Systematic review of pharmacological, complementary, and alternative therapies for the prevention of calcium oxalate stones

Objective: Several therapeutic modalities for the prevention of calcium oxalate (CaOx) stones have been studied, but only a select few of these modalities have been incorporated into the American Urological Association guidelines. Our study aimed to organize and interrogate existing research that may be promising for CaOx prevention. Methods: A literature search was conducted using MEDLINE and Embase from inception to November 16, 2022. Our study population included adults with or without a history of CaOx kidney stones. Studies in which patients were treated with pharmacotherapies, herbal supplements, or uncategorized research chemicals that are not included in the current American Urological Association guidelines for preventing CaOx stones were included. Nonoriginal research was excluded. Results: Out of the 6155 identified articles, 38 were included in the final analysis. The five distinct categories of interventions for stone prevention were “medications”, “herbal supplements”, “food and macronutrients”, “micronutrients”, and “enzymes and probiotics”. Modalities that were found to reduce known urinary risk factors were tolvaptan, cranberry juice, magnesium citrate, oxalate-degrading enzyme ALLN-177, and malic acid. Prophylaxis that reduced stone formation were sodium-glucose cotransporter-2 inhibitors, eicosapentaenoic acid, ethane-1-hydroxy-1,1-disphosphonate. Therapies that reduced urinary risk factors and stone formation were Phyllanthus niruri, rice bran, and magnesium hydroxide. Conclusion: Several of the identified therapies may provide prophylactic benefits for CaOx stone formation and may be useful for inclusion in guidelines for kidney stone prevention.