Prevention of Recurrent Nephrolithiasis in Adults
Authors: David S.H. Bell
Journal: Annals of Internal Medicine (2015)

Letters7 April 2015Prevention of Recurrent Nephrolithiasis in AdultsDavid S.H. Bell, MDDavid S.H. Bell, MDFrom Southside Endocrinology, Mountain Brook, Alabama.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-5074 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Qaseem and colleagues (1) did not indicate under what circumstances citrates, thiazides, or allopurinol should be used to avoid a recurrence of nephrolithiasis. If hypercalciuria is present, thiazide diuretics obviously should be used. However, use of thiazides in the presence of uricosuria may be counterproductive. Allopurinol should be used with uricosuria, but allopurinol and citrates also may be successfully used in the absence of hypercalciuria or uricosuria.Obese patients with type 2 diabetes frequently have acidic urine due to hyperinsulinemia, inducing a decrease in ammonia production in the proximal tubule and sodium clearance. The resulting lower urine ...References1. Qaseem A, Dallas P, Forciea MA, Starkey M, Denberg TD; Clinical Guidelines Committee of the American College of Physicians. Dietary and pharmacologic management to prevent recurrent nephrolithiasis in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161:659-67. [PMID: 25364887] doi:10.7326/M13-2908 LinkGoogle Scholar2. Sakhaee K, Adams-Huet B, Moe OW, Pak CY. Pathophysiologic basis for normouricosuric uric acid nephrolithiasis. Kidney Int. 2002;62:971-9. [PMID: 12164880] CrossrefMedlineGoogle Scholar3. Daudon M, Traxer O, Conort P, Lacour B, Jungers P. Type 2 diabetes increases the risk for uric acid stones. J Am Soc Nephrol. 2006;17:2026-33. [PMID: 16775030] CrossrefMedlineGoogle Scholar4. Bell DS. Beware the low urine pH—the major cause of the increased prevalence of nephrolithiasis in the patient with type 2 diabetes. Diabetes Obes Metab. 2012;14:299-303. [PMID: 21992452] doi:10.1111/j.1463-1326.2011.01519.x CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Southside Endocrinology, Mountain Brook, Alabama.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOf InterestForms.do?msNum=L15-0050. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDietary and Pharmacologic Management to Prevent Recurrent Nephrolithiasis in Adults: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Paul Dallas , Mary Ann Forciea , Melissa Starkey , Thomas D. Denberg , and Dietary and Pharmacologic Management to Prevent Recurrent Nephrolithiasis in Adults: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Paul Dallas , Mary Ann Forciea , Melissa Starkey , Thomas D. Denberg , and Prevention of Recurrent Nephrolithiasis in Adults Amy E. Krambeck and John C. Lieske Prevention of Recurrent Nephrolithiasis in Adults Amir Qaseem , Howard A. Fink , and Thomas D. Denberg Prevention of Recurrent Nephrolithiasis in Adults Amy E. Krambeck and John C. Lieske Prevention of Recurrent Nephrolithiasis in Adults Amir Qaseem , Howard A. Fink , and Thomas D. Denberg Metrics 7 April 2015Volume 162, Issue 7Page: 528KeywordsDisclosureDiureticsExcretionHyperinsulinemiaOverweightSodiumType 2 diabetesUric acidUrine ePublished: 7 April 2015 Issue Published: 7 April 2015 CopyrightCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...