Intended for healthcare professionals

Clinical Review State of the Art Review

Medical management of renal stones

BMJ 2016; 352 doi: (Published 14 March 2016) Cite this as: BMJ 2016;352:i52
  1. Monica S C Morgan, doctor1,
  2. Margaret S Pearle, professor of urology1
  1. 1Department of Urology, UT Southwestern Medical Center, Dallas, TX 75390-9110, USA
  1. Correspondence to: M S Pearle margaret.pearle{at}


The prevalence of kidney stones is increasing in industrialized nations, resulting in a corresponding rise in economic burden. Nephrolithiasis is now recognized as both a chronic and systemic condition, which further underscores the impact of the disease. Diet and environment play an important role in stone disease, presumably by modulating urine composition. Dietary modification as a preventive treatment to decrease lithogenic risk factors and prevent stone recurrence has gained interest because of its potential to be safer and more economical than drug treatment. However, not all abnormalities are likely to be amenable to dietary therapy, and in some cases drugs are necessary to reduce the risk of stone formation. Unfortunately, no new drugs have been developed for stone prevention since the 1980s when potassium citrate was introduced, perhaps because the long observation period needed to demonstrate efficacy discourages investigators from embarking on clinical trials. Nonetheless, effective established treatment regimens are currently available for stone prevention.


  • Contributors: MSCM and MSP both contributed to the conception and design of the review and the acquisition, analysis, and interpretation of the data. MSCM made the draft and MSP critically revised it for important intellectual content and approved the final version to be published. Both authors are guarantors.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: none.

  • Provenance and peer review: Commissioned; externally peer reviewed.

  • No patients were asked for input in the creation of this article.

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