Five Years of Experience with Selective Therapy in Recurrent Calcium Nephrolithiasis

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Abstract
The efficacy of selective treatment in 126 patients with recurrent Ca urolithiasis who were chosen on the basis of ability to correct underlying physiochemical disturbances was evaluated. Patients with hyperparathyroidism underwent an operation. Patients with renal hypercalciuria were treated with thiazide and those with absorptive hypercalciuria were given a low Ca, low oxalate diet with or without thiazide. The only treatment for normocalciuric patients was high fluid intake, which was suggested also to the other groups. A significant individual mean reduction in stone formation was observed in all groups after 5 yr of treatment. Only 48% of the normocalciuric patients were in remission after 5 yr of high fluid intake therapy and 45% of those with absorptive hypercalciuria were free of recurrence with diet only. Thiazide treatment seemed to be effective despite the type of hypercalciuria. The effect of the treatment on stone formation was mediated through reduction of risk factors in the urine. A high level of risk factors commonly predicted stone recurrence.