Medical prevention of renal stone disease

Medical treatment designed to prevent stone formation is important in idiop athic calcium oxalate nephrolithiasis, because of the high rate of stone re currence. Several randomized trials have established the values of conserva tive and drug treatments. A high fluid intake alone has been reported to in hibit the recurrence of stone formation in single stone formers. In patient s with recurrent disease, a significant reduction in stone formation rate f rom pretreatment was found in the placebo group maintained on a conservativ e program, underscoring the importance of increased fluid intake and dietar y modification. In patients with active recurrent stone disease, treatment with drugs along with a conservative program is necessary. Atlopurinol, thi azide, potassium citrate and potassium-magnesium citrate have been shown to inhibit stone formation compared with placebo. It has not been clearly est ablished that a selective treatment is more effective than a more randomly chosen drug treatment. Anothe r adva ntage of m ed ical approach is its a h i I ity to correct nonrenal complications of stone disease, such as bone to ss that sometimes accompanies stone disease.