How to cite: Monga MJ. Kidney Stone Prevention: Diet, Supplements, and Medications. Grand Rounds in Urology. March 2026. Accessed Apr 2026. https://grandroundsinurology.com/kidney-stone-prevention-diet-supplements-and-medications/
Summary
Manoj J. Monga, MD, FACS, FRCS, Professor and Chair, Department of Urology, University of California, San Diego, San Diego, California, reviews dietary and medical strategies for preventing recurrent kidney stones, emphasizing that although genetic factors contribute significantly to risk, modifiable lifestyle factors remain central to prevention.
Dr. Monga explains that calcium oxalate stones are strongly influenced by genetic predisposition, but uric acid stones are more responsive to dietary modification, particularly through urinary alkalinization. He introduces empirical dietary recommendations applicable to most patients, regardless of stone type, including increased fluid intake, sodium restriction, increased intake of fruits and vegetables, and maintaining adequate dietary calcium intake.
Fluid intake is highlighted as the most impactful intervention, with a target of at least 2 liters of urine output per day. Patients achieving this target have lower recurrence rates and longer intervals between stone events. He notes that adherence strategies, including behavioral reminders, may be more effective than technology-based interventions.
Dietary citrate plays a key role in preventing calcium deposition by binding calcium and reducing crystal formation. Sources include citrus fruits and certain beverages, while excessive intake of phosphoric acid-containing sodas may increase risk. Increasing fruits and vegetables improves urinary citrate, potassium, and magnesium levels while reducing overall stone risk.
Dr. Monga addresses common misconceptions, particularly the inappropriate restriction of dietary calcium. Low calcium intake increases oxalate absorption and stone risk, while adequate intake reduces recurrence. Sodium restriction is also emphasized, as high sodium intake increases urinary calcium excretion.
For patients requiring additional intervention, he outlines a stepwise approach to medical therapy. Thiazide diuretics reduce urinary calcium and improve bone density, while potassium citrate increases urinary pH and citrate levels. Magnesium and vitamin B6 may be considered in selected patients.
He emphasizes that most patients can achieve meaningful risk reduction through dietary modification alone, reserving pharmacologic therapy for those who do not respond to initial interventions.
About the UCSD Urology Symposium for Primary Care Physicians & Advanced Practice Providers
The UCSD (University of California San Diego) Urology Symposium for Primary Care Physicians & Advanced Practice Providers conference brings together primary care physicians, advanced practice providers, and early-career urology clinicians who play pivotal roles in the urologic care continuum. It features topics such as benign prostatic hyperplasia, overactive bladder, kidney stones, sexual health, and urologic oncology. Through didactic lectures and interactive sessions that highlight the patient journey, the conference educates practitioners on guiding patients and their families toward the most appropriate therapies.
ABOUT THE AUTHOR
Manoj J. Monga, MD, FACS, FRCS, is a Professor and the Chair of the Department of Urology at the University of California, San Diego, where he oversees the department’s research, teaching, and clinical care. He is recognized as an international authority in endourology (minimally invasive urologic surgery) and kidney stone disease. His clinical expertise includes kidney stone prevention, medical and surgical management of kidney stone disease, and endoscopic management of upper tract transitional cell cancer and benign strictures.
