Kidney stones frequently recur, but the risk can often be reduced. Consultant Urological Surgeon Mr Neil Haldar explains how fluids, diet, testing and targeted treatment can help prevent further stones.

How to Prevent Kidney Stones: An Evidence-Based Guide to Diet, Fluids, Tests and Treatment

Passing a kidney stone is an experience few people forget. The pain can be sudden, severe and frightening, and it may lead to an emergency hospital visit or an operation.

Unfortunately, a kidney stone is not always a one-off event. Without preventive measures, approximately half of people who have formed one stone may develop another within the following five to ten years.

The encouraging news is that kidney stone recurrence is not inevitable. By identifying why a stone formed and addressing the relevant risk factors, it is often possible to substantially reduce the likelihood of further stones.

The most important points

Most people seeking to prevent kidney stones should:

• drink enough fluid to produce a high volume of dilute urine;
• maintain a normal calcium intake rather than avoiding dairy products;
• reduce salt and excessive animal protein;
• avoid unnecessary high-dose vitamin C supplements;
• have any passed or surgically removed stone analysed;
• undergo metabolic investigation when there is a significant risk of recurrence; and
• use preventive medication only when it is appropriate for their stone type and biochemical results.

The right prevention plan depends on the type of stone you form. Advice suitable for a calcium oxalate stone may be ineffective—or occasionally counterproductive—for someone with a calcium phosphate, uric acid, infection or cystine stone.

Why do kidney stones keep coming back?

Kidney stones develop when substances dissolved in the urine become sufficiently concentrated to form crystals. These crystals can enlarge and join together, eventually producing a stone.

Several factors may contribute:

• not producing enough urine;
• excessive urinary calcium;
• excessive urinary oxalate;
• low urinary citrate;
• persistently acidic or alkaline urine;
• excessive urinary uric acid;
• urinary infection;
• inherited conditions;
• bowel disease or previous bowel surgery;
• particular medicines; and
• metabolic conditions such as gout, obesity, insulin resistance or hyperparathyroidism.

An operation can remove a stone, but it does not necessarily change the biochemical environment in which the stone formed. Unless that underlying environment is addressed, another stone may develop.

This is why effective kidney stone prevention involves more than simply treating each stone as it appears.

Why kidney stone prevention matters

Avoiding further pain and emergency treatment

Renal colic is among the most severe forms of pain. It may also be accompanied by nausea, vomiting, urinary symptoms and bleeding in the urine.

A recurrent stone can interrupt work, travel and family life without warning. It may be particularly consequential for pilots, professional drivers, offshore workers and others whose occupations make an unexpected episode difficult or dangerous.

Reducing the need for repeated operations

Modern treatments such as ureteroscopy and laser lithotripsy, shockwave lithotripsy and percutaneous nephrolithotomy can treat stones effectively. However, repeated procedures may involve anaesthesia, ureteric stents, time away from work and exposure to further imaging.

Preventing another stone is preferable to repeatedly treating the consequences.

Protecting kidney function

Most people who experience an uncomplicated kidney stone do not suffer permanent kidney damage. However, repeated obstruction, severe infection, extensive stone disease or repeated intervention can affect kidney function in some patients.

Recurrent stone formers also have higher rates of chronic kidney disease than people who have never formed stones.

Identifying wider health problems

Kidney stones can sometimes be a marker of another condition.

Calcium-containing stones may be associated with hyperparathyroidism, bone loss or abnormalities of calcium handling. Uric acid stones are often associated with persistently acidic urine, obesity, type 2 diabetes, gout and metabolic syndrome.

Investigating recurrent stones can therefore reveal important information about a patient’s wider health.

The first step: find out what your stone is made from

Stone analysis is one of the most useful parts of a kidney stone assessment.

If you pass a stone, try to collect it using a clean container or stone strainer. Stones removed during surgery should also be sent for laboratory analysis.

The result helps determine which preventive strategy is likely to be most effective.

What are the different types of kidney stone?

Calcium oxalate stones

Calcium oxalate is the commonest stone material, accounting for most kidney stones.

These stones may be associated with:

• low urine volume;
• excessive urinary calcium;
• excessive urinary oxalate;
• low urinary citrate;
• a high-salt diet;
• excessive animal protein;
• bowel disease or malabsorption; and
• high-dose vitamin C supplementation.

The name can be misleading. Calcium oxalate stones are not usually prevented by cutting calcium out of the diet. In fact, an unnecessarily low-calcium diet can increase oxalate absorption and may make calcium oxalate stones more likely.

Calcium phosphate stones

Calcium phosphate stones are more likely to form in alkaline urine.

Their presence should prompt consideration of underlying causes such as:

• primary hyperparathyroidism;
• distal renal tubular acidosis;
• recurrent urinary infection; and
• medicines that alter urine chemistry, including topiramate and acetazolamide.

Because calcium phosphate stones favour alkaline urine, treatment that raises urinary pH must be used carefully.

An important exception is distal renal tubular acidosis. Although the urine is already relatively alkaline, citrate or bicarbonate treatment may still be required to correct the underlying acid-base disorder and low urinary citrate.

Uric acid stones

Uric acid stones form primarily because the urine is persistently too acidic. A high blood or urinary uric acid level may contribute, but low urinary pH is frequently the main driver.

Uric acid stones are more common in people with:

• type 2 diabetes;
• insulin resistance;
• obesity;
• gout;
• metabolic syndrome;
• chronic diarrhoea; and
• diets containing excessive purine-rich animal foods.

Unlike calcium stones, uric acid stones can often be dissolved with medication that makes the urine less acidic.

Struvite or infection stones

Struvite stones form in association with particular urinary infections caused by bacteria that alter the urine’s chemistry.

They can grow rapidly and may develop into large branching stones known as staghorn calculi.

Prevention requires control of the infection and, wherever possible, complete removal of the stone. A residual infected fragment can act as a focus for rapid regrowth.

Cystine stones

Cystine stones are uncommon and result from an inherited condition called cystinuria.

They often first appear in childhood or early adult life and can recur aggressively. Patients usually require particularly high fluid intake, urinary alkalinisation and lifelong specialist follow-up.

Does everyone need a full metabolic stone assessment?

Not every person who develops a single uncomplicated calcium oxalate stone requires exhaustive testing. However, the threshold for further investigation should be low when the risk or consequences of recurrence are significant.

A fuller metabolic assessment is particularly appropriate for:

• people who have formed more than one stone;
• children and young adults;
• patients with multiple or bilateral stones;
• anyone with a family history of kidney stones;
• people with a solitary or transplanted kidney;
• patients with reduced kidney function;
• people with uric acid, calcium phosphate, cystine or infection stones;
• patients with bowel disease, chronic diarrhoea or previous bowel surgery;
• people who have undergone bariatric surgery;
• patients with osteoporosis, hypercalcaemia or suspected hyperparathyroidism;
• patients taking medicines known to increase stone risk; and
• people whose work or circumstances would make another stone particularly hazardous.

All children who form urinary stones should receive an appropriate metabolic evaluation.

What does a kidney stone assessment involve?

Stone analysis

The stone is analysed in a specialist laboratory to identify its chemical composition.

This information should be interpreted alongside blood results, urine chemistry, medical history, medication and imaging.

Blood tests

Blood tests may include:

• kidney function;
• sodium and potassium;
• calcium and albumin;
• bicarbonate;
• phosphate;
• uric acid;
• vitamin D; and
• parathyroid hormone when calcium is raised or hyperparathyroidism is suspected.

Urine testing

A routine urine sample can assess:

• blood;
• infection;
• urinary pH;
• crystals; and
• other abnormalities.

A urine culture may be required if infection is suspected.

A 24-hour urine collection

A 24-hour urine test measures the substances excreted in the urine over a complete day.

Depending on the laboratory and clinical question, it may assess:

• total urine volume;
• calcium;
• oxalate;
• citrate;
• uric acid;
• sodium;
• magnesium;
• phosphate;
• creatinine; and
• urinary pH.

Two consecutive collections are often preferred for a detailed metabolic assessment because urine composition varies from day to day.

The initial collection should normally be performed after the acute stone episode has settled, infection has been treated, and you have returned to your usual diet and fluid intake. Testing performed during an acute obstruction may not accurately represent your normal metabolism.

Imaging

Imaging is used to establish whether stones remain in the kidneys or ureters and to monitor whether they are changing.

A low-dose non-contrast CT scan is highly sensitive for urinary stones. Ultrasound is often preferred for surveillance where appropriate because it avoids repeated radiation exposure.

The choice of imaging and the interval between scans should be individualised.

Ten practical ways to prevent kidney stones

1. Drink enough fluid

Increasing urine volume is the foundation of kidney stone prevention.

When urine volume is low, calcium, oxalate, uric acid and other substances become more concentrated. This increases the chance that crystals will form and grow.

Many stone formers are advised to drink approximately 2.5 to 3 litres of fluid daily, aiming to produce around 2 to 2.5 litres of urine or more. The amount required varies according to body size, climate, occupation, exercise, medical conditions and the type of stone.

People who exercise heavily, work in hot environments or travel to hot countries may need considerably more.

Those with heart failure, advanced kidney disease or another condition requiring fluid restriction should seek medical advice before increasing fluid intake.

Spread your drinks throughout the day

Drinking a large volume in the evening does not compensate fully for producing concentrated urine throughout the rest of the day.

Regular intake is usually more effective:

• drink soon after getting up;
• drink with and between meals;
• keep water available while working;
• increase intake before, during and after exercise; and
• drink extra in hot weather or during long journeys.

A drink before bed can help reduce overnight concentration, although this needs to be balanced against troublesome nocturia and individual medical circumstances.

Look at your urine colour

Urine colour is not a laboratory measurement, but it provides a useful everyday guide.

Pale straw-coloured urine generally suggests reasonable hydration. Persistently dark yellow urine often means that you need more fluid.

Some medicines, foods and vitamin supplements can alter urine colour, so it is not a perfect test.

2. Make water your main drink

Water is the simplest and most reliable choice.

There is no need to buy expensive bottled water specifically to prevent stones. Hard tap water has not been shown to be an important cause of kidney stones, and its calcium content does not mean that it must be avoided.

Total fluid volume matters much more than whether the water is hard or soft.

3. Consider adding fresh lemon juice

Lemon and lime contain citrate. Citrate can bind calcium in the urine and interfere with the processes by which some calcium stones form.

Adding fresh lemon juice to water is included in NICE dietary advice for stone prevention. However, dietary lemon juice should not be regarded as equivalent to prescribed potassium citrate when a significant biochemical abnormality has been identified.

Avoid adding large amounts of sugar. Frequent acidic drinks may also affect dental enamel, so dilution and sensible dental care are important.

4. Do not unnecessarily restrict dietary calcium

This is one of the most important—and most commonly misunderstood—principles of kidney stone prevention.

Calcium in food binds to oxalate in the bowel. The resulting complex remains in the gut and is excreted rather than absorbed into the bloodstream and subsequently passed into the urine.

When dietary calcium is severely restricted, more free oxalate may be absorbed. This can increase urinary oxalate and potentially increase the risk of calcium oxalate stones.

A low-calcium diet can also damage bone health.

Most adults should therefore maintain a normal dietary calcium intake, generally around 700 to 1,200 mg daily depending on age and individual nutritional requirements.

Useful sources include:

• milk;
• yoghurt;
• cheese in moderation;
• calcium-fortified plant drinks;
• tinned fish containing edible bones; and
• selected green vegetables.

Try to consume calcium-containing foods with meals, particularly when the meal contains oxalate.

What about calcium tablets?

Calcium supplements are different from calcium obtained naturally in food.

Do not start or stop a medically necessary calcium supplement without discussing it with your doctor. When a supplement is required in someone who forms stones, it is often preferable to take it with food so that the calcium can bind dietary oxalate in the bowel.

The correct decision depends on bone health, dietary intake, blood tests, stone composition and urine results.

5. Reduce salt

A high salt intake can increase the amount of calcium passed into the urine.

Reducing sodium can therefore be particularly helpful for people with excessive urinary calcium.

In the UK, a reasonable general target is no more than approximately 6 g of salt per day. Much of this comes from manufactured food rather than salt deliberately added at the table.

Common sources include:

• ready meals;
• takeaway food;
• processed meats;
• bread;
• sauces;
• soups;
• salty snacks;
• stock cubes; and
• some cheeses.

Check food labels and compare products. A food that does not taste particularly salty may still contain a substantial amount of sodium.

6. Avoid excessive animal protein

Animal protein can increase the acid load that must be handled by the kidneys. In susceptible people, excessive intake may increase urinary calcium and uric acid while reducing citrate.

The aim is usually moderation rather than complete avoidance.

Protein requirements vary with age, body size, activity, health and recovery from illness. A dietitian can provide individual guidance where necessary.

People with uric acid stones or excessive urinary uric acid may be advised to reduce purine-rich foods such as:

• organ meats;
• large quantities of red meat;
• some shellfish;
• certain oily fish; and
• meat extracts.

Plant proteins do not generally produce the same acid load as large quantities of animal protein.

7. Manage dietary oxalate intelligently

Not everyone with a calcium oxalate stone needs a highly restrictive low-oxalate diet.

Many foods containing oxalate are otherwise nutritious. Unnecessary restriction can make the diet less healthy and difficult to sustain.

Oxalate restriction is most useful when a 24-hour urine collection has confirmed high urinary oxalate or when there is a recognised condition causing excessive oxalate absorption.

Foods with particularly high oxalate content include:

• spinach;
• rhubarb;
• beetroot;
• almonds and cashews;
• wheat bran;
• cocoa and chocolate;
• some soy products; and
• very large quantities of black tea.

Rather than automatically eliminating every oxalate-containing food, two measures are often more useful:

Eat calcium and oxalate together. Consuming a normal calcium-containing food with an oxalate-containing meal helps bind oxalate in the bowel.

Avoid dehydration. High urinary oxalate is more likely to cause problems when urine volume is low.

Patients with inflammatory bowel disease, previous bowel resection, an ileostomy or malabsorptive bariatric surgery may develop enteric hyperoxaluria and require more specialist dietary advice.

8. Be cautious with high-dose vitamin C

Vitamin C is partly metabolised to oxalate.

Normal vitamin C obtained from fruit and vegetables is not usually a concern. However, high-dose vitamin C supplements—particularly doses of 1,000 mg daily or more—may increase urinary oxalate in susceptible individuals.

Check multivitamins, immune-support products and effervescent supplements, as several products may contain vitamin C.

9. Eat more fruit, vegetables and fibre

A diet rich in vegetables and fruit provides potassium and alkali and may increase urinary citrate.

A balanced dietary pattern resembling the DASH diet—rich in fruit, vegetables, whole grains and moderate amounts of lower-fat dairy—has been associated with a lower risk of kidney stone formation.

Fruit and vegetables also support blood pressure, weight, bowel health and wider cardiovascular health.

Patients with advanced kidney disease or a requirement to restrict potassium should obtain individual dietary advice.

10. Reduce sugary and cola drinks

Sugar-sweetened drinks and beverages containing large amounts of fructose are associated with a higher risk of stone formation.

Water should remain the main drink.

Coffee and tea do not normally need to be avoided solely because of kidney stones, although sugar, syrups and dehydration still matter. Patients with high urinary oxalate may need individual advice about very large quantities of strong black tea.

Alcohol is not a kidney stone treatment. It may initially increase urine production but can subsequently contribute to dehydration if fluid is not replaced. Beer also contains purines, which may be relevant for some uric acid stone formers.

Maintain a healthy weight and address metabolic health

Obesity, insulin resistance, metabolic syndrome and type 2 diabetes are strongly associated with persistently acidic urine and uric acid stone formation.

Improving weight, activity levels, blood pressure and blood sugar control can address several of the metabolic factors associated with stones.

This should be achieved through sustainable changes rather than extreme diets. Some high-protein or highly restrictive weight-loss diets may worsen urinary risk factors.

A note about bariatric surgery

Malabsorptive bariatric operations, particularly Roux-en-Y gastric bypass, can increase oxalate absorption and raise the risk of calcium oxalate stones.

Patients who have undergone this type of surgery may require:

• particularly careful hydration;
• calcium taken with meals;
• reduced dietary oxalate;
• appropriate fat intake;
• citrate treatment in selected cases; and
• metabolic follow-up.

Sleeve gastrectomy generally has a lower stone risk than malabsorptive procedures.

Preventing different types of kidney stones

Preventing calcium oxalate stones

For most calcium oxalate stone formers, prevention begins with:

• increasing urine volume;
• maintaining normal dietary calcium;
• reducing salt;
• avoiding excessive animal protein;
• treating high urinary oxalate when present;
• increasing fruit and vegetable intake; and
• correcting low urinary citrate.

Medication may be considered when dietary changes are insufficient or when a significant biochemical abnormality has been identified.

Potassium citrate

Potassium citrate raises urinary citrate and makes the urine less acidic.

It may be considered for adults with recurrent stones that are predominantly calcium oxalate. The decision should also take account of urinary citrate and pH, kidney function, serum potassium and other medicines.

Potassium citrate requires monitoring and is not appropriate for everyone.

Thiazide-type medicines

Thiazide and thiazide-like medicines can reduce urinary calcium and have traditionally been used in recurrent calcium stone formers with hypercalciuria.

However, the NOSTONE randomised trial found that hydrochlorothiazide at doses of 12.5 mg, 25 mg or 50 mg did not significantly reduce its combined primary outcome of symptomatic or radiological stone recurrence compared with placebo.

This does not mean that thiazide-type treatment has no role. It does mean that treatment should be selected carefully, particularly where there is marked hypercalciuria, high blood pressure or reduced bone density.

Possible adverse effects include low potassium, gout, changes in blood sugar and other metabolic effects, so follow-up blood tests are required.

Allopurinol

Allopurinol may be considered when excessive urinary uric acid contributes to recurrent calcium oxalate stones.

It is not a general preventive treatment for every calcium stone former.

Preventing calcium phosphate stones

Calcium phosphate stones require a different approach because they favour alkaline urine.

Important steps include investigating for:

• primary hyperparathyroidism;
• distal renal tubular acidosis;
• urinary infection;
• excessive urinary calcium; and
• causative medicines such as topiramate or acetazolamide.

Treatment that raises urinary pH must be used cautiously because excessive alkalinisation can increase calcium phosphate supersaturation.

However, patients with distal renal tubular acidosis may still need citrate or bicarbonate to correct metabolic acidosis and low citrate. Specialist assessment is therefore important.

Preventing and dissolving uric acid stones

The principal problem in most uric acid stone formers is persistently acidic urine.

Treatment usually involves potassium citrate or, in selected cases, sodium bicarbonate. Patients may be taught to check freshly passed urine with pH strips and adjust treatment according to a clinician-approved plan.

The target depends on the purpose of treatment.

For routine prevention, the urine is made less acidic without raising the pH unnecessarily. When attempting to dissolve a confirmed uric acid stone, a higher target—often approximately pH 7.0 to 7.2—may be used under close supervision.

Excessive alkalinisation should be avoided because it may encourage calcium phosphate stones.

Allopurinol may be added when urinary uric acid is genuinely excessive, but raising urine pH remains central for many patients.

Weight management, improved diabetes control and moderation of purine-rich foods address the underlying metabolic drivers.

An obstructing stone, infection, severe symptoms or uncertainty over the stone’s composition may require surgery rather than attempted dissolution.

Preventing struvite or infection stones

Infection stones cannot be managed through diet and hydration alone.

Treatment usually requires:

• complete stone removal where possible;
• urine culture;
• appropriately targeted antibiotics;
• correction of urinary obstruction or stasis;
• treatment of any anatomical abnormality; and
• continued surveillance.

Any residual infected stone material can provide a focus for regrowth.

Preventing cystine stones

Cystine stone prevention requires an intensive, lifelong programme.

Patients are generally advised to produce more than 3 litres of urine daily. This may require drinking during the evening and sometimes overnight.

Urinary alkalinisation is used to improve cystine solubility, with current EAU guidance recommending a urinary pH above 7.5 under specialist supervision.

Patients should monitor urine pH carefully because excessive alkalinisation can create other problems.

Salt reduction is also important because sodium intake can increase urinary cystine excretion.

When fluids, salt restriction and alkalinisation are insufficient, a specialist medicine such as tiopronin may be considered.

Medicines and supplements that may increase stone risk

A medication review should form part of the assessment.

Medicines and supplements associated with stones in particular circumstances include:

• topiramate;
• acetazolamide;
• zonisamide;
• loop diuretics;
• high-dose vitamin C;
• inappropriately timed calcium supplements;
• excessive vitamin D in susceptible patients; and
• certain antiviral and antibiotic medicines that can crystallise in the urine.

Do not stop a prescribed medicine without discussing it with the clinician responsible for your care.

Often the correct approach is not simply to stop treatment, but to assess the individual risk, consider alternatives and monitor urine chemistry.

How do you know whether prevention is working?

Prevention should be measurable.

A patient may follow dietary advice carefully but still have low urine volume, excessive calcium or insufficient citrate. Conversely, modest sustainable changes may produce a significant biochemical improvement.

Where preventive medication has been started, the EAU suggests repeating the 24-hour urine test after approximately eight to twelve weeks. This allows the treatment or dosage to be adjusted.

Once the urinary abnormalities have stabilised, annual testing may be sufficient for established recurrent stone formers, although the schedule should be individualised.

Follow-up may include:

• repeat 24-hour urine collections;
• blood tests;
• urine cultures where appropriate;
• monitoring of urinary pH;
• ultrasound or low-dose CT; and
• review of medication side effects.

The goal is not merely to produce a laboratory result within a generic “normal range”. It is to reduce the urinary supersaturation relevant to your particular stone while avoiding the creation of a different problem.

A practical daily kidney stone prevention plan

For many calcium oxalate stone formers, a realistic daily routine might look like this:

1. Start drinking water early in the day.
2. Continue drinking regularly rather than trying to catch up in the evening.
3. Increase fluid intake during exercise and hot weather.
4. Include a normal calcium-containing food with each main meal.
5. Keep processed, takeaway and highly salted foods to a minimum.
6. Eat sensible portions of meat and fish rather than building every meal around large quantities of animal protein.
7. Fill a substantial part of the plate with vegetables.
8. Choose water rather than sugary or cola drinks.
9. Avoid unnecessary high-dose vitamin C supplements.
10. Take any prescribed preventive medicine consistently and attend follow-up testing.

The correct plan will be different for uric acid, calcium phosphate, infection and cystine stones.

Common kidney stone prevention myths

“I have a calcium stone, so I must avoid calcium”

Usually false.

Normal dietary calcium helps bind oxalate in the bowel. Severe calcium restriction may increase oxalate absorption and can damage bone health.

“Hard water causes kidney stones”

There is no good evidence that drinking ordinary hard tap water is a major cause of kidney stones.

Drinking enough fluid matters far more than the mineral content of the water.

“Lemon water can dissolve every kidney stone”

False.

Lemon water may contribute dietary citrate, but calcium stones cannot be dissolved by drinking lemon juice.

Confirmed uric acid stones may sometimes be dissolved through carefully monitored medical alkalinisation.

“Everyone with a stone should avoid spinach, nuts and chocolate”

Not necessarily.

Targeted oxalate reduction is most useful when high urinary oxalate has been demonstrated, or there is a recognised risk of excessive oxalate absorption.

“Beer helps flush out kidney stones”

Beer is not a recommended treatment.

Alcohol can ultimately contribute to dehydration, and beer contains purines that may be relevant to uric acid stone formation.

“Once a stone has been removed, the problem is cured”

Not always.

Surgery removes the existing stone but may not change the reason it formed. Prevention and appropriate follow-up remain important.

When should you seek urgent medical attention?

Seek urgent assessment if you have suspected kidney stone symptoms together with:

• fever;
• shivering or rigors;
• feeling severely unwell;
• persistent vomiting;
• very little or no urine;
• severe pain that is not controlled;
• a known solitary kidney;
• pregnancy;
• significant kidney disease; or
• signs of sepsis.

A urinary infection behind an obstructing stone is a urological emergency. It may require urgent drainage of the kidney as well as antibiotics.

When should you see a urologist about kidney stone prevention?

A specialist assessment is particularly worthwhile if:

• you have formed more than one stone;
• you continue to develop stones despite increasing fluid intake;
• you have stones in both kidneys;
• you have multiple stones;
• your stone is not a straightforward calcium oxalate stone;
• you have a solitary or transplanted kidney;
• you have reduced kidney function;
• you have bowel disease or previous bariatric surgery;
• you have high blood calcium;
• you have recurrent urinary infection;
• you formed stones during childhood or early adulthood; or
• another stone would have serious occupational or personal consequences.

A structured assessment can identify whether you need stone analysis, blood tests, 24-hour urine testing, surveillance imaging or preventive medication.

Frequently asked questions about preventing kidney stones

Reducing kidney stone recurrence through individualised care

Kidney stone prevention should not consist of vague advice to “drink more water”.

The most effective approach combines:

• reliable stone analysis;
• appropriate blood and urine testing;
• high urine volume;
• sensible dietary changes;
• treatment directed at the specific stone type;
• measurement of the response; and
• ongoing review where recurrence risk remains high.

For many patients, another stone is not inevitable. Once the underlying risk factors are understood, a practical and sustainable prevention plan can often reduce the likelihood of further pain, emergency treatment and surgery.

About Mr Neil Haldar

Mr Neil Haldar is a Consultant Urological Surgeon with extensive experience in the investigation and treatment of kidney and ureteric stones, general urology, uro-oncology, laparoscopic surgery and robotic surgery.

Patients with recurrent or complex stone disease can be assessed for stone composition, metabolic risk factors, appropriate imaging and an individualised prevention strategy.

To arrange a private consultation, please use the contact or appointment section of mrhaldar.com.

Evidence and further reading

This article has been informed by:

• National Institute for Health and Care Excellence: Renal and ureteric stones—assessment and management (NG118).
• European Association of Urology: EAU Guidelines on Urolithiasis, 2026.
• Dhayat NA and colleagues: Hydrochlorothiazide and Prevention of Kidney-Stone Recurrence, New England Journal of Medicine, 2023.

This article is intended to provide general information and does not replace a medical consultation. Kidney stone prevention should be tailored to stone composition, kidney function, urine chemistry, other medical conditions and current medication.