BOTTOM LINE
For patients with first-time kidney stones, conservative therapy (dietary modification only) is the most cost-effective strategy. In recurrent stone formers, both empiric therapy (dietary modification and potassium citrate) and a modified simple metabolic evaluation (one 24-hour urine collection for renal stone risk factors, with both potassium citrate and hydrochlorothiazide for patients with hypercalciuria and potassium citrate alone for patients with normocalciuria) are equally cost-effective. (LOE=2b)