A 40-year-old has recurrent calcium oxalate stones despite urine output above 2.5 L/day and sodium restriction. Serum calcium and 24-hour urinary

Question

A 40-year-old has recurrent calcium oxalate stones despite urine output above 2.5 L/day and sodium restriction. Serum calcium and 24-hour urinary calcium are normal, but urinary citrate is persistently low. Which pharmacological prevention is most appropriate?

Accepted Answer

Start potassium citrate with monitoring of potassium, kidney function and urinary response

Answer

Use long-term tamsulosin to prevent formation of new renal calculi

Answer

Start a low-dose thiazide and monitor electrolytes despite urinary calcium remaining within the reference interval

Answer

Start calcium supplements between meals to bind urinary citrate

Answer

Start allopurinol for recurrent calcium stones with normal urinary urate

Recurrent Nephrolithiasis — RACP Adult Medicine MCQ

A 40-year-old has recurrent calcium oxalate stones despite urine output above 2.5 L/day and sodium restriction. Serum calcium and 24-hour urinary calcium are normal, but urinary citrate is persistently low. Which pharmacological prevention is most appropriate?