In kidney stone disease associated with hypercalciuria, which therapies are used?

• A. Thiazide
• B. Potassium citrate
• C. Water
• D. All of the above

Answer: (D)

In kidney stone disease with hypercalciuria, preventing stones involves addressing three practical angles: lowering the amount of calcium in the urine, preventing crystallization by providing an inhibitor, and keeping the urine sufficiently dilute. Thiazide diuretics reduce urinary calcium by increasing calcium reabsorption in the distal tubule, which lowers the calcium available to form stones. Potassium citrate supplies citrate, which binds calcium and inhibits calcium salt crystallization; it also tends to raise urine pH, helping prevent certain stone types. Maintaining high fluid intake dilutes the urine, reducing the concentration of stone-forming salts and the risk of saturation. Because each approach tackles a different aspect of stone risk, using all of them together is a common and effective strategy.