# Recurrent Urolithiasis (Kidney Stone Prevention) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: DailyMed Allopurinol Tablet Package Insert (DailyMed, NLM) · DailyMed Hydrochlorothiazide Tablet Package Insert (DailyMed, NLM) · DailyMed Urocit-K (Potassium Citrate Extended-Release Tablets) Package Insert (DailyMed, NLM) · EAU Guidelines on Urolithiasis 2023 - Verified date: 2026-08 ## Verified against - DailyMed Allopurinol Tablet Package Insert (DailyMed, NLM) - DailyMed Hydrochlorothiazide Tablet Package Insert (DailyMed, NLM) - DailyMed Urocit-K (Potassium Citrate Extended-Release Tablets) Package Insert (DailyMed, NLM) - Urolithiasis - disease-level clinical article (urolithiasis-prevention-clinical.txt) ## Treatment metadata - Potassium citrate — 1080 mg — oral.solid - Allopurinol — 100 mg — oral.solid - Hydrochlorothiazide — 25 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text RECURRENT UROLITHIASIS (KIDNEY STONE PREVENTION) Sources: DailyMed Allopurinol Tablet Package Insert (DailyMed, NLM) · DailyMed Hydrochlorothiazide Tablet Package Insert (DailyMed, NLM) · DailyMed Urocit-K (Potassium Citrate Extended- Release Tablets) Package Insert (DailyMed, NLM) · EAU Guidelines on Urolithiasis 2023 Review status: REVIEWED against DailyMed Allopurinol Tablet Package Insert (DailyMed, NLM), DailyMed Hydrochlorothiazide Tablet Package Insert (DailyMed, NLM), DailyMed Urocit-K (Potassium Citrate Extended-Release Tablets) Package Insert (DailyMed, NLM), Urolithiasis - disease-level clinical article (urolithiasis-prevention-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Unilateral, colicky flank or abdominal pain that comes and goes is the classic stone presentation [abdominal pain] - Pain shifts toward the groin, scrotum, or labia as a stone moves toward the bladder junction [groin pain] - Nausea, vomiting, and fever can accompany the pain of a stone [fever · nausea · vomiting] - Constant shifting and inability to stay still, rather than lying motionless, is typical of stone pain - A child with a stone may present with irritability and crying rather than describing pain [irritability] SIGNS - what you find (2) - The abdomen is usually soft and not distended on exam despite the degree of pain - Hemodynamic instability can develop when a stone leads to obstruction with sepsis [sepsis] TESTS (6) - Microscopic blood on urinalysis is found in about 90% of stone patients - Renal ultrasound is the preferred initial study in pregnant and pediatric patients to avoid radiation - Non-contrast CT of the abdomen and pelvis is the most accurate study, at 95% sensitivity and 98% specificity - A stone under 3 mm can be missed on CT because it may fall between the imaging slices - A low-dose CT protocol is avoided once the patient's BMI is above 30 - The STONE score combines sex, symptom timing, nausea, and hematuria to gauge how likely a stone is IF NOT THIS - what else fits (4) - Pelvic inflammatory disease is a differential to weigh against suspected renal colic - A spontaneous abortion should be excluded as a cause of pelvic pain in a pregnant patient - A renal artery aneurysm is a vascular differential for flank pain - Small bowel obstruction can cause colicky abdominal pain that resembles renal colic Source StatPearls "Urolithiasis" - disease-level clinical article Status traced to the source above Rx: Alkalinisation | If hyperuricosuria | If hypercalciuria | Main treatment ALKALINISATION 1. POTASSIUM CITRATE [1st line] Adult 1080 mg (10 mEq) three times daily with meals, titrate to maintain urinary pH between 6.2 and 6.8 - long-term Peds Under pediatric urology/nephrology supervision only Source DailyMed Urocit-K (Potassium Citrate Extended-Release Tablets) Package Insert (DailyMed, NLM) Why Alkalinizes urine to prevent hypocitraturic calcium oxalate, uric acid, and cystine stones Caution CONTRAINDICATED in hyperkalemia, severe renal impairment, and peptic ulcer disease. Monitor serum potassium and renal function regularly. Egypt KALEMAPEX 10 MEQ (1080 MG) 30 XR TABS. MULTI-APEX 187.50 EGP CITRO-K 1.102G/5ML 120ML SYRUP EUROPEAN EGYP... 9.00 EGP -> ? strength differs, ? different route - not oral solid IF HYPERURICOSURIA 2. ALLOPURINOL [1st line] Adult 200 mg to 300 mg orally daily in divided doses or as the single equivalent. - long-term Peds Specialist pediatric use only Source DailyMed Allopurinol Tablet Package Insert (DailyMed, NLM) Why Indicated when 24-hour urine demonstrates hyperuricosuria (>800 mg/day in men, >750 mg/day in women) Caution Discontinue immediately if skin rash occurs (risk of severe cutaneous adverse reactions). Advise them to increase fluid intake during therapy (i.e., for adults, at least 2 liters of liquids per day) and to stay well hydrated to prevent kidney stones. Egypt NO-URIC 100 MG 50 TABS. EIPICO 12.00 EGP (0.24/unit) URIC PURE 100MG 50 TAB. MEPACO 13.50 EGP (0.27/unit) LESSURIC 100MG 20 TAB. ALEXANDRIA 6.00 EGP (0.30/unit) ZYLORIC 100 MG 30 TABS. GLAXO SMITHKL... 39.00 EGP (1.30/unit) IF HYPERCALCIURIA 3. HYDROCHLOROTHIAZIDE [1st line] Adult 25-50 mg once daily in the morning for hypercalciuric calcium stone formers - long-term Peds Specialist pediatric nephrology use only Source DailyMed Hydrochlorothiazide Tablet Package Insert (DailyMed, NLM) Why Thiazide diuretic that lowers urinary calcium excretion by increasing distal renal tubular calcium reabsorption; used to prevent recurrent calcium stone formation in patients with hypercalciuria. Caution Reduces urinary calcium excretion by enhancing distal nephron calcium reabsorption. Monitor serum potassium (hypokalemia risk) and serum uric acid. Restrict dietary sodium intake to optimize hypocalciuric efficacy. Egypt HYDROZIDE 25 MG 30 SCORED TABS. EPCI 8.00 EGP MAIN TREATMENT 4. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Urolithiasis - disease-level clinical article (urolithiasis-prevention-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Struvite stones largely require surgical intervention rather than the medical/preventive drug therapies on this page, and need close urology follow-up. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)