<p><strong>For adult patients with recurrent calcium-based stones and no detectable abnormalities on metabolic testing, clinicians may offer thiazides and/or alkali therapy. (<em>Conditional Recommendation; Evidence Level: Grade C</em>) </strong></p>
Discussion
Discussion
<p>Several studies have demonstrated that thiazides and alkali citrate reduce stone recurrence or residual stone regrowth in patients with calcium-based stones who have normal urinary calcium and citrate levels.<sup>32, 54</sup> Clinicians may offer thiazides and/or alkali therapy to patients who have no abnormalities on metabolic testing or in whom abnormalities have been adequately addressed but calcium-based stone formation persists. While no studies define the optimal selection, sequence, or dosing of these agents in this context, clinicians may consider the frequency of administration and potential side effects as they engage in shared decision-making with patients.</p>