Metabolic evaluation of urolithiasis: a narrative review

Urolithiasis is a common condition with high recurrence rates, often driven by metabolic abnormalities, dietary habits, and systemic disorders. Metabolic evaluation plays a key role in identifying modifiable risk factors such as hypercalciuria, hyperoxaluria, hypocitraturia, and hyperuricosuria. Despite its clinical value, metabolic evaluation remains underused in practice. This narrative review highlights the rationale, methods, and therapeutic implications of metabolic assessment in patients with recurrent or high-risk stone disease. The evaluation includes medical and dietary history, physical examination, blood and urine tests, 24‑h urine collections, and stone analysis. Tailored interventions-ranging from dietary advice to pharmacologic treatments such as thiazides, potassium citrate, and allopurinol-can reduce stone recurrence and prevent complications such as chronic kidney disease. Ongoing follow-up is essential to assess treatment response and modify strategies. Adherence to current guidelines and broader implementation of metabolic workup can significantly improve patient outcomes and reduce the global burden of stone disease.