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You keep forming them, and you are already doing the obvious things
You probably know your stone type in millimetres, you drink more water than anyone you know, and you have read more about oxalate than most people who have treated you. This page assumes all of that.
What the current evidence supports
Annals of Internal Medicine, 2026A systematic review published in 2026 pooled 31 studies, 26 of them randomised trials, and assessed what actually prevents recurrence. For adults with calcium oxalate or calcium phosphate stones, the interventions that may reduce recurrence were:
- Increased water intake
- A diet with normal to high calcium, low protein and low sodium
- Thiazide diuretics
- Alkali treatment
- Allopurinol
Two things stand out from that list. Calcium is not something to minimise — it appears as part of the pattern associated with fewer recurrences, which catches out a lot of people who cut dairy years ago. And three of the five are prescriptions, which no amount of dietary effort substitutes for.
The review rated every one of those conclusions as low strength of evidence — its own assessment. That is still the best-evidenced list available, and it is worth knowing how much certainty sits behind it.
The review also found no difference between selective and empirical pharmacotherapy — that is, treating based on your 24-hour urine results versus treating on general principles. If you have wondered whether the metabolic workup changes the plan, that question is genuinely open.
The actual problem
One test a year is not a feedback loop
You change something in March. Your next 24-hour collection is in November. In between, you have no idea whether it did anything — and when the result arrives, the previous one is a PDF in an email you cannot find.
That is the gap. Not knowledge — you have plenty. It is that the interval between measurements is long enough to make cause and effect nearly unreadable.
Put every test in one place
Enter each collection you have — values and the reference range your own laboratory printed — and every marker gets a line across all of them. Citrate over three years. Volume before and after you changed what you drink. Then print one page for your next appointment instead of arriving with three PDFs.
It stays in your browser. Nothing is sent to us, and we could not read it if we wanted to.
If your current care is not working
Forming stones despite doing the right things is a reason to ask whether the workup was complete, not a reason to try harder at the same measures. Two things worth checking:
A urologist who does metabolic evaluations
15,517 listed by state, with Medicare stone-procedure volumes where we have them, and the four questions that reveal whether a practice does prevention at all.
A renal dietitian
Diet does much of the work here and urologists are not dietitians. 187 hold the renal nutrition credential nationally — a small list, and that is the point.
Evidence summaries
What the studies found, with the citations- What actually prevents kidney stones coming back: the 2026 evidence review
- Lemon water, lemonade and citrus: what the research says about kidney stones
- Kidney stone types: why prevention depends on what yours is made of
- How much water should you drink to prevent kidney stones?
- Spinach and kidney stones: what the research actually says about oxalate
- Soda and energy drinks: what the research says about kidney stones
- Salt, sodium and the DASH diet: what the evidence says about kidney stones
- Cranberry juice and kidney stones: what the research actually found
- Calcium and kidney stones: why cutting it back is not what the evidence supports
- Apple cider vinegar and kidney stones: what the research actually found
One more thing
Studies into prevention are small and slow, largely because they cannot recruit enough people who form stones. If you would consider taking part in one, adding your name is the most useful thing anyone in your position can do — and it costs nothing but an email address.