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Recurrent Nephrolithiasis in Adults: Comparative Effectiveness of Preventive Medical Strategies.


John M. Eisenberg Center for Clinical Decisions and Communications Science.


Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007-.
AHRQ Comparative Effectiveness Reviews.
2013 Aug 08.


In response to a request from the public, the Minnesota Evidence-based Practice Center, funded by AHRQ, performed a systematic review of the literature to examine the comparative effectiveness and adverse effects of interventions to prevent kidney stone recurrence in adults aged 18 years or older. Biochemical measurements for predicting the risk of stone recurrence after treatment were also evaluated. Studies that addressed acute pain management and treatment to promote expulsion of ureteral stones were excluded. This review focused on recurrent calcium stones in patients with or without residual stones or stone fragments. Many of the studies assessed in this review included patients with idiopathic calcium stones, although not all studies specified the etiology of kidney stones in the included population. For evaluating the relative effectiveness of interventions for preventing stone recurrence, only randomized controlled trials (RCTs) were included. For assessing adverse effects of the interventions, in addition to RCTs, prospective observational studies of at least 100 participants being treated for secondary prevention of kidney stones were included. A search of the clinical study literature published from 1948 through 2011 using predetermined inclusion and exclusion criteria yielded 28 RCTs that were included in the systematic review. The full report, listing all studies, is available at This summary, based on the full report of research evidence, is provided to inform discussions of options with patients and to assist in decisionmaking along with consideration of a patient’s values and preferences. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines.

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