Clinicalkey AI in action: What is the management of hypercalciuria in a person with a second renal stone?

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The management of hypercalciuria in a person with a second renal stone involves dietary modifications, increased fluid intake, and potentially medication such as thiazide diuretics or potassium citrate.^[1-4]

• Dietary modifications include reducing sodium intake to no more than 2g per day and limiting animal protein intake to 0.8 to 1.0g/kg per day. Adequate calcium intake (1000mg per day for a 19- to 50-year-old man or woman) is also recommended, preferably from dairy products rather than supplements.^[1]

• Increasing fluid intake to achieve a urine volume of more than 2.5 L daily can help reduce the risk of stone recurrence.^[2][4]

• Thiazide diuretics, such as chlorthalidone (12.5 to 25mg/day), can be beneficial for patients with persistent hypercalciuria. These medications lower urinary calcium and reduce recurrent stone formation by about 50%. However, they are effective only if patients restrict dietary sodium.^[1]

• Potassium citrate therapy can also be beneficial, especially for patients with recurrent calcium stones and low urinary citrate levels. It increases urinary citrate excretion, binds urinary calcium, and further decreases recurrent stone formation.^[1-2]

• In some cases, allopurinol may be prescribed for patients with recurrent calcium oxalate stones who have hyperuricosuria and urinary calcium levels within the reference range.^[2]

Additional Information

References

1.Nephrolithiasis.新しいタブ／ウィンドウで開く Bushinsky, David A., In Goldman-Cecil Medicine (pp. 803).

2.Nephrolithiasis.新しいタブ／ウィンドウで開く,Elsevier ClinicalKey, Clinical Overview

3.Urinary Lithiasis.新しいタブ／ウィンドウで開く,Di Carlo, Heather N., Crigger, Chad B., In Nelson Textbook of Pediatrics (pp. 3311).

4.Urinary Stone Disease: Diagnosis, Medical Therapy, and Surgical Management.新しいタブ／ウィンドウで開く,Ludwig WW, Matlaga BR., The Medical Clinics of North America. 2018;102(2):265-277. doi:10.1016/j.mcna.2017.10.004.

Answer generated on May 13, 2024 

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