Background: Kidney stones are associated with various biochemical disturbances in urine. Various drugs and dietary changes have been recommended to halt stone recurrence. Objective: To determine whether a correction of urinary abnormalities by appropriate pharmacological agents and dietary modification may ameliorate stone disease. Methods: A review of the literature was conducted on the role of diet, metabolic disorders and drugs for stone prevention. Results/conclusion: Metabolic risk factors are hypercalciuria, hypocitraturia, hyperoxaluria, hyperuricosuria, and abnormally low urinary pH. Dietary–environmental risk factors include high urinary sodium and low urine volume. Rare or less commonly encountered risk factors are high urinary cystine, and alkaline urine from an infection with urea-splitting organisms. To ameliorate or correct the above disturbances, all patients should be offered dietary modification, including restricted intake of sodium, oxalate and animal proteins. Useful drugs include thiazide or indapamide to control hypercalciuria, potassium citrate to correct hypocitraturia and undue urinary acidity, and allopurinol for co-existing hyperuricemia or marked hyperuricosuria.