution of solutes	Adequate to maintain urine volume > 2 liters daily.	Useful for all SF. May be used as sole treatment for patients with a single stone episode.	Avoid fluids containing excess salt or carbohydrates
Diet	Lowers supersaturation by decreasing calcium and oxalate excretion	Na < 100 mmol/day Protein < 0.8–1 gm animal protein/kg BW	Especially useful for hypercalciuric or hyperuricosuric SF.	May be hard to maintain
		Oxalate < 100 mg/day	Hyperoxaluric SF	May be hard to maintain
	Maintains bone mineral, prevents hyperoxaluria	Calcium 800–1000 mg/day	All calcium SF	Should obtain from dietary sources, avoid supplements
Thiazide-type diuretics	Lowers supersaturation by decreasing calcium excretion	Chlorthalidone 12.5–50 mg daily Indapamide 1.25–2.5 daily Hydrochlorothiazide 12.5–25 mg twice daily	Hypercalciuric SF, may be useful for some normocalciuric SF	Hypokalemia, lowers blood pressure (may be desirable), allergy and sun sensitivity
Potassium alkali	Lowers supersaturation by chelating calcium Inhibits calcium crystal growth	Potassium citrate 10–20 meq bid-tid	Hypocitraturic SF	Monitor urine pH and CaP SS, avoid SS > 1
Allopurinol	Lowers urine uric acid concentration, which may improve solubility of calcium salts	100–300 mg/day (may be taken once daily)	Hyperuricosuric calcium SF	Allergy, may be severe.