Complications
Potassium citrate may be supplemented for both calcium oxalate and calcium phosphate stone formers if urinary citrate is too low.
Oversupplementation with potassium citrate may lead to urine pH >6.5, which favors calcium phosphate stone formation.
Whether increasing pH overcomes the inhibitory effect of citrate is unknown. This concern may be alleviated if thiazides are used to reduce urinary calcium.
Urinary tract infections are thought to be more common in patients with medullary sponge kidney.[11]
Etiology is attributed to urinary stasis and infection of kidney stones.
Diagnosis is by symptoms, urinalysis, and urine culture.
Infected stones require urologic intervention.
Urinary tract infections are thought to be more common in patients with medullary sponge kidney.[11]
Etiology is attributed to urinary stasis and infection of kidney stones.
Diagnosis is by symptoms, urinalysis, and urine culture.
Infected stones require urologic intervention.
The main goals of treatment are infection control and symptom reduction. The decision whether to treat the patient empirically and whether to admit the patient for intravenous antibiotic treatment should be based on patients' symptoms and comorbidities.
Can occur with or without stones.
Etiology is thought to be due to crystalluria, infection, or stones.
Diagnosis is by symptoms of gross hematuria or by urinalysis for microscopic hematuria.
Treatment of infection and metabolic risk factors for stones may decrease recurrence.
May occur with thiazide diuretic treatment for hypercalciuria unresponsive to salt restriction.
Diagnosis is by electrolyte panel after starting the diuretic, and treatment is with either increased dietary potassium intake or potassium supplements.
Hypokalemia may lead to decreased urinary citrate, which may increase stone formation. Therefore, potassium citrate is the preferred supplement, but even potassium chloride will increase urine citrate, albeit not as much.
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