TOPLINE

Patients with recurrent kidney stones had similar urine risk markers for kidney stones whether they started preventive treatment right away or after receiving a 24-hour urine test.

METHODOLOGY

• Researchers conducted a randomized trial to compare whether starting treatment immediately or tailoring treatment based on 24‑hour urine testing was better for patients with recurrent kidney stones.
• They included 56 adults (mean age, 44.5 years; 54% women) who had at least two symptomatic calcium kidney stone events in the previous 5 years. All were recruited from a urology clinic between 2022 and 2025.
• Patients were randomly assigned to one of two groups: One started standardized diet counseling with daily indapamide and potassium citrate right away; the other received diet advice and medications (indapamide, potassium citrate, and/or allopurinol) tailored after receiving a 24-hour urine test.
• The primary outcomes were how concentrated calcium oxalate and calcium phosphate were in the 24-hour urine samples at 8 weeks, reflecting their potential to form crystals.
• Secondary outcomes included measures of uric acid, urine volume and pH, and 24-hour excretion of calcium, uric acid, and sodium.

TAKEAWAY

• Among 40 patients who completed the 8-week follow-up, those who started treatment immediately and those who received tailored treatment did not show significant differences in urine markers for calcium oxalate or calcium phosphate crystal formation.
• The two groups showed no significant differences in urine volume, pH, or excretion of calcium, oxalate, citrate, uric acid, and sodium.
• Both groups maintained similarly high adherence to medications and had no significant differences in rates of side effects.

IN PRACTICE

“The choice between selective and empiric therapy may depend more on local resources, patient preferences, and clinician expertise than on inherent superiority of either approach,” the researchers wrote.

“The most clinically useful framework may be selective use of selectivity: identifying which patients require detailed metabolic phenotyping and which can safely begin effective prevention immediately,” Gregory E. Tasian, MD, wrote in an editorial comment.

SOURCE

The study was led by Ryan S. Hsi, MD, of the University of California in Orange, California. It was published online on June 30 in the Journal of Urology.

LIMITATIONS

The 8-week follow-up duration may not indicate long-term recurrence of stones.

DISCLOSURES

The study received support from the National Institutes of Health and the National Center for Advancing Translational Sciences. One author reported serving on the editorial board of the Journal of Urology. The authors disclosed no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.