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Recurrent Nephrolithiasis — RACP Adult Medicine MCQ

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ModerateNephrologyRecurrent NephrolithiasisRACP Adult Medicine

A 40-year-old woman presents with recurrent calcium oxalate kidney stones. 24-hour urine shows hypercalciuria (calcium 9.5 mmol/day), low urine citrate, and normal urine volume. Serum calcium and PTH are normal. What is the most appropriate preventive therapy?

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Correct answer: E — Hydrochlorothiazide

Hypercalciuria is the most common metabolic abnormality in calcium stone formers. Thiazide diuretics (hydrochlorothiazide, indapamide) reduce urinary calcium excretion by promoting proximal tubular calcium reabsorption. Additionally, low citrate should be addressed with potassium citrate. Dietary sodium restriction and adequate fluid intake (>2.5 L/day) are essential.

Reference: KHA-CARI – 2024 – Kidney Stone Prevention; AUA/EAU 2024 Stone Guidelines