This week on BackTable Urology, Dr. Manoj Monga (UC San Diego) invites Dr. Margaret Pearle (UT Southwestern) to discuss kidney stone prevention with lifestyle changes and medical therapy.

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SHOW NOTES

First, the doctors reflect on Dr. Pearle and Dr. Yair Lotan’s paper from 2008 that predicted the impact of climate change on kidney stones. Dr Pearle then shares her recommendations for lifestyle changes to prevent kidney stones, such as increasing fluid intake and reducing sodium and animal protein intake. She also advises on reducing oxalate intake in diets and maintaining adequate calcium intake to ensure bone health.

Next, the doctors discuss strategies for treating and preventing stones with medical therapy. They explore the use of thiazides and potassium citrate for both calcium oxalate and calcium phosphate stones, as well as the importance of evaluating PTH levels and serum uric acid levels in these patients. They also discuss the role of dietary oxalate and bowel disease in determining when to order genetic testing. Additionally, they explore the nuances of treating hypercalciuria with thiazide holidays and the use of potassium citrate as a second line therapy. Potassium citrate is beneficial for alkalinization and citrate supplementation. There are different benefits when comparing the liquid formulation to the tablets.

Finally, they discuss the use of urinary pH and xanthine oxidase inhibitors, the importance of genetic testing, and the importance of fluid intake and potassium citrate for cystine stones.

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RESOURCES

Brikowski TH, Lotan Y, Pearle MS. Climate-related increase in the prevalence of urolithiasis in the United States. Proc Natl Acad Sci U S A. 2008 Jul 15;105(28):9841-6. doi: 10.1073/pnas.0709652105. Epub 2008 Jul 14. PMID: 18626008; PMCID: PMC2474527.