How to Prevent Kidney Stones From Coming Back | Dr. Theodore Cisu

The short answer: Many people who pass one kidney stone will form another, but you can lower your risk. The most important step is drinking enough water to make about 2.5 liters (85 ounces) of urine a day. Knowing what your stone was made of, and for some people a 24-hour urine test, shows why stones are forming. That leads to diet changes and, when needed, medication tailored to you.

Written by Theodore Cisu, MD, board-certified urologist. Based on the American Urological Association (AUA) guideline on the medical management of kidney stones (2026). Last reviewed November 2026.

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Why do kidney stones come back?

Stones form when minerals in the urine become too concentrated and stick together. Passing or removing a stone doesn't change the conditions that made it. Low urine volume, high levels of calcium, oxalate, uric acid or sodium in the urine, and low levels of citrate (a natural stone blocker) all raise the risk. Family history, some medical conditions and some medicines also play a role.

In July 2026 the AUA released a new guideline on preventing and managing kidney stones, its first full update since 2014. For the first time it includes children and teens. It also gives guidance on when genetic testing makes sense for people at high risk.

If you have a stone causing pain right now, read our guide to kidney stones stuck in the ureter. This article is about preventing the next one.

Step 1: Find out what your stone is made of

If you pass a stone or have one removed, it should be sent for analysis. The type of stone points to the right prevention plan:

• Calcium oxalate: the most common type
• Calcium phosphate
• Uric acid: linked to acidic urine, and often to diet, gout or diabetes
• Struvite: formed with certain urinary infections
• Cystine: from a rare inherited condition

Keep a strainer handy. If you pass a stone at home, save it and bring it to your visit.

Step 2: Drink enough, mostly water

The 2026 AUA guideline encourages adults with calcium-based stones to drink enough water to make about 2.5 liters (85 ounces) of urine a day. Because you also lose fluid through sweat and breathing, that means drinking more than 2.5 liters, and even more in hot weather, with exercise or with outdoor work.

• Carry a water bottle and refill it through the day.
• Aim for urine that looks pale yellow most of the time.
• Have a glass with each meal and one in the evening.
• Limit soft drinks. The new guideline says adults with stones may be advised to cut back on them.

A 24-hour urine test is the only way to know for sure that you are reaching your urine target.

Step 3: Diet changes tailored to you

The 2026 guideline favors diet advice tailored to what you actually eat and to your urine test results. Depending on your results, common changes include:

• Cutting back on salt. Extra sodium pulls more calcium into the urine. Processed foods, restaurant meals, deli meats and canned soups are big sources.
• Keeping calcium normal. Most people with calcium stones should not cut out dairy or other calcium-rich foods. Calcium eaten with meals binds oxalate in the gut, so less reaches the urine. Calcium supplements are a different matter, so ask before taking them.
• Moderating animal protein. Large amounts of meat, poultry and seafood raise uric acid and lower citrate in the urine.
• Eating more fruits and vegetables. These can raise urine citrate.
• Limiting very high-oxalate foods, such as spinach, nuts and rhubarb, mainly if testing shows high urine oxalate.

Step 4: Metabolic testing and the 24-hour urine

A basic evaluation after a stone includes a medical and diet history, blood tests and a urine test. For people at higher risk, a 24-hour urine collection adds much more. You collect all of your urine for a full day at home, on a normal day of eating and drinking, using a kit that is mailed to a lab. It measures:

• Total urine volume
• Calcium, oxalate, uric acid and citrate
• Sodium and other markers of diet
• Urine pH (acidity)

Testing is usually advised if you have had more than one stone, or if you are at higher risk after a first stone. Higher risk includes children, people with one kidney, large or many stones, a strong family history, bowel conditions or bariatric surgery, and stones made of uric acid, cystine or struvite. Anyone who wants to know their personal risk can ask about testing. A repeat collection after starting treatment shows whether the plan is working.

Step 5: Medications when needed

When fluids and diet aren't enough, or testing shows a clear problem, medication can lower the chance of new stones. Under the 2026 guideline:

Thiazide diuretics

For adults with repeat calcium stones and high or borderline-high urine calcium, a thiazide or thiazide-like water pill should be offered. It lowers the amount of calcium in the urine.

Alkali therapy (such as potassium citrate)

Alkali medicines raise urine citrate and pH. The guideline says they may be recommended for adults with repeat calcium oxalate stones, and for children with calcium stones. They are also used to make urine less acidic for uric acid and cystine stones.

Allopurinol

For adults with repeat calcium oxalate stones and high or borderline-high urine uric acid, allopurinol may be offered.

Other situations

• If you keep forming calcium stones and testing shows no clear cause, a thiazide, alkali or both may still help.
• If you have repeat stones but no stone analysis or urine test is available, your doctor may suggest starting a medicine based on your history.
• Struvite stones are treated mainly by removing them completely and treating infection. A medicine called acetohydroxamic acid may be offered when a struvite stone can't be removed with surgery.
• Cystine stones often need high fluid intake, alkali and sometimes a special cystine-binding medicine.

If you take a stone medicine, you'll need periodic blood tests to check for side effects.

Follow-up: staying stone-free

Prevention works best as a long-term plan. Follow-up usually includes repeat urine testing to check your progress and imaging from time to time to look for new stones before they cause trouble. Small stones found early may be easier to treat.

When to see a urologist

• You've had more than one kidney stone
• You've had one stone and are at higher risk, or your child has had a stone
• A scan shows stones still in your kidneys
• You want to know why you form stones and what you can do

If you have a stone now with fever or chills, pain you can't control, vomiting, or very little urine, go to the emergency room.

Seeing Dr. Cisu for kidney stone prevention

A stone prevention visit works well by telehealth from anywhere in Virginia. Our office can request your stone analysis, CT scans, ultrasounds and lab results so Dr. Cisu reviews them first. He can order a 24-hour urine test and go over the results with you. Dr. Cisu also treats kidney stones with ureteroscopy and other procedures. Second opinions are welcome, and in-person visits are available in Charlottesville and Fishersville. No referral is needed. Book an appointment.

Frequently asked questions

How much water should I drink to prevent kidney stones?

Enough to make about 2.5 liters (85 ounces) of urine a day. For most people that means drinking somewhat more than that, and more on hot days or when you sweat. Pale yellow urine is a helpful everyday sign.

Should I stop eating dairy if I had a calcium stone?

Usually not. For most people with calcium stones, a normal amount of calcium from food helps by binding oxalate in the gut. Cutting calcium too low can actually raise stone risk. Ask your urologist about calcium supplements.

Do I need a 24-hour urine test after my first stone?

Not always. It is recommended for people with repeat stones and for first-time stone formers at higher risk. If you're curious about your own risk, it's reasonable to ask for one.

Does soda cause kidney stones?

Soft drinks have been linked to stone risk, and the 2026 AUA guideline says adults with stones may be advised to limit them. Water is the best choice.

Does lemon juice help prevent kidney stones?

Citrus juices contain citrate, a natural stone blocker. Adding lemon to your water can be a pleasant way to drink more. If your urine citrate is low, your urologist may suggest a prescription medicine, which delivers a more reliable dose.

Are kidney stones hereditary?

Stones often run in families, and a few types come from inherited conditions. The 2026 guideline addresses genetic testing for some people at high risk, such as those with cystine stones or stones starting in childhood.

Sources

• American Urological Association. AUA Releases Guideline on Medical Management of Kidney Stones (July 30, 2026).
• American Urological Association. Medical Management of Kidney Stones: AUA Guideline (2026).

This article is for general education and isn't a substitute for medical advice. Talk with your doctor before changing your diet or starting a supplement. If you have a kidney stone with fever or chills, call 911 or go to the nearest emergency room.