Citrate therapy for calcium and uric acid stones

Despite revolutionary advances in the surgical management of stone disease over the past three decades, recurrence rates without adjuvant medical therapy are high, underscoring the important role of metabolic evaluation and targeted medical therapy. Calcium and uric acid calculi comprise nearly 85–90 % of all kidney stones encountered in common clinical practice. Evidence from clinical trials suggests that alkali citrate pharmacotherapy, alone or in combination with other medical and dietary therapies, is effective for the metaphylaxis of calcium nephrolithiasis occurring in a wide range of clinical settings and of calcium nephrolithiasis-associated conditions. Clinical evidence also supports the use of alkali citrate therapy as first-line treatment of uric acid stones or mixed uric acid and calcium stones. Data from studies on dietary citrate therapy suggest that several beverages including vegetable juices, citrus juices, sports drinks, and various sodas with a high citrate content can induce a citraturic response to varying degrees, but concomitant alkalinizing effects appear to best be achieved with beverages containing potassium citrate rather than citric acid. Further studies on pharmacologic and dietary citrate therapies are needed to more comprehensively define their role in the management of calcium and uric acid nephrolithiasis.