Glucagon-like peptide-1 receptor agonists, weight loss, and urolithiasis: what urologists should know

Obesity and type 2 diabetes mellitus are closely linked to urolithiasis risk through adverse urinary chemistry, including lower urine pH and higher lithogenic supersaturation. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used for glycemic control and weight loss, creating a need to clarify their implications for stone-forming patients.

A narrative mini-review was performed using targeted searches of PubMed and screening of reference lists of relevant articles for studies evaluating GLP-1RA therapy in stone formers or reporting changes in 24-hour urine parameters. Evidence was summarized qualitatively with emphasis on urinary risk factors, and clinical outcomes.

Across cohorts of stone formers receiving GLP-1RAs, urinary parameters show an overall neutral pattern, with no consistent, clinically meaningful shifts in urine volume, pH, citrate, or supersaturation indices. Some datasets report favorable changes in selected markers, including higher urinary citrate in diabetic stone formers and reduced stone growth signals in imaging-based analyses, but these findings remain hypothesis-generating due to retrospective designs and potential confounding. Evidence for effects on hard clinical outcomes such as new stone formation, recurrence, or need for intervention is limited.

Current evidence suggests GLP-1RAs can be incorporated into the management of patients with urolithiasis who require pharmacologic weight loss or diabetes therapy, without a consistent signal of increased lithogenic risk. Clinical focus should remain on established prevention strategies, particularly maintaining urine volume during treatment initiation and gastrointestinal adverse effects, while prospective studies with standardized imaging and stone endpoints are needed.