Nephrolithiasis

After stone passage or successful medical/surgical treatment, patients with risk of recurrence should be evaluated metabolically with serum studies and 24-hour urine for metabolic studies to determine whether any metabolic abnormalities exist that predispose to recurrent stone formation. Patients can then alter their diet/lifestyle or be placed on the appropriate medication if needed. Patients with cystine stones are more likely to require additional urologic interventions over time despite medical therapy and close follow-up.[159]Moore SL, Cook P, de Coninck V, et al. Outcomes and long-term follow-up of patients with cystine stones: a systematic review. Curr Urol Rep. 2019 Apr 15;20(6):27. http://www.ncbi.nlm.nih.gov/pubmed/30989375?tool=bestpractice.com

Periodic 24-hour urine monitoring should be performed to assess the efficacy of dietary/lifestyle changes and medications. Serum labs should be repeated periodically in patients on pharmacologic therapy to assess for adverse effects.[17]Pearle MS, Goldfarb DS, Assimos DG, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014 Aug;192(2):316-24. https://www.auajournals.org/doi/10.1016/j.juro.2014.05.006 http://www.ncbi.nlm.nih.gov/pubmed/24857648?tool=bestpractice.com ​ Imaging with noncontrast computed tomography (CT) scan, renal ultrasound, or KUB should be carried out every 6-12 months to monitor for recurrence or increase in the size of existing stones.