How to cite: Streeper NM. Metabolic Evaluation & Medical Management for Kidney Stone Prevention. Grand Rounds in Urology. February 2026. Accessed Oct 2026. https://grandroundsinurology.com/metabolic-evaluation-medical-management-for-kidney-stone-prevention/
Summary
Necole M. Streeper, MD, Associate Professor of Urology, Medical College of Wisconsin, Madison, Wisconsin, presents an overview of kidney stone disease, a chronic condition with a high recurrence rate. Dr. Streeper reports that approximately 1 in 10 adults in the United States will develop kidney stones and notes that recurrence rates approach 50 percent within five to ten years.
Dr. Streeper describes risk assessment based on patient history, stone composition, and comorbid conditions. She explains that metabolic evaluation includes stone analysis, 24-hour urine testing, and serum studies, including basic metabolic panel, calcium, parathyroid hormone, vitamin D, and uric acid. She emphasizes that 24-hour urine testing provides key information for identifying modifiable risk factors.
Dr. Streeper identifies low urine volume as the most common risk factor and recommends fluid intake sufficient to achieve urine output greater than 2.5 liters per day. She reviews hypercalciuria as a common metabolic abnormality and explains that treatment includes thiazide diuretics after evaluation for primary hyperparathyroidism. She notes the importance of monitoring for hypokalemia and maintaining a low-sodium diet.
Dr. Streeper discusses additional metabolic abnormalities, including hyperoxaluria, hypocitraturia, and hyperuricosuria. She explains that hypocitraturia is managed with alkalinization using potassium citrate or sodium bicarbonate, with monitoring of urine citrate and pH. Uric acid stones are associated with low urine pH and are treated with alkalinization. She describes the use of allopurinol in patients with recurrent calcium oxalate stones and hyperuricosuria.
Dr. Streeper reviews management of less common conditions, such as cystinuria and infection stones, and emphasizes the need for ongoing monitoring with repeat 24-hour urine testing to assess treatment response and adherence.
About the 45th Annual Ralph E. Hopkins Urology Seminar
The Annual Ralph E. Hopkins Urology Seminar, also known as the Jackson Hole Seminars, brings together distinguished urologists, clinical researchers, and thought leaders to share wisdom and experience that drives meaningful progress in patient care. Changes occur in medicine and urology on an almost daily basis, so it is imperative that the practicing urologist remains on the cutting edge. Urologists need to keep current on assessing, diagnosing, and treating urologic conditions in the clinical setting. The 45th meeting took place in 2026, focusing on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, emerging surgical techniques, and general urology. 2026 also marked the meeting’s first-ever all-female speaker panel.
ABOUT THE AUTHOR
Necole M. Streeper, MD, is an Associate Professor of Urology at the Medical College of Wisconsin, Madison, Wisconsin. She specializes in surgically treating complex kidney stone disease and the prevention of kidney stones.
Dr. Streeper earned her medical degree from the University of Iowa. After a residency in Urology at the University of Texas Health Science Center, she completed a fellowship in Endourology and Minimally Invasive Surgery at the University of Wisconsin-Madison.
Dr. Streeper’s clinical research is dedicated to improving the prevention and treatment of kidney stones, and she is interested in identifying management strategies to improve the quality of life in patients with kidney stones. She has received NIH/NIDDK grant support to develop technology (SipIT) to improve fluid consumption for the prevention of kidney stones. Dr. Streeper is the lead investigator for MCW as a research site in the North American Stone Quality of Life Consortium, and has authored more than 50 research publications and book chapters in the field of kidney stone disease.
