Metabolic Stone Prevention
Prevention is where stone disease is won or lost — one universal lever (fluid) plus targeted measures matched to the metabolic abnormality on the 24-hour urine.
The big picture
Prevention is where stone disease is actually won or lost. Removing a stone treats today; preventing the next one treats the disease. The good news is that prevention rests on a small number of well-evidenced levers — one that helps every stone former (fluid), and a few targeted ones matched to the metabolic abnormality found on the 24-hour urine. Get the universal measure right and apply the targeted ones, and recurrence falls sharply.
The framework: one universal measure (fluid), the dietary levers (sodium, animal protein, calcium, oxalate), and the targeted pharmacology (thiazide, potassium citrate, allopurinol, thiol drugs).
Mechanism pathway
Tap any step to see why it happens.
Diagnostic algorithm
Each step answers one question. Tap to expand.
Board traps
Fluid (urine >2.5 L/day) helps every stone former — the universal first measure.
Do NOT restrict dietary calcium — it raises oxalate absorption and worsens stones; restrict sodium instead.
High animal protein lowers protective citrate (acid load) — moderate it.
Match the drug to the 24-hour urine: thiazide (hypercalciuria), potassium citrate (hypocitraturia / uric acid), allopurinol (hyperuricosuria), thiols (cystine).
Recheck the 24-hour urine to confirm the lever worked.