The American Urological Association (AUA) just released a new clinical practice guideline, Medical Management of Kidney Stones. The guideline features 39 statements on topics ranging from diagnosis through follow-up. Medical Management of Kidney Stones addresses adult and pediatric patients, providing a framework for the prevention, diagnosis, treatment, and follow-up of kidney stones.

The 2026 guideline replaces the previous 2014 guideline. The AUA notes that its therapeutic approaches have not dramatically changed since the publication of that guideline, and they remain focused on traditional treatment methods. Near the conclusion of the guideline, the AUA points out that prioritizing more RCTs addressing the efficacy and safety of emerging therapies is needed to better expand clinical guidance on kidney stone management. 

Today, we’re taking a brief look at key recommendations included in the 2026 AUA guideline, Medical Management of Kidney Stones. We are focusing on the ten statements that were graded as moderate and conditional recommendations. View the full-text guideline for the most complete version to view all the statements in their entirety including the clinical principles and expert opinions. 

Key Highlights from the AUA Medical Management of Kidney Stones Guideline
  • Urinary volume of 2.5 L or 85 oz daily via water should be encouraged in adults with a history of calcium-based stones.
  • Directed dietary advice, based on the patient’s existing diet and metabolic testing, may be offered to adult patients with recurrent calcium-based stones.
  • Thiazide or a thiazide-like diuretic should be offered to adults with recurrent calcium-based kidney stones who have relatively high or high urinary calcium. 
  • Alkali therapy may be recommended to adult patients with recurrent calcium oxalate kidney stones to reduce the risk of recurrence.
  • Alkali therapy may be recommended to pediatric patients with calcium stones to reduce the risk of recurrence.
  • Allopurinol may be offered to adult patients with recurrent calcium oxalate stones and relatively high or high urinary uric acid.
  • Alkali therapy and/or thiazides may be offered to adult patients with recurrent calcium-based stones who have no detectable abnormalities on metabolic testing.
  • Clinicians may offer acetohydroxamic acid to adult patients with struvite stones not amenable to surgical removal.
  • Adults with kidney stones may be recommended to limit soft drink consumption.
  • In the absence of urine chemistry, empiric preventative pharmacotherapy may be offered to adult patients with recurrent kidney stones of unknown composition.

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