Balancing Stone Prevention and Kidney Function: A Therapeutic Dilemma

Abstract

Managing nephrolithiasis in chronic kidney disease (CKD) poses a therapeutic challenge: preventing stone recurrence while preserving kidney function. Standard urological interventions and preventive strategies, such as high fluid intake, thiazides, and potassium citrate, cut recurrence by 50–60% in healthy kidneys but risk fluid overload, hyperkalemia, and diminished efficacy in CKD as glomerular filtration rate (GFR) declines. Often, stone prevention and CKD care are addressed separately, leaving clinicians without unified guidance for this rising patient group. This review explores the bidirectional relationship between nephrolithiasis and CKD, integrating pathophysiology and therapeutic strategies into a practical, decision-oriented framework. It offers tailored interventions based on GFR category, stone type, and comorbid conditions, emphasizing the potential for dual-purpose therapies. Going beyond previous reviews, it connects clinical practice with existing research gaps, offering tools to balance outcomes and guide future studies.