TYPE	TREATMENT	DIET		TX	PH
Calcium oxalate	dihydrate	H calcium and magnesium
	monohydrate	H – urinary oxalic acid
Calcium phosphate					RTA, parathyroid
Pseudomonas, Proteus, klebsiella urea splitting – causes stones. Low caffeine, low vitamin c

Hypercalciuria:  > 5.0 mmol/24 h. 

• Want to increase urinary PH, use alkaline citrate or sodium bicarb.  No if recurrent UTI’s, high bp, pure calcium phosphate stone, renal insufficiency.  Try bulk preparation like Metamucil. 
• If high ph and sufficient excretion of citrate, tx with magnesium.  NO if renal insufficiency.

Uralyt U, Urocit – K, Polycitra – K: 3-6 g through out day with  additional 6 m at hs. 

Sodium Bicarb: 4.5 g/d  - 3 capsuls with 500 mg tid

Magnesium 200-400 mg / d 8.25-16.5 mmol/d

Hypercalciuria: . 8 mm Ca/24 h needs treatment

• Thiazide 25-50 mg day (increases Ca resorption in distal tubules), No with gout, hypotension, hypokalemia, sodium restriction, BP control.

URIC ACID

Hyperuricosuria:  Uric acid excretion 4mmol/24h.  Allopurinol 300 mg day.  If serum uric acid >380 umol/l give 100mg/d.   Decrease purines in diet.

Hyperuricemia > 380 umol/l  (6.4 mg/100 ml)

Low PH and higher uric acid = uric acid stones. Low purine diet. Drink citrus juices.

Hypocitraturia: citrate < 2.5 mmol / 24 h. Uralyt U, Urocit – K, Polycitra – K: 9-12 g through out day up to a PH of 7.0. Sodium Bicarb: 4.5 g/d  - 3 capsuls with 500 mg tid ( caution sodium increases hypercalcuria).  May also use if decreased tolerance for alkali citrate. 

Calcium Citrate use before calcium potassium citrate so don’t get increased potassium intoxication.

Struvite and Staghorn Stones:  Urinary infections associated with kidney stones can be a difficult and important problem to treat.  Certain types of infections cause the development of kidney stones.  These infections produce an enzyme called urease.  This enzyme causes the urine pH to increase favoring the formation of magnesium ammonium phosphate (struvite) crystals.  Certain bacteria which cause an increase in urine pH, are associated with these stones.  A common cause is Proteus bacteria.

A surgeon with experience in the care of cystinuria patients is necessary for successful surgical removal.  These stones are very hard and usually cannot be removed with lithotripsy.  People with cystinuria can go on to develop chronic kidney infections and permanent kidney scarring. Like struvite or infectious stones, cystine stones can develop into large staghorn shaped stones which fill the cavities of the kidney. Although they are not made of calcium, they can be seen on xray,

struvite stones
Struvite stones are a type of stone that contains the mineral magnesium and the waste product ammonia. It may form after an infection in the urinary system.