Metaphylaxis of urolithiasis: Focus on hypercalcemia

Abstract

The increase of urolithiasis prevalence in the world simultaneously with the spread of saving stone-removing technologies actualizes the problem of long-term postoperative management to prevent recurrence of the disease.

The aim of this study was to highlight international experience in preventive strategies for patients with a history of calcium-containing stones (calcium oxalates and phosphates) and to determine indications for the prescription of thiazides in hypercalciuria. It was sourced on the 2025 Guidelines of the European Association of Urologists, which emphasize the basic metabolic evaluation of the patient and the priority implementation of fluid balance control, adaptation of food models (with protein/sodium restriction) and lifestyle, and additional pharmacological component in case of calciuria above 320 mg or 8 mmol per day (thiazides). A spectrum of differential diagnoses and therapeutic measures depending on the level of calcium excretion presented. The peculiarities of the use of preventive strategies in the pediatric population have specified. The metabolic profile and urine pH analyzed as options of possible impact. The available data on the sedimentation zones of certain urine compounds (oxalates, phosphates, uric acid, cystine) and the possibilities of their correction are summarized and presented.