Advise adult patients to drink 2.5 to 3 litres of water per day and children and young people (depending on their age) 1 to 2 litres.[16]National Institute for Health and Care Excellence. Renal and ureteric stones: assessment and management. January 2019 [internet publication].
https://www.nice.org.uk/guidance/ng118
[43]Agarwal MM, Singh SK, Mavuduru R, et al. Preventive fluid and dietary therapy for urolithiasis: an appraisal of strength, controversies and lacunae of current literature. Indian J Urol. 2011 Jul;27(3):310-9.
https://www.doi.org/10.4103/0970-1591.85423
http://www.ncbi.nlm.nih.gov/pubmed/22022052?tool=bestpractice.com
[44]Borghi L, Meschi T, Schianchi T, et al. Urine volume: stone risk factor and preventive measure. Nephron. 1999;8(suppl 1):31-7.
http://www.ncbi.nlm.nih.gov/pubmed/9873212?tool=bestpractice.com
In patients who are known stone formers, a target output of 2 to 2.5 litres per day is recommended; intake volume may need to be up to 4 litres per day to achieve this.[71]Pearle MS, Goldfarb DS, Assimos DG, et al.; American Urological Association. Medical management of kidney stones: AUA guideline. J Urol. 2014 Aug;192(2):316-24.
http://www.jurology.com/article/S0022-5347(14)03532-0/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/24857648?tool=bestpractice.com
[72]Cheungpasitporn W, Rossetti S, Friend K, et al. Treatment effect, adherence, and safety of high fluid intake for the prevention of incident and recurrent kidney stones: a systematic review and meta-analysis. J Nephrol. 2016 Apr;29(2):211-9.
http://www.ncbi.nlm.nih.gov/pubmed/26022722?tool=bestpractice.com
[73]Bao Y, Tu X, Wei Q. Water for preventing urinary stones. Cochrane Database Syst Rev. 2020 Feb 11;2:CD004292.
https://www.doi.org/10.1002/14651858.CD004292.pub4
http://www.ncbi.nlm.nih.gov/pubmed/32045491?tool=bestpractice.com
Also encourage the patient to adopt a low sodium intake and a normal calcium intake.[16]National Institute for Health and Care Excellence. Renal and ureteric stones: assessment and management. January 2019 [internet publication].
https://www.nice.org.uk/guidance/ng118
[46]Wang Z, Zhang Y, Wei W. Effect of dietary treatment and fluid intake on the prevention of recurrent calcium stones and changes in urine composition: a meta-analysis and systematic review. PLoS One. 2021 Apr 19;16(4):e0250257.
https://www.doi.org/10.1371/journal.pone.0250257
http://www.ncbi.nlm.nih.gov/pubmed/33872340?tool=bestpractice.com
People with nephrolithiasis are often advised to avoid a high protein diet. The European Association of Urology recommends limiting animal protein to 0.8 to 1.0 g/kg/day.[47]European Association of Urology. EAU guidelines on urolithiasis. 2024 [internet publication].
https://uroweb.org/guideline/urolithiasis
However, the National Institute for Health and Care Excellence (NICE) in the UK does not give a recommendation regarding protein intake based on its assessment that the evidence on the effectiveness of low protein intake in reducing stone recurrence is inconclusive.[16]National Institute for Health and Care Excellence. Renal and ureteric stones: assessment and management. January 2019 [internet publication].
https://www.nice.org.uk/guidance/ng118
Encourage the patient to establish a healthy lifestyle, including physical activity habits, to achieve and maintain a healthy weight.[74]National Institute for Health and Care Excellence. Preventing excess weight gain. March 2015 [internet publication].
https://www.nice.org.uk/guidance/ng7