At the International Kidney Stone Institute, our goal is nothing less than the cure.
If urine studies show that a patient excretes too much calcium in the urine, it may be necessary to use medication to reduce this output. The medications commonly prescribe to reduce high calcium output are called thiazide diuretics. Examples are hydrochlorthiazide, chlorthalidone, naqua and indapaminde. These are a special type of "water pill" that helps the kidneys retain calcium in the body for storage in bones and tissues. This has great advantage for patients whose bone calcium has been depleted by long-term over-excretion of calcium, and can increase bone density quiet efficiently. A primary side effect of this class of medication is that in exchange for calcium, the kidneys excrete more potassium than they otherwise would. This requires close monitoring and possible supplementation through dietary intake or medication.
For patients who excrete too much uric acid, increasing the risk for uric acid stones, a common medication called Allopurinol may be prescribed. This medication interrupts the chain of chemical reactions whereby metabolized protein by-products are converted to uric acid. The chemicals that remain are excreted in the urine in a benign form that does not cause stones. Reducing uric acid in the urine has two-fold benefits for the uric-acid stone former. First, there are simply fewer uric acid molecules to form the crystals that become stone. Second, because uric acid stones form in an acidic environment, reducing the overall acid in the urine creates a less favorable (more basic) pH for uric acid stone formation.
The urine of some stone-forming patients lacks adequate citrate. Citrate is a naturally occurring substance that clocks the formation of stone crystals. It is found in lemons in high concentrations. Citrate is measure in 24-hour urine studies and if found to be too low, can be supplemented with potassium citrate, available in tablet, syrup and powder forms. This medication can increase urine citrate, a natural stone inhibitor, in patients. Also, because it is combined with potassium, it can be used to supplement the potassium of those patients on thiazide diuretics. Third, citrate raises the pH of urine. Citrates must be used judiciously, as too much of this medication in certain patients can raise the pH so high that they are put at risk of forming stones that thrive in very basic pH, such as calcium phosphate stones.