Treated and Untreated Recurrent Calcium Nephrolithiasis in Patients with Idiopathic Hypercalciuria, Hyperuricosuria, or No Metabolic Disorder

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Abstract
Recurrent calcium oxalate stone-forming patients (202) with idiopathic hypercalciuria or hyperuricosuria, or both, were treated for an average of 2.91 yr (1-7 yr) with thiazide or allopurinol, or both. The frequency of new stone formation was drastically reduced. During the treatment period of 625 patient yr, 220.0 new stones should have occurred, whereas 22 were actually formed (.chi.2 = 178, P < 0.001). Patients (34) without discernible metabolic disturbances and treated only with increased fluid intake and dietary advice formed 29 new stones compared to a predicted 33.2 stones (87.3%). Thirty similar patients treated with thiazide and allopurinol formed 6 stones compared to a predicted 31.8, P < 0.001. Chronic reversal of idiopathic hypercalciuria and hyperuricosuria with thiazide and allopurinol was an effective way to prevent recurrent calcium oxalate stones. Conservative measures are only of marginal effectiveness in treating metabolically normal stone forming patients; however, thiazide and allopurinol appear to decrease new stone formation.