Nephrolithiasis is a highly prevalent disease presenting itself mostly at a working age, which leads to a great economic burden on health system. Kidney Stone disease should be viewed as a systemic disorder, associated with or predictive of hypertension, insulin resistance, chronic kidney disease and cardiovascular damage. According to current guidelines and evidence, a full screening of risk factors for kidney stones and for cardiovascular damage should be recommended in all cases of kidney stone disease, yet it is rarely performed, and a real-world clinical practice is lacking. The aim of this narrative literature is to serve as guidance for a patient-tailored dietary suggestion after a clinical and biochemistry evaluation, with limited resources, and still offer a rational management of kidney stone patients. Meta-analysis, systematic review, experimental studies, case-control plus high-impact factor journals PubMed and EMBASE, on the topic were included. Search criteria included metabolic profile, metabolic work-up, kidney stone, urolithiasis between 2010 and 2020.