What about medications?
Thiazides remain the mainstay of kidney stone treatment for hypercalciuria that is not secondary to high salt intake, according to Dr. Wood.
While important, thiazide treatment is likely underused because it requires that urologists follow up with labs. Thiazides, according to Dr. Wood, also treat hypertension and can interact with other anti-hypertensive medication.
“Patients with aggressive stone formation and high urinary calcium who have normal urinary sodium and are consuming normal amounts of or the recommended daily allowance of calcium would benefit from thiazide diuretics that lower urinary calcium,” Dr. Pearle said.
The evidence also suggests potassium citrate or other alkalization methods effectively manage kidney stone disease, according to Dr. Wood.
“Those, too, are usually directed by the 24-hour urine or sometimes by stone compositions,” he said.
Again, there are barriers to treatment. Potassium citrate, or UroCit-K, can be extremely expensive and difficult for patients to tolerate, as gastrointestinal side effects are common, according to Dr. Wood. Another issue with potassium citrate is the need to monitor patients who may have chronic kidney disease with labs to make sure they don’t become hyperkalemic while on the medication.
One medication that urologists shouldn’t be using as a first-line treatment for uric acid stones is allopurinol, according to the AUA guideline.
“The key to prevention of uric acid stones is not to lower urinary uric acid but to raise pH. Allopurinol is occasionally indicated if patients still form stones despite correcting urine pH, but they will likely continue to make stones on allopurinol if you don’t correct pH,” Dr. Pearle said.
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