Potassium Citrate Hypocitraturia Targeted Treatment — ESENeph MCQ

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HardRenal Stone DiseasePotassium Citrate Hypocitraturia Targeted TreatmentESENeph

A recurrent stone former has hexagonal urinary crystals and a positive sodium nitroprusside test. Urine volume remains low despite counselling. Which long-term strategy is most appropriate?

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Correct answer: C — High fluid intake, urine alkalinisation, then thiol therapy

Hexagonal crystals and a positive cyanide–nitroprusside test indicate cystinuria. Treatment begins with very high fluid intake, sodium moderation and potassium-citrate alkalinisation to improve cystine solubility. Tiopronin or another cystine-binding thiol drug is added when conservative measures do not control recurrence. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: NICE NG118: Renal and ureteric stones. https://www.nice.org.uk/guidance/ng118/chapter/recommendations