Medical Management of Kidney Stones: AUA Guideline (2026) Part I: Evaluation of Patients with Kidney Stones and Dietary Management of Patients with Calcium Stones

PURPOSE: The purpose of this Guideline is to provide a framework for the medical evaluation, treatment, and follow-up of patients with a history of kidney stones in order to reduce the likelihood of recurrent disease. The summary presented herein represents Part I of the two-part series dedicated to Medical Management of Kidney Stones. Please refer to Part II for additional information on this topic. MATERIALS AND METHODS: The systematic review utilized in the creation of this Guideline is based on research conducted by the Research Triangle Institute (RTI) International-University of North Carolina at Chapel Hill Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ) and funded by the Patient-Centered Outcomes Research Institute® (PCORI®). The EPC extracted and synthesized comparative effectiveness and harms outcomes for preventive treatment with diet or pharmacologic agents and surveillance imaging strategies in nonpregnant adults and children with a history of nephrolithiasis from 30 publications. RESULTS: A series of Guideline statements were developed that addresses the identification of individuals at high-risk of stone recurrence, the metabolic evaluation of high-risk and interested patients, treatment with dietary measures and pharmacologic therapy, and follow-up for assessment of therapeutic effects. The statements were developed based on the evidence base for this Guideline. CONCLUSIONS: Using the best available evidence and the expert opinions of the Panel, this Guideline offers recommendations for the initiation of dietary measures and drug therapy to allow for active treatment of motivated and high-risk patients with the goal of reducing the risk of stone recurrence.