It is usually the sequella of medullary sponge kidney that require management (stones and infection). Many patients have hypercalciuria and are treated with thiazide diurectics to limit stone formation. If thiazides cannot be used, inorganic phosphates may be appropriate if no infections are present. For patients with renal stones, thiazides should be given even if they do not have hypercalciuria. Some studies show that these medications arrest the development of nephrolithiasis.
Because infections are not unusual, cultures should be periodically sent. Coagulase-positive staphlococci are most common and should be treated even if cultures are less than 100,000.
If your friend already has stones as you mentioned, the ESWL can be used. It should not be difficult to break these stones. If they don