American College of Physicians’ new kidney stones guidelines

Just out.

Recommendation 1: ACP recommends management with increased fluid intake spread throughout the day to achieve at least 2 L of urine per day to prevent recurrent nephrolithiasis [kidney stones]. (Grade: weak recommendation, low-quality evidence) […]

Recommendation 2: ACP recommends pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol to prevent recurrent nephrolithiasis in patients with active disease in which increased fluid intake fails to reduce the formation of stones. (Grade: weak recommendation, moderate-quality evidence)

That’s it. No strong recommendations based on high-quality evidence, unfortunately.

So, if you’re a stone maker, or might be, drink your water, at least. The evidence may be low-quality, but water can’t do harm at the quantity required. (Sure, you can drink other things, but they’ll add calories, chemicals, crap you don’t need, or cost more. Your call.)

For what it’s worth, I’ve been told by my nephrologist that lemon juice doesn’t provide enough citrate to bother with. (Of course if you drink enough of it … but I don’t know what “enough” means. I think on the order of a cup or so per day isn’t it. I have no data to point to, however.)

The full paper is here. A shorter summary for patients is here.


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