Veronese N. et al., 2025: Preventing and treating kidney stones: an umbrella review of meta-analyses of non-surgical randomized controlled trials.
Nicola Veronese 1, Stefano Ciriminna 2, Chiara M Errera 2, Maria C Garlisi 2, Ottavia Tulone 2, Vitalba Sapienza 2, Maria E Ciuppa 2, Rossella Capitummino 2, Chiara Giannettino 2, Ottavia G Plano 2, Salvatore F Contarino 3, Giuseppe Guagenti 3, Calogero Cottone 3, Federica Cardillo 3, Manuel Gilante 3, Lucia Campo 3, Gabriele Tulone 3, Alchiede Simonato 3, Mario Barbagallo 2, Nicola Pavan 3
1Unit of Geriatrics, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy -
2Unit of Geriatrics, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy.
3Urology Clinic, Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, Palermo, Italy.
Abstract
Introduction: Kidney stones represent a significant health burden due to their high prevalence, recurrence, and associated healthcare costs. Medical interventions are crucial for preventing and treating kidney stones, especially for patients at high risk or those undergoing extracorporeal shock wave lithotripsy (SWL). This umbrella review aims to synthesize evidence from systematic reviews and meta-analyses of randomized controlled trials (RCTs) evaluating the efficacy of non-surgical medical treatments in preventing and managing kidney stones.
Evidence acquisition: A comprehensive search was conducted across Medline, Embase, and Web of Science until February 2024. Systematic reviews with meta-analyses of RCTs focusing on non-surgical medical interventions for kidney stone prevention and treatment were included. The GRADE framework evaluated the certainty of evidence.
Evidence synthesis: Among 2481 records initially considered, nine systematic reviews comprising 88 RCTs and 27,286 participants were included. Supported by a high level of evidence according to the GRADE, tamsulosin, compared to placebo, demonstrated improved stone clearance post-SWL, while vitamin D and calcium supplementation were ineffective for primary prevention. In 571 patients affected by recurrent kidney calculi, the use of thiazides, compared to placebo, was associated with a statistically significant decrease in renal stones of 66% (GRADE: high level of evidence). The use of potassium citrate was able to prevent the risk of nephrolithiasis recurrence of 79%, supported by a high level of evidence.
Conclusions: Several medical interventions for kidney stone management are supported by high-certainty evidence, particularly post-SWL α-blocker therapy and potassium citrate for recurrence prevention.
Minerva Urol Nephrol. 2025 Aug;77(4):472-478. doi: 10.23736/S2724-6051.25.06296-2.
PMID: 40891477 FREE ARTICLE
Comments 1
This report summarizes data regarding prevention of recurrent stone formation from systematic reviews and meta-analyses. This information is of importance for all patients with stone disease and particularly for patients treated with SWL in whom residual stones/fragments significantly increase the risk of new stone formation. As indicated the data are an umbrella review comprising results from 27 286 patients in 88 RCTs.
1. Increased fluid/water intake reduces the risk of stone formation 61%.
2. Alfa-receptor antagonists resulted in increased stone clearance.
3. Thiazides decreased stone formation 66%
4. Potassium citrate reduced stone formation 79% by increasing urinary citrate and pH.
5. Importantly: Increased calcium and vitamin D intake did not affect stone formation.
Hans-Göran Tiselius